If you’re puzzled by the concept of knowledge work, hopefully this blog will provide you some clarity on this important concept!
Knowledge work is about managing complex problems.
A problem is ‘complex’ when there are multiple different ways we can- and indeed need to- look at that problem. Things get even harder when these different perspectives contradict each other. A complex problem will have multiple possible outcomes. The distinct skill of the knowledge worker(1) is to create understanding when working with complex problems. Creating understanding needs 3 elements: critical creative Exploration, to construct an Explanation that guides action, and Evaluation to determine the value and impact of this.
This concept of knowledge work describes the everyday work of clinicians using expert generalist skills to deliver whole person care.
To do that the generalist clinician first explores the multiple perspectives on the problem - the patient’s understanding, the scientific evidence enshrined within healthcare guidelines, and their knowledge of the local context and determinants of health - including, but not exclusively, healthcare factors. This exploration takes place in the consultation between the clinician and patient; through review of clinical records and published evidence, and via multidisciplinary team discussions within daily practice.
With the patient, the clinician constructs an explanation of the problem and agrees a plan to manage it. This might involve some further tests (collecting more data), or a plan to try a course of treatment and review its effect (a ‘trial and learn’ approach). Using knowledge work to manage complex problems therefore relies on a 3rd stage – evaluating the impact of applying the explanation. This might involve ‘safety netting’, which is commonly used in practice (if it doesn’t get better by a certain time, come back). Sometimes, it needs a specific plan to meet, review and revise the explanation, for instance, a follow-up consultation in a month to re-evaluate the situation.
Knowledge work is therefore integral to multiple everyday decisions in our daily practice, in our work to to explore a concern, tailor an explanation and management plan and evaluate the outcome (2,3). Knowledge work can help us to explain an illness, negotiate whether to start or stop a treatment, refer someone for a test or arrange a consultant review. Knowledge work can support us in taking a whole person focus when negotiating a management plan in someone with multiple health problems, or when approaching a single health problem with a challenging context. Beyond our everyday work seeing patients, knowledge work is used everyday by GPs teaching, performing vital research and leading and developing our healthcare services.
Peter Drucker first described the concept of a knowledge worker1 and his ideas are widely recognised in professions outside of medicine, such as IT and engineering. A knowledge worker knows about their field of expertise, but is also able to apply what they know in a personal, social, and organisational context. WiseGP champions this way of thinking within the work of medical practice.
General Practice has often been described as a discipline that knows “a little about a lot”. However, when we consider the complex problems solved through knowledge work in everyday clinical practice, we can see it’s not just about what you know, but how you use what you know(4).
Knowledge can’t simply be defined as the facts we have learned from textbooks and guidelines. It encompasses a ‘tacit dimension’, shaped by our internal beliefs, thoughts and ideas, expertise and professional judgement; knowledge that we don’t always know we know(5). Whilst some decisions we make may seem straightforward on the surface, there is often a huge amount of tacit judgement involved. Consider the decision about whether to send an unwell child to hospital. We can refer to guidelines, but a huge number of other factors influence our decision making, such as how worried the parents are, our ‘gut feelings’ and our past experiences managing similar situations. Our role is to integrate all these pieces of information to create a new understanding of the situation. This is knowledge work.
References
1. Drucker, P. (1959). The Landmarks of Tomorrow. Harper: University of Virginia.
2. Reeve, J. (2022). Rethinking generalist healthcare: opportunities from challenges. BJGP. 72 (720): 338-339. https://bjgp.org/content/72/720/338
3. Reeve, J. (2022). Rethinking generalist healthcare: opportunities from challenges. BJGP Life. https://bjgplife.com/rethinking-generalist-healthcare-opportunities-from-challenges/
4. Wenzel, RP. (2017). Medical education in the era of alternate facts. New Engl J Med. 377 (7), 607-609.
5. Ray, T. (2009). Rethinking Polanyi’s Concept of Tacit Knowledge: From Personal Knowing to Imagined Institutions. Minerva. 47(1), 75–92. https://doi.org/10.1007/s11024-009-9119-1