"Water cooler" learning: knowledge sharing at the clinical "backstage" and its contribution to patient safety

This paper seeks to identify the instances of informal knowledge sharing at the "backstage" of the clinical environment and to demonstrate their contribution to organisational learning and patient safety.

The approach takes the form of an ethnographic study in two Day Surgery Units in the UK National Health Service undertaken over three months in various clinical and non-clinical settings. The observations recorded the instances of communication and knowledge sharing, as well as taking into account the wider socio-cultural and organisational context.

The study identified situations of informal knowledge sharing. These were characterised by degrees of homogeneity/heterogeneity and patency/privacy. Focusing on three sites--staff lounge, storeroom, and theatre corridor, the paper elaborates the context and content of knowledge sharing, and the contributions to clinical practice, service function and learning.

Backstage knowledge sharing is premised on shared understanding, trust and mutuality and situational opportunity. This contrasts with more formal models of learning advocated in policy. Services managers might embrace, rather than replace, these relationships, whilst emphasising the need for knowledge to be shared more widely amongst peers and service leaders.

To date, little research in the area of patient safety has considered the contribution of informal learning at the "backstage". This is an important, if taken-for-granted, part of everyday practice and makes a "hidden" contribution to organisational learning.