Abstract Title
Towards understanding informal learning in networks of healthcare professionals Results of a qualitative empirical study


John Bibby
Micky Kerr
Ronald Maier
Stephan Schaeper
Stefan Thalmann
Tamsin Treasure-Jones
Lena Waizenegger


8BB Teaching and learning: Principles


Bradford Districts Clinical Commissioning Group - Leeds Institute of Medical Education (LIME) - Bradford - United Kingdom
University of Innsbruck - School of Management - Innsbruck - Austria
University of Leeds - School of Management Information Systems - Leeds - United Kingdom


With ever shorter cycles of innovation, most healthcare professionals adopt short-term, self-organised ways of informal learning. Compared to more traditional learning settings, the unstructured, creative and expertise-driven informal learning cannot be designed with standardized management approaches and cannot be easily supported by information and communication technologies (ICT).

Summary of Results

Network Maturity - Network Dynamics

We identified that network members:


  • engage in multiple, overlapping networks
  • switch between networks
  • create sub-networks


in order to connect to other healthcare professionals and gain timely access to valued knowledge.



Current Tool Usage















Localised Learning



Challenges of Informal Learning

There seems to be a need for work integrated ICT solutions lowering the cognitive load, filtering the most relevant knowledge and ensuring that the high privacy and security demands of healthcare are maintained. The integration of social technologies might enhance a firm’s ability to apply the new knowledge to their products, services, and innovative activities (Roberts et al., 2012) and also reduce the cognitive load for the users.


Perceived challenges of informal learning

Proposed solutions by our agents

Information overload

Cut information push to manageable information of interest

Communication among distributed members

Use virtual communication channels effectively and organise more meetings on a regional level

Interruption of work

Implement some learning time-outs

Content and technology complexity

Support of multiple media types as well as technology that fits to the habits of the agents

Free-riding and reluctant sharing

Encourage users to contribute

Language unfit for target audience

Language guidelines

Doubtful quality of shared knowledge

Balancing moderation and freedom of choice within networks; Repository for quality assured knowledge

Uncertainties about legal consequences of knowledge sharing

Keeping records e.g., by filing notes or taking pictures



Knowledge Protection - the "ends" of knowledge sharing


Open to certain extent

Open to certain group

Open to certain topic


General open, but details protected

Share with subgroups of network

Share topical knowledge only


Reluctance to contribute

Fear of imitation

Uncertainty about sharing behavior and legal issues

Legal restrictions

Collaboration with competitors


Forums, blogs ->

e-mail, phone

IPR tool to enforce NDAs

Collaborative IT for protection awareness

Protection capability




Take-home Messages

Informal learning is the dominant way of learning in healthcare, takes place in multiple, overlapping networks and demands new organisational and technological responses.

Summary of Work

The main goal was to improve our understanding of how informal learning and knowledge sharing currently take place in healthcare and how supportive ICT can look like. Therefore, we conducted an exploratory study to investigate the state-of-practice with the help of 23 interviewees representing six healthcare networks.



Our key findings include

  • detailed network demographics
  • rich descriptions of 13 informal learning and knowledge sharing practices
  • in-depth discussions of the results using the lenses:
    • absorptive capacity
    • knowledge protection
    • localised learning
    • challenges
    • network maturity. 



Network Demographics 



Overview about the informal learning and knowledge sharing practices


Informal Learning and Knowledge Sharing Practices

We consider an informal learning practice as any learning activity that, intentionally or unintentionally performed by the learner that is triggered by some event, follows no prescribed process, and ends with an unspecified learning outcome (Clough et al., 2008; Schugurensky, 2000; Vavoula et al., 2005).

In this study, we investigated informal learning practices in the described healthcare networks. Therefore, we use the theory of ACAP (Cohen & Levinthal, 1990) as a reference framework to highlight relationships between the different practices. We found that network members use various practices to identify (acquire), assimilate (integrate), and make use of knowledge (exploit).


The promotion of localised learning is one of the major tasks of networks of SMEs to facilitate learning and knowledge sharing. A well-performed process of localised learning in a network positively affects the ability to absorb, assimilate and apply external knowledge of the member organisations.


Changes in the network (sub-)structures influence the ability to absorb, assimilate and apply external knowledge of the member organisations and demand tools that flexibly serve personal, organisational and social networks complementing each other.


Enhancing organisational IT capabilities for connecting its employees in and beyond the organisational boundaries positively affects the ability to absorb, assimilate and apply knowledge of the member organisations.


