Vicky Ward
In this blog post Vicky Ward responds to questions from Co-Editor-in-Chief, Dan Mallinson about her recent publication, ‘Knowledge practices in integrated care: an examination of health and social care teams using collective knowledge creation theory’.
Integrated care is commonly seen as the means to bridge gaps between organisations, services and professions across the health and care landscape and improve care. The promise is compelling: bring health and social care practitioners together, and they’ll share their expertise to create holistic, joined-up care for people with complex needs. Simple, right?
Not quite. After spending over two years observing case management meetings across five integrated teams, I found that knowledge sharing was far messier than the policy rhetoric suggests. My research drew on organisational knowledge creation theory to reveal four patterns that help explain why this is the case.
What is collective knowledge creation theory, anyway?
Organisational knowledge creation theory (OKC) emerged from business research but has become influential for understanding how groups solve complex problems together. The core idea: knowledge creation involves making tacit knowledge (the ‘know-how’ that lives in people’s heads and actions) explicit so it can be discussed and acted upon.
Central to OKC is dialogue. Not just conversation, but sustained inquiry that challenges assumptions and opens new possibilities. This kind of reflective dialogue creates conditions for groups to transcend individual perspectives and generate new insights.
For integrated care, this framework matters. Policy assumes that bringing practitioners together will enable them to combine expertise and create holistic care plans. OKC gives us a way to examine whether—and how—this actually happens.
What did I find?
Over 26 months, I observed 112.5 hours of case management meetings across five teams. During meetings I asked ‘knowledge-oriented questions’ designed to prompt reflection about what teams knew, needed to know, and where they could find relevant information. Four striking patterns emerged:
- Instrumental questioning dominated. Teams relied on factual questions (demanding specific answers) and professionally-oriented questions (precursors to sharing bounded expertise). These often made people feel criticised or led to the questioner imposing their solution on the team. The questions I introduced were initially uncomfortable and team members called them ‘questions without answers’. They did prompt reflection, however, which many came to value.
- Interactions were unstructured and unreflective. Discussions during meetings felt circular and chaotic with team members describing these conversations as ‘going off on a tangent’. More significantly, teams lacked reflective dialogue and rarely examined assumptions or explored contradictions. They viewed reflective questions as tools for staying ‘on track’ rather than opportunities for deeper inquiry.
- Teams struggled to remember and apply prior learning. This surprised me most. Teams forgot previous discussions and rarely identified patterns across similar situations. When facing a ‘difficult’ case, they seldom asked what they’d learned from similar experiences. This collective forgetting meant teams missed opportunities to develop transferable insights.
- Knowledge horizons were narrow. Teams drew primarily on knowledge within the meeting room and rarely sought input from patients, families, or outside professionals. Within meetings, teams focused heavily on facts while tacit knowledge, feelings and uncertainties largely remained unspoken.
What does this mean for integrated care?
These findings may help to explain why integrated care hasn’t consistently delivered improvements for patients and the wider system. The problem isn’t just professional or organisational barriers. It’s more likely to be about fundamental knowledge practices that constrain collective knowledge creation.
The good news? These practices can be changed. Based on this research, I’d suggest three priorities:
- Support reflective dialogue: Integrated care policy needs to signal that group reflection is valuable by providing teams with time for it and opportunities to develop their reflective capacity. This isn’t a luxury; it’s central to knowledge creation.
- Broaden knowledge horizons: Teams need explicit encouragement and practical support to access diverse knowledge sources and incorporate knowledge from patients and families. Part of this should involve reflecting on which forms and sources of knowledge are valued, and which are marginalised.
- Rethink questioning practices: The questions teams ask shape what knowledge gets shared and who participates. Open, reflective questions need to be embedded into case management procedures, not as bureaucratic requirements but as prompts for genuine inquiry.
Integrated teams have enormous potential for improving care, but realising that potential requires more than bringing people together in the same room. It requires conditions for genuine collective knowledge creation, which means paying attention to everyday practices through which knowledge is shared, questioned, remembered and applied.
Image credit: James McKay. Used with permission.
Vicky Ward is a Reader in Management in the Department of Management and Director of Impact and Innovation for the University of St Andrews Business School. Vicky is particularly interested in the use of knowledge-related frameworks to guide action and thinking.
Read the original research in Evidence & Policy:
Ward, V. (2025). Knowledge practices in integrated care: an examination of health and social care teams using collective knowledge creation theory. Evidence & Policy. DOI: 10.1332/17442648Y2025D000000058. OPEN ACCESS
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