Knowing – in Medicine

Abstract

In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains - the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning.

The Cynefin framework: A tool for analyzing qualitative data in information science?

“…In health it has been used in a variety of contexts; for example, choosing approaches to health promotion (Van Beurden, Kia, Zask, Dietrich,& Rose, 2013), developing research in organizational behavior (Mark, 2006), analyzing chronic care (Martin et al, 2011), and understanding knowledge in clinical practice (Sturmberg & Martin, 2008).…”

Complexity and health – yesterday's traditions, tomorrow's future

“…Knowing is complex [18]; every issue we seem to know in medicine -and for that matter in general -is context sensitive and can be seen through another prism providing us with additional 'frames' of understanding. These 'frames' provide new mental structures that shape the way we see the world [19]; systems and complexity science therefore offers an extension to understanding, rather than a panacea, to the current intellectual, therapeutic, organizational and educational crisis in medicine [8,9,18,20,21].…”

Tourism and the public sector in England since 2010: a disorderly transition?

“…One potential approach, among several recent advances in organisational studies (Michaels 2009;Browning and Boudes 2005) that may assist in the interpretation of public sector support for tourism, its future development and its ability to contribute to other policy goals (Table 1), is the 'Cynefin Framework' (Snowden 2002(Snowden , 2005Kurtz and Snowden 2003). To date, this has been variously applied to interpret approaches to disaster recovery in business (Antunes et al 2011), information brokerage (Michaels 2009), future developments in education (Hiscock 2004;Fensham 2011), food security (Shepherd et al 2006), managing risks (French et al 2011;Grotan et al 2011), knowledge production in healthcare (Mark 2006) and medicine (Sturmberg and Martin 2008) but not as yet travel and tourism.…”