Health Care and the Tacit Database

24 May

In a recent article (here), I discussed the potential of an organisation’s tacit database- an organisation’s frontline expertise and rules of thumb which are highly effective, but remain hidden from the wider organisation.

Tacit skills can remain hidden due to a separation between planners and frontline workers. For example, when a strategy is created by a planner (director, manager, board etc.) it is adapted to local conditions by frontline workers. This results in the strategy being changed, so it is more effective in a particular situation. Unless the adaptions are feedback between the frontline and the planner, these adaptions are lost, they become “ghost cases”. The adaptions represent the application of theory into practice, and unless this interaction is recorded, the opportunity to continually learn, improve and adapt is wasted.

Planners are left thinking their plans work just fine as they are. In the meantime frontline workers apply expertise and adapt plans to local conditions, but consider these actions taken for granted and not worth mentioning. As a result, all organisations could benefit from managing tacit data to capture learning, improve project management, and develop strategic agility. But for new and developing areas, where the learning curve is so steep and accelerated, tacit data could be a decisive factor in achieving goals faster, safer and more effectively.

Ghatak et al (, 2016) ( Article available here) identify an area where managing the tacit database is vital-healthcare in developing countries. The Ghatak et al article discusses how frontline healthcare management (in developing countries) needs development, stating

“We aim to shine a light on the “invisible army” of frontline managers in developing countries and propose practical actions to unlock their potential”

Three of the practical actions the authors suggest are listed below-


  • empowering culture that fosters collaboration and trust among frontline managers and their teams, their supervisors, and the communities they serve
  • disciplined performance-management practices that motivate frontline managers to pursue a narrow set of targets, regularly reviewed during routine performance dialogues
  • functioning data and information systems oriented to support frontline decision making

Each of these actions can be supported by managing tacit data from frontline workers. Creating a feedback loop between frontline managers and their teams builds trust, as expertise is used as a strategic resource. For example, the adaptions of frontline workers are noticed by managers, and then used to improve plans.

Tacit data provides insight on how frontline workers make sense of situations. If the sense making is shared, then staff feel more confident they are on the same page when they share information (patient handovers for example). This builds trust in teams, reducing the need to frequently re-check instructions, and focus on patient care. Examples of our work in this area is here and here.

Tacit data supports performance management by collecting cognitive and behavioural information on how tasks are tackled and completed. Emphasis shifts from not only outcome (how well or not a task was completed) to process (what thinking was used to produce an outcome). This type of data makes performance easier to manage and improve, as steps in both cognition (reasoning) and behaviour (action) can be located and improved.

The result of managing tacit data is improved decision making. In complex environments, such as healthcare management, there is rarely a perfect decision which naturally flows to a perfect outcome. Instead there are decisions which initiate a course of action. Good decision making is actively managing a course of action, and adapting choices as they encounter surprises, barriers and unexpected events. If frontline managers can stay in touch with the consequences of their decisions, as frontline staff enact them, managers become improved and more adaptable decision makers. Managing the tacit database provides managers with a method of evaluating their decision making, increasing their knowledge of frontline expertise, and a method of continually improving plans, procedures and processes.



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