Knowledge practices in integrated care: an examination of health and social care teams using collective knowledge creation theory

Integrated systems of care are increasingly seen as the means to bridge gaps between organisations, services and professions, increase quality, and decrease costly duplication across the health and care landscape. Integration and integrated health and care teams, composed of locality-oriented health and social care practitioners, have become central to global health policies. Integrated teams are expected to share distinct bodies of knowledge, evidence and expertise and use this to create holistic care plans. However, little research has examined how they achieve these knowledge-related goals. This research uses organizational knowledge creation theory to examine the discursive practices within integrated teams. Observational data from case management meetings across five integrated teams highlight four key themes: 1) Instrumental questioning dominated discussions, often making participants feel criticized and leading to the imposition of questioners' opinions. 2) Interactions were typically unstructured and unreflective, hindering clear objectives and limiting knowledge sharing and creation. 3) Teams often failed to retain and apply prior learning, struggling to identify cross-case insights. 4) Teams relied heavily on internal knowledge sources, rarely seeking evidence from patients, families, or other professionals. These discursive practices undermine the policy goals of integrated care, particularly with regard to knowledge and evidence. To address this, teams need support to expand the forms of knowledge and evidence they draw upon, discuss contradictions and uncertainties, and value reflective, curiosity-driven dialogue.