This thesis is about knowledge that interconnects across different domains, and the
social interactions that support the mobilisation of such knowledge for clinical
practice. These issues are explored in the context of sepsis care in Scotland.
Sepsis claims the lives of at least 52,000 people in the UK each year, more than breast,
bowel and prostate cancer combined. While Hippocrates observed the dangers of
sepsis well over two thousand years ago, only in the last 25 years has a coordinated
research strategy been established to guide modern therapeutic efforts. Yet despite a
mounting clinical evidence base, the cause(s), progression, treatment and even the
very definition of sepsis remain often unclear and sometimes contested. In care
settings, the clinical manifestations of sepsis are frequently subtle and difficult to
distinguish from other common conditions, and the lack of a definitive diagnostic test
heightens the range of knowledge clinicians depend upon in order to recognise and
treat potentially septic patients.
Within this context of uncertainty, connecting the domains of research, policy and
practice remains an enduring concern in sepsis care, as with many other clinical issues.
In particular, there are significant challenges in ensuring that knowledge (and
knowing) in each of these domains better connect for continued improvements in
patient care.
This thesis then contributes to improved understanding of the persistent ‘knowing in
practice’ problem: using a knowledge mobilisation framing to capture the
development, sharing, and use of knowledge, where these processes are
conceptualised as multifaceted and intertwined rather than segmented and detached.
With a dual focus on both knowers and their knowledge, this work seeks a closer understanding of the social interactions that contribute to an interconnected
‘knowledge network’, a network that can, in turn, underpin better, safer patient care.
Using a qualitative case study design, this study provides a detailed exploration of an
interconnected knowledge network (on sepsis care in Scotland) that successfully drew
together the research, policy, and practice communities and resulted in improved
patient outcomes. Drawing on documentary, observational, and interview data, this
work found that knowledge is carefully curated (through social interactions) in order
to connect knowledge from the different domains and to support the mobilisation of
new actionable understandings for care. Tensions within both what knowledge ‘is’, as
well as the social system in which knowledge is employed, are negotiated
and nurtured by social practices that have been termed ‘shepherding’. Shepherding
practices are those that tend to the social interactions that support the mobilisation of
knowledge, and they are in evidence throughout the distributed areas of research,
policy and practice. In concluding, this thesis argues that – because knowledge is
complex and emergent, and because mobilising knowledge is an ongoing social
process – a developmental perspective needs to be taken as the normative frame for
the ‘knowing in practice’ problem.
The thesis makes two main contributions:
• empirically it provides a rich and detailed account of interconnected
knowledge and the social interactions that contribute to the mobilisation of
that knowledge in sepsis care in Scotland;
• theoretically, this work extends the academic literature that explores the
diversity, complexity, and interconnectivity of knowledge for practice by
emphasising the role of social interactions in supporting knowledge networks;
and the study demonstrates the successful use of Soft Knowledge Systems
(SKS) and Clinical Mindlines (CM) as a combined ‘relational knowledge
systems’ lens to better understand knowledge mobilisation processes."This work was supported by the 600th Anniversary Scholarship provided by the School
of Management, University of St Andrews." -- Acknowledgement
