Using saliency and tacit knowledge for person-centred care: a two-phased qualitative study on patient and family involvement in residential care

As workforce shortages increase, collaboration between residents, their informal networks and care professionals (triad) must intensify to ensure person-centred care. Such care, which aligns with personal preferences, needs and values, requires saliency and sharing of tacit knowledge among those involved. Saliency is the ability to recognise a significant signal in a given situation that demands attention because it appears to be relevant to a person's care and well-being. Tacit knowledge is knowledge gained through experience, is difficult to articulate, and often guides action without conscious deliberation. This two-phased study (2022, 2024) explored (1) how saliency based on tacit knowledge of the personhood of a care recipient informs person-centred responses of care professionals and (2) how a person-centred learning culture can be fostered in which tacit knowledge is shared within triads.

To effectively facilitate a learning culture in which tacit knowledge is shared and applied, to achieve optimal person-centred care.

Both phases took place on residential wards for people with dementia and somatic care. Narratives of successful examples and best practices of using tacit knowledge were collected through observations and interviews. Based on these insights and in co-creation with all stakeholders, an innovative supportive tool was developed. This consists of a seasonal calendar and a questioning game, enriched with eight elaborated practical examples. The tool facilitates dialogue and reflection and encourages the use of tacit knowledge in the daily lives of residents.

Across two phases, we identified a three-step process in which residents, family members and professionals within the care triad recognise saliency, surface tacit knowledge and translate it into person-centred actions. This process, illustrated in eight triadic examples, informed a supportive tool that structures shared reflection and learning in daily practice, strengthening person-centred care despite task-oriented routines and time pressure.

Saliency and using tacit knowledge of parties cooperating in a triad are essential for person-centred care. Facilitating dialogue and reflection strengthens such collaboration. Concrete examples of best practices and narratives of successful communication support a learning climate that optimises person-centred care.