"Knowledge transfer often needs to be a two-way street", says shared knowledge expert Nancy M. Dixon (Common Knowledge Associates, Dallas, Texas, USA).

“Whether you’re a nurse, physician, radiologist, or other health care worker, you are always trying something new,” points out Nancy M. Dixon, a knowledge-sharing expert and co-founder of Common Knowledge Associates, Dallas, Texas, USA. “This learning has become critical to our work lives.”

As new technologies arrive, new ways of implementing them must be developed. And an organization wants its teams to share all their new knowledge—for example, “when one team learns bar coding medications in the ICU, the hospital won’t have to go through the whole learning curve again but can take what it already knows.”

However, the best practices for transferring knowledge between teams may not be what you expect, says Dixon, who analyzed how successful organizations accomplish it in Common Knowledge: How Companies Thrive by Sharing What They Know.

Explicit and Tacit Knowledge
Dixon makes a crucial distinction between explicit knowledge, which may be easy to pass on, and tacit knowledge, which calls for a quite different approach.

Explicit knowledge can be embodied in straightforward and accessible forms, such as a patient safety summary. Employees with a need to know are typically quite comfortable asking for such material.

But tacit knowledge is not so easily summarized or transferred. For instance, suppose you want to copy another group’s successful effort to make changes in the way physicians write a prescription. That won’t be covered neatly in a document; covering all the context of the situation requires some discussion with your peers in the other group, Dixon notes. “They have to understand your relationship with physicians and what you’ve tried so far. And why would they take 20 minutes to talk unless they knew you?”

Taking a Reciprocal Approach
In fact, thinking of this process as simply “transferring knowledge” can get us into trouble, Dixon declares. “If you focus only on the person with the knowledge, that’s the school model: a one-way transfer from those who know to those who don’t know. That’s not a very good model for continuous learning.”

Instead, we should aim to build a reciprocal model, which takes an opposite approach, Dixon recommends. With this model, people who need the knowledge actively seek it out, and then build a reciprocal relationship with those who have the experience.

“The heart of the reciprocal model is that everyone has stuff they can learn from others, and everyone has things they can help others with,” says Dixon. “You get some knowledge, develop your own, and share it with those from whom you got knowledge. It becomes a more even relationship.”

“It’s not very hard to think of ways to create the reciprocal model,” once you kick the habit of thinking in the school model, she adds.

Trust Me
The key issue for the reciprocal model is creating an atmosphere of trust, where people feel that they can ask questions without being put down.

This is best done by getting people together so that they can discuss their experiences and build relationships, which makes the sharing less scary, Dixon says.

She’s seeing the rise of “communities of practice” (ICU nurses, for instance) that provide a mechanism for this. The Institute for Healthcare Improvement Collaboratives—which brings together people from dozens of hospitals plus experts—offer another good example, she says.

Bringing people together helps to kick-start an ongoing process of sharing learning, she emphasizes. Virtual Collaboratives, in which people communicate electronically, “don’t work that well unless people have an initial face-to-face experience to build relationships and trust,” she says.

On the Front Lines
Ideally, this kind of shared learning should permeate an organization, Dixon says.

Traditional organizations assume that people at the top know the most, and tell the people at the bottom exactly what to do. But that may be misleading. For instance, “Nurses may know more than administrators about how to implement new procedures,” if administrators haven’t been playing a hands-on role recently, Dixon points out.

“It’s interesting that in so many industries, including health care, people at the top typically travel and people on the front lines don’t, even though people no longer think of travel as a pleasure,” Dixon comments. “People on the front lines are learning things and they could learn from each other. They need to have the same face-to-face meetings.”

Reinvented Here
Each organization needs to reinvent knowledge for its own particular requirements, Dixon says.

“We are constantly inventing and reinventing in the implementing stage as well as the technology stage,” she says. “Even if I visit your site or we sit down over coffee, what you tell me about is something you have invented. In order to use it in my setting, I will have to reinvent it.”

Organizations need to provide “the time, space, and cultural acceptance to do the reinvention stage.” The PDSA (Plan-Do-Study-Act) approach followed by IHI accepts this need, “understanding that things may not work the first time,” Dixon concludes.