Multiplicities of Knowledge and Learning: Exploring the Codes of Knowing in Healthcare Governance

Abstract

This paper examines healthcare governance in Sweden, focusing on two key trends: "Knowledge-based management" and "Trust-based management" (in Swedish, “kunskapsstyrning” and “tillitsbaserad styrning”). These trends are analysed through three dimensions of governance, rooted in theories of knowledge and learning, each represented on a continuum. The first dimension assesses the extent to which governance prioritizes tacit versus explicit knowledge. The second considers the locus of knowledge, distinguishing whether it resides within individuals or social groups, thereby influencing whether learning is oriented toward individual or collective processes. The third dimension contrasts learning that reproduces established knowledge with learning that generates innovation and new knowledge. Through detailed document analysis, the paper highlights disparities between Knowledge-based management and Trust-based management at the policy level, particularly in their discursive constructions of knowledge and learning across these three dimensions. The analysis suggests that these governance approaches sometimes conflict, requiring a choice between pursuing the ideals of Knowledge-based management or Trust-based management, while at other times, they can coexist side by side. This paper contributes to the discourse on healthcare governance by providing an analytical framework for understanding how governance approaches embody distinct “codes of knowing” and support varying modes of knowledge and learning processes.