Healthcare organisations run on more than just textbooks and protocols – they run on the hard-earned, experience-based know-how of their staff. Much of this vital knowledge is tacit knowledge: the unwritten, institution-specific wisdom that clinicians and staff accumulate through practice. Tacit knowledge ranges from local prescribing quirks to informal workflow hacks. This post explores why tacit knowledge is a hidden asset in healthcare, how it influences daily practice, and why capturing and sharing it is crucial for patient safety, efficient operations, and training the next generation of providers.
What is Tacit Knowledge in Healthcare?
In simple terms, tacit knowledge is the “know-how” that lives in people’s heads – often gained through years of experience – and is hard to write down or transfer directly. Unlike explicit knowledge (the formal “what to do” documented in guidelines), tacit knowledge is the informal “how to do it” that comes from personal experience.
Tacit knowledge is context-specific, intuitive, and hard (but not impossible) to formalise. It includes skills, insights, and institutional practices. In healthcare, this encompasses everything from clinical intuition to knowing how to navigate a hospital’s computer systems. It’s no surprise that most human knowledge isn’t in manuals at all – studies suggest up to 90% of an organisation’s knowledge is embedded in employees’ minds and not formally documented. In other words, the vast majority of “how things get done” in a hospital resides as tacit know-how carried by its people. This makes tacit knowledge a bit of a “black box” – essential but opaque. Hospital leaders might not see it directly, yet they rely on it daily. Tacit knowledge is like the hidden wiring of an organisation: it’s hard to see, hard to transfer, but if you could harness it, you’d ensure sustainable knowledge even as staff come and go.
Tacit Knowledge in Everyday Clinical Practice
Even if tacit knowledge sounds abstract, it shows up everywhere in daily clinical and operational workflows. Seasoned staff often operate on “mindlines” – internalised, experience-based guidelines. Consider these common examples of tacit knowledge in healthcare:
Local treatment guidelines: Hospitals often maintain their own antibiotic prescribing protocols tailored to local resistance patterns. These internal guidelines (e.g. which antibiotic is first-line for pneumonia at your hospital) embody localised content. Clinicians moving between hospitals quickly learn that “the way we do things here” may differ from national guidance – and they must adapt to those tacit local rules.
Operational workflows and “how to get things done”: Every facility has its own way to book a scan, make a referral, initiate a consult, or manage a discharge. This might include which forms to fill, which system codes to use, or which person to call to expedite a service. Rarely are these steps fully captured in a formal SOP; instead, new staff pick them up by asking colleagues or through trial and error. For instance, figuring out how to request an urgent MRI may involve knowing the unspoken rule that “you call Technician X before 5 PM” – a tip not found in any handbook.
Informal ward practices and protocols: Tacit knowledge includes the unwritten norms on each unit. One ward might have a specific escalation protocol (e.g. “If a patient deteriorates on Ward A, notify the charge nurse first, then the on-call doctor”). These practices are passed down through mentorship or team culture. They’re highly local – even “local jargon” can develop.
EHR usage and documentation tips: Electronic health records are used everywhere, but how staff navigate them efficiently is often tacit. Every experienced unit secretary or resident doctor has pointers like “In our system, it’s faster to enter orders using template Y” or “Dr. Smith likes the problem list formatted this way.” These little tricks make workflows smoother but usually aren’t in any official IT manual.
Front-line providers continuously blend explicit knowledge (like clinical guidelines) with tacit knowledge (like their own experience or a colleague’s advice). Research shows that clinicians lean heavily on tacit cues.
Because tacit know-how is so prevalent, ignoring it can be risky. If a new hire or rotating trainee doesn’t have access to this unwritten knowledge, they might struggle or make missteps not due to lack of medical knowledge, but simply not knowing “how we do things here.” This is why healthcare organisations are increasingly recognising tacit knowledge as operational gold. Capturing those local guidelines, workflows, and tips can prevent everyday inefficiencies and even safety issues.
Why Capturing Tacit Knowledge Matters
Given that tacit knowledge drives so much of clinical care, actively sharing and managing it can yield major benefits. Here are key reasons healthcare organisations should invest in capturing this hidden knowledge base:
Faster Onboarding and Smoother Transitions
When new staff join or rotate in and go through “induction” or “orientation”, there is often a steep learning curve of tacit knowledge. A resident transferring from one hospital to another might spend weeks discovering all the local policies and “gotchas” by trial and error. This not only slows them down but also creates frustration and potential errors. By capturing tacit knowledge and making it easily accessible, organisations can dramatically speed up onboarding.
Imagine a new nurse or junior doctor having a one-stop internal wiki or “playbook” that explains exactly how to navigate the local electronic prescribing system, or lists the steps to schedule an imaging study at that facility – instead of relying on whoever is free to show them.
Such knowledge repositories turn implicit know-how into an explicit onboarding resource.
There’s also a knowledge retention benefit. When experienced staff retire or leave or rotate onwards, they take valuable know-how with them. Organisations that fail to capture this face a knowledge drain. A robust tacit knowledge-sharing system ensures that an institution’s hard-won lessons don’t walk out the door. Instead, they become part of institutional memory that new staff can learn from. This is crucial for continuity in high-turnover environments like hospitals. It also shortens the “experience gap” – new hires can learn in weeks what might have taken years of on-the-job experience, because the insights of predecessors are documented and passed on.
Efficiency, Effectiveness, and Better Outcomes
Tacit knowledge (or lack thereof) has a direct impact on operational efficiency and clinical effectiveness. Healthcare is a fast-paced environment – having the right knowledge at the right time can mean the difference between a timely intervention and a delay. Sharing tacit knowledge speeds up decision-making and reduces friction in workflows:
Point-of-care decisions are faster. If a clinician can quickly access local know-how (say, via a quick search on an internal knowledge base or app), they can make informed decisions without hunting down a specialist for advice. A great example comes from hospitals using antimicrobial prescribing apps. One doctor noted it “saves five minutes a patient… use it for six patients in a shift and there’s half an hour. That’s the difference between seeing another patient and not.” This kind of time saved – by instantly tapping into codified tacit knowledge – can translate into seeing more patients and reducing waiting times.
Treatments start sooner. Tacit knowledge tools can eliminate delays in care. In the words of one nurse practitioner, having guidelines at the fingertips meant that for an acutely ill patient “instead of digging into their golden hour looking for a computer, you can look [up the info] at the bedside and a minute later you’ve written a prescription”. Faster initiation of treatment, especially in emergencies, can directly improve patient outcomes. In sepsis or stroke, for instance, every minute counts – making sure clinicians don’t waste time seeking how to manage local procedures (like where to find the drug or how to get approval) can literally save lives.
Consistency and error reduction. When tacit knowledge is shared widely, practices become more standardised and evidence-based across the board. Clinicians are more likely to follow the best process if it’s readily available and validated. Research indicates that clinicians believe such tools “refresh my memory” and “reduce errors”, integrating tacit reminders into practice. Simply put, easy access to the collective wisdom (the “pocket expert”) means fewer omissions. A consultant in the MicroGuide study mentioned they use the app as a double-check – “eight or nine times out of ten, I’ll double-check we’re adhering to the guidelines” – which prevents slips and reinforces correct actions. Reducing variability in how things are done (when that variability is unintended) usually means more reliable, higher-quality care.
Innovation and quality improvement. Tacit knowledge is also the seed of innovation. Front-line staff often know where the bottlenecks and workarounds are – turning these insights into explicit improvements can drive quality. Organisations that capture staff suggestions and local fixes (for instance, through regular debriefs or suggestion systems) can transform those tacit insights into system-wide changes. Thus, fostering a culture of sharing tacit insights can be a source of continuous improvement.
In summary, making tacit knowledge accessible transforms it from an individual asset to an organisational asset – improving efficiency (time saved, smoother operations), effectiveness (more consistent evidence-based practice), and ultimately patient outcomes (through faster, safer care).
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