ABSTRACT
Throughout western healthcare systems, there has been a proliferation in the guidelines and protocols that regulate clinical decision-making. Increasingly, clinicians have been required to adhere to codified and explicit procedures and to measure their performance against specific health outcome indicators. This chapter shows how standardised health outcome measures for neurorehabilitation patients are used within a multi-disciplinary team, and how tacit knowledge is intrinsic to this process. Professionals’ interpretations of the meanings of certain outcome measurements, such as the Barthel Index and other measurements of patients’ functional abilities, are dependent upon other kinds of taken-for-granted knowledge. Clinicians adjust individual patients’ scores – and ostensible changes in them – in the light of their clinical judgement and contextual circumstances. Thus, encoded knowledge is explicated, supplemented and sometimes challenged by embedded and tacit knowledge. This chapter outlines the nature and importance of tacit knowledge; it summarises the linkage between evidence-based medicine and health outcome measures and presents qualitative case-study evidence about the uses of outcome measurement in neurorehabilitation. The conclusions reiterate the inevitability of tacit knowledge and the limitations this places on the pursuit of standardisation.
