ABSTRACT
This chapter explores tacit knowledge sharing at the place where clinicians provide care to patients: the sharp end. It is at this point in the process where effective, accurate, and accessible knowledge has the greatest potential of good or harm. The local area of focus, where tacit knowledge is typically shared, is the clinical microsystem and its related subcultures. The capacity of a healthcare organization to 'preserve sense making' requires 'preconditions' or a set of shared assumptions and 'designs' or new ways of thinking about what is done according to Berwick. Technological tools to enable this have yet to be fully adopted at the sharp end. Technology with emphasis on decision support software/analysis might ignore activity-based knowledge, the context of the care environment and the value that tacit knowledge can provide. The notion of spread of knowledge within the unit and out to other frontline units has yet to be embraced proactively as a factor in quality care.