The organisations need to effectively balance knowledge sharing and protection. Clear strategies for knowledge protection in a network positively affect the ability to absorb, assimilate and apply external knowledge of the member organisations


The research leading to the presented results was partially funded by the European Commission under the 7th Framework Programme (FP7) and LEARNING LAYERS (project no.318209).


Audretsch, B. (1998). Agglomeration and the location of innovative activity. Oxford review of economic policy, 14(2), 18-29.

Autant-Bernard, C., Fadairo, M., & Massard, N. (2013). Knowledge diffusion and innovation policies within the European regions: Challenges based on recent empirical evidence. Research Policy, 42(1), 196-210.

Boschma, R. (2005). Proximity and Innovation: A Critical Assessment. Regional Studies, 39(1), 61-74.

Clough, G., Jones, A. C., McAndrew, P., & Scanlon, E. (2008). Informal learning with PDAs and smartphones. Journal of Computer Assisted Learning, 24(5), 359-371.

Cohen, W. M., & Levinthal, D. A. (1990). Absorptive capacity: a new perspective on learning and innovation. Administrative Science Quarterly, 128-152.

Roberts, N., Galluch, P. S., Dinger, M., & Grover, V. (2012). Absorptive Capacity and Information Systems Research: Review, Synthesis, and Directions for Future Research. MIS Quarterly, 36(2), 625-648.

Schugurensky, D. (2000). The forms of informal learning: Towards a conceptualization of the field.

Vavoula, G., Scanlon, E., Lonsdale, P., Sharples, M., & Jones, A. (2005). Report on empirical work with mobile learning and literature on mobile learning in science. Jointly Executed Integrated Research Projects (JEIRP) D, 33.

Zahra, S. A., & George, G. (2002). Absorptive capacity: A review, reconceptualization, and extension. Academy of Management Review, 27(2), 185-203.

Summary of Results

Network Maturity - Network Dynamics

Relationships among network members are developing and ties grow and separate in different constellations. These network dynamics are deemed to influence learning and knowledge sharing and may lead to challenges for the design of measures to support complex structures. In a first analysis we identified three goals that members of networks follow when types of structural dynamics in the studied networks. This section elaborates on the findings with respect to network dynamics along statements from interviews in the construction and healthcare networks.


Shaping type and frequency of communication in networks to increase effectiveness of knowledge sharing.

Agents described the shaping of communication in networks to meet their personal goal of effective communication as a key to gain value form a network when time is the most restricted resource. Agents state that network meetings are helpful in new networks or as a new member to a network to [HC-N2-4] “build up relationship with people who you meet with and talk with.” However, network meetings are time consuming and little effective on the actual problems members struggle with. An agent explains how fewer network meetings need to be scheduled and communication can be shifted to online communication tools, once an atmosphere of sharing has been created [HC-N6-4]: “And I think as networks do progress than the frequency of the meeting can reduce and you can look other media, email or whatever, to complement it so that you build up the relationships […] you can have targeted discussions or you may find sort of little project groups within the networks.” This safes meeting time and changes the dynamics of a network towards an environment with faster and more frequent interactions. However, even if online tools are provided, quick answers to problems are gained through phone calls. One agent who is member of a studied online network explains that if he is seeking quick help, he arranges [CO-N4-1] “either a personal meeting or, if it [the problem] is easy to solve, he calls a person.”

Summing up, these statements indicate that network members need to be ready for the introduction of a communication platform, which requires an atmosphere of sharing among a critical mass of people. When such a state is reached (e.g. through personal network meetings), communication can be shifted from personal meetings to more solution oriented online communication channels.


Connecting independent networks via a central node to accomplish tasks with frequently changing policies.

Agents have discussed the challenge of their local networks to accomplish tasks that had to follow frequently changing policies. One agent explains the dynamic context of the network [HC-N6-2]: “there’s a background of constant change.” Healthcare professionals initially addressed the policy that regulated a certain task on a local level and as an agent explains, there were [HC-N6-2] “two hundred [local groups] at that time so they all went and devised their own systems.” With the term “system” he refers to processes as well as software tools helping to accomplish the task. Since these “systems” needed to be changed whenever a policy was changed effort were substantial. Members of the network tried to [HC-N6-3] “formalise them a bit better, so the regional networks [were] […] set up.” These links are managed by the regional network managers. Again later, the task was [HC-N6-2] “recognised as a process that needs support and needs a bit of, needs national guidance rather than every local organisation making it’s, making up its own rules because it wasn’t given any steer from central government.” This connection process was further triggered by the need for comparable results and coherent reporting. Therefore, a national node was introduced that connected the regional networks and provides them with policies and tools. We also found that such links between networks can be working groups where members from different networks participate [CO-N1-3]: “The architects consider us, the construction sector, still as enemies. Here, we need to make efforts at persuasion and we only can achieve that by using the working groups. […] we were five including the president of the chamber of architects and the president of the chamber of engineers.”

Summing up, this dynamic process triggered alternating by bottom-up and top-down, caused several structural changes. Currently, networks operate on a local level but are formally supported and coordinated by regional and national network nodes, resulting in an overall tree-like network structure.

Different networks also help via ongoing support [HC-N6-5]: “we will link with that network and I often speak at that network and we’ll have some other people from that network speaking to our network because basically the appraisal leads support and give, provide a lot of the information that the responsible officer needs to be able to make the recommendations.”


Merging independent networks to one larger network to increase competitiveness of a network.

Agents report on the fusions of their regional network with other regional networks to increase competitiveness. The network organisations primarily act as service providers to their members and are in competition with private organisations. The initial structure of the regional networks was introduced in a top-down approach focusing on locally independent networks. After less than two years, the independent regional network structure was considered inefficient in service provision and in competition with other service providers. An interview explains the fusions [HC-N3-1]: “we are now merging with [regional network] to become the [network] that covers the [regional] geographical footprint.” Agents describe a former fusion [HC-N3-3]: “a merge of two organisations can feel quite destabilising but I actually felt meeting as a team like that was quite reassuring actually; […] the two organisations have similar cultures so it didn’t feel like there was going to be an organisational clash.” Another agent explains [HC-N3-2]: “that’s given us more people and areas to compare with.” For the future, an agent outlines his expectations of further merges [HC-N3-1]: “I think there will be in the future some kind of formal body […] [it] is effectively.” We also found that networks independently develop over time and then merge to combine the strength of their different professional foci [CO-N3-6]: “there were two parallel streams, one network focusing on ecological building and one with traditional craft businesses. […] Then both members of both streams realized that they have to cooperate to acquire interesting orders. Consequently, both streams merged and formalized as [the current network].”

The effects of these fusions of regional network management resulted in changes of the network management structures and less competition. Network members as well as the network organisation had to adapt to this situations with less local linking but a larger regional context.



Challenges of Informal Learning



Localised Learning

Previous research showed that localised learning is important for absorbing and assimilating knowledge in networks and particular in networks with a geographical restriction (Audretsch, 1998; Autant-Bernard et al., 2013; Boschma, 2005). In this section, we first present the observed process of localised learning before detailing the influencing dimensions in terms of proximities.(Audretsch, 1998; Autant-Bernard et al., 2013; Boschma, 2005).

We recognized four phases for the process of localised learning:

1. Initiation of the Localization

One important trigger of localised learning is the need to acquire new knowledge to solve work problems. A new work context, new materials or new machines characterize the need for knowledge acquisition. Further, in cases where, new knowledge is available or employees become aware of new knowledge, the localization process is initiated. Examples are new guidelines, standards published, new products available, or new research results published. In both cases the person becoming aware of the new knowledge initiates a discussion in the personal network and the own organisation. A request to the management board of the network is initiated, if the application of new knowledge is vague and if possible, interdependencies are not evaluated. Either this is particularly the case if the new knowledge is considered as standardized knowledge or is subject of standardization or regulation initiatives. Here the backing from the network is considered crucial. An agent said [CO-N5-1] “If a new standard is released it is crucial to identify the relevant aspects. In most cases, only 10% of this long document are relevant for us. […] We need safety and reliability to avoid claims for compensation if we interpreted details of the new standard wrongly.” Another agent pointed out [HC-N4-1] “all the guidelines need to be interpreted and that’s why I’ve talked about mind lines, which is our interpretation of the guidelines and there’s a lot of work.” Further, a senior member of the network initiates a request if they found no suitable solution in the local network and they consider the usefulness and relevance for a potential solution for other network members high.

2. Evaluation and Problem Solving

After escalating the problem or the need for specifying the application of new knowledge, the issue is discussed in network meetings and forwarded to domain experts. One network member said [HC-N2-1]: “one member might volunteer to sit and read it and go through it with the GP, um, and then send it round and then you can decide whether to implement it or not.” Further, the evaluation of the issue in a larger group can also involve other sub-networks of the same network. Here, the chairperson of a regional network said [CO-N5-1]: “First I contacted the