Jacky Swan

In this chapter we introduce knowledge mobilization and explain how the book is organized. Our starting point is that “knowledge mobilization” explains, better than alternative linear “transfer” models, how knowledge actually circulates, how practice is affected, and what enables or constrains efforts to translate knowledge across contexts. We then elaborate our view and develop a guiding framework for the book. We argue that knowledge mobilization is driven by a variety of interconnected and purposeful agents that include individuals, but also formal organizations, networks, and professional groups. We also contend that the complex ecology of healthcare plays a critical role in knowledge mobilization efforts. From this we derive the idea that processes and practices need to be traced if we are to develop realistic and useful accounts of how and why knowledge mobilization actually happens (or not).

This chapter discusses the global travel of a specific approach to incident investigation (Root Cause Analysis or RCA for short). We assess how knowledge of the technique was mobilized, from the United States to Australia, the United Kingdom and beyond. We argue that the mobilization and world spanning circulation of this set of practices was sustained and facilitated by the construction of an “anxiety-reassurance” package. This package raised public and professional anxiety about patient safety and created reassurance by proposing a new management solution to solve this problem. Playing together these two seemingly opposite discourses, the innovation generated a wave of interest and urgency that it then rode and that allowed rapid globalization. We suggest that a focus on the innovation as a well-oiled piece of discursive machinery helps us to understand the active role of innovations in fueling their own translation without reverting to the old idea that innovations are “diffused.”

This concluding chapter revisits the guiding framework outlined in the Introduction and highlights, in brief, what this collection tells us about agency, the nested ecology, and processes/practices of knowledge mobilization. It also underlines the practical insights that can be gained from a collective body of work that actually utilizes theoretically grounded, rich, qualitative empirical research studies and which focus on what is actually happening in the field. The chapters in this collection thus extend existing theory and provide concrete insights on ways to support (or prevent) knowledge mobilization and change. The Conclusions move to developing the knowledge mobilization agenda, with suggestions on where this might usefully take us in the future. This is not a manifesto for change—there are probably too many of those in already in healthcare—but, rather, modest suggestions about future lines of research and avenues for practice.

Studies suggest that the experience of liminality – of being in an ambiguous, ‘betwixt and between’ position – has creative potential for organizations. We contribute to theory on the link between liminality and creative agency through a study of the coordinators of ‘knowledge-sharing communities’; one of the latest examples of a ‘neo-bureaucratic’ practice that seeks to elicit innovative responses from employees while intensifying control by the organization. Through a role-centred perspective, our study found that both the structural and interpretive aspects of coordinators’ role enactments promoted a degree of creative agency. ‘Front-stage’ and ‘back-stage’ activities were developed to meet the divergent expectations posed by senior management and community members, and the ambiguity of their roles prompted an array of different role interpretations. Our findings contribute to theory by showing how the link between liminality and creative agency is not confined to roles and spaces (consultancy work, professional expertise) that are positioned across organizational boundaries, or free from norms and expectations, but may also apply to roles that are ambiguously situated within organizational contexts and that are subject to divergent expectations. This shows how neo-bureaucratic forms may be both reproduced and renewed through the creative responses of individual managers.

This chapter aims to deepen our understanding of judgments in organizations. Whilst previous studies have underscored the situated nature of individual judgments exercised by e.g. leaders or managers, our research focuses on how judgments emerge as organizational responses to recurrently emerging moral dilemmas. Accordingly, the chapter studies a setting (decision practices in the English healthcare sector) where moral puzzles (to fund or not to fund healthcare for apparently atypical patients) demand ongoing attention and systemic handling. The chapter conducted (and present findings of) a focused ethnography of the ways expert decision-making panels in three health authorities confronted, engaged, and coped with morally perplexed situations. The moral perplexity there lay in that panels were called upon to prudently and demonstrably determine whether a particular patient deserved or not exceptional investment, when the healthcare needs and rights of all patients under the same health system were taken into consideration. By adopting a practice perspective, the chapter develops an analytical account of the effortful accomplishments (sociomaterial activities or intertwined “projects” in practice theory terms), which enabled the recurrent collective exercise of judgments in accordance with publicly recognizable moral expectations—namely notions of fairness. The main contribution lies in conceptualizing the work of rendering moral judgments as practical, organized pursuits possible and meaningful, and hence in complementing current “ecological understandings” of individual judgment-making in organizations.

The deal–making process requires entrepreneurial actors to create and maintain wide networks of weak ties while simultaneously developing stronger collaborative ties that will enable opportunities to be realized. We currently lack an adequate account of how these activities are integrated by deal–makers under conditions of risk and uncertainty. In an empirical study of deal making in early–stage technology ventures, we find that deal–makers rely on different forms of trust in the early and later phases. Based on this study, we develop a process model and propositions on the role of trust in integrating strong and weak ties in deal making.

In this paper, we advance understanding of how rational decision making transpires through distinctive organizational practices. We respond to recent calls, which have convincingly argued for the need to think of ‘rational decision making’ as a practical accomplishment, yet have not elucidated how it is an emergently performed and constituted organizational phenomenon. Accordingly, we study empirically decision making in a context where actors seek to be purposefully rational when making healthcare funding decisions. Building upon a focused ethnography in the English healthcare sector, we provide an account of how rational decision making is accomplished through practices of deliberation. We show that, deliberation practices constitute an assemblage of three interrelated activities: performing procedural requirements, making sense of decision cases and deliberating the merits of cases. We also show how at the heart of deliberation practices lied a concern to carefully and systematically produce rational as in fair decisions. Contrary to existing literature, our findings suggest that rational decision making required a distinct performativity process, which involved analyzing and ‘calculating’ the consequences of a resultant decision in terms of fairness and public justifiability; not merely for efficiency (e.g. funding a drug that ‘works’ and is cost-effective).