Unsettling settled knowing: reconciling differences in expert practice

Abstract

Occupational subgroups with similar training often develop differing work practices within their local settings. These differences may create inconsistencies when organizational change brings subgroups together to work alongside each other. Based on a two-year qualitative study of a hospital merger combining two neonatal intensive care units, we consider how differing expert practices may be challenged, preserved or reconciled when subgroups are brought together. We find that reconciliation processes are unexpectedly triggered by novice newcomers who struggle to socialize into a consistent way of working. Comparing five expert practices over time, we also find that when groups are able to converge around the type of knowledge that should apply to expert practices (abstract vs. experiential knowledge), a form of reconciliation is possible, but when there is divergence around the type of knowledge that is relevant to the situation, reconciliation fails. Converging on experiential knowledge implies a simplified process of reconciliation that preserves expert autonomy while masking residual differences. Converging on abstract knowledge involves a complex, multi-layered process in which expert subgroups need to revert in part to mechanisms resembling those that underpinned their initial socialization into the discipline. These mechanisms include mobilizing evidence to update abstract knowledge, situated mentoring with respected experts, and authoritative reinforcing via interventions from high-status professionals. Our study highlights the challenges of changing expert practices that are rooted in ingrained experiential knowledge. It reveals that abstract knowledge alone is insufficient, and that reconciliation invariably involves settlements and agreements on what form of knowledge matters.