Lost in transfer: the role of epistemic cultures to mobilize improvement knowledge in health-care collaborations

Purpose This study aims to elucidate how actors from communities that differ in their epistemic culture, i.e., specific aspects related to knowledge or its validation that make up how we know what we know, negotiate and translate process improvement knowledge through deliberate attempts to promote collaboration between them. Design/methodology/approach Using a longitudinal case study, a practice-based qualitative approach is deployed by using “practices” as the unit of analysis with sustained data collection over a 12-month period. Ethnographic methods were used to generate data from observations of the interactions between operations improvement advisors and target clinicians (nurses and doctors) at workshops, off-line interviews with the workshop participants before, between and after the workshops and background discussions with officials at the Department of Health responsible for the intervention. Findings If different epistemic cultures are brought together, “problems of proximity” emerge that highlight epistemic divides between the policymakers, operations managers (knowledge “advisors”) and clinician-manager (knowledge ‘targets). Humans, as epistemic cultures, are autopoietic systems. To continuously recreate, they need to remain closed and only selected channels allow for signals that need to be translated by the receiver. The findings support this argument that knowledge mobilization should be perceived as an act of translation rather than transfer, revealing an ongoing “collective conversation” between actors characterized by tensions as different epistemic cultures negotiate and translate process improvement knowledge in different ways. Originality/value The authors show that mobilizing knowledge across disciplinary boundaries in complex multi-stakeholder contexts involves translation across epistemic cultures. Neglecting this aspect may explain the failure of many lean health-care implementations. This moves research beyond rational, objectivist models of knowledge mobilization dominant in the operations management literature that assume the unproblematic transfer of knowledge.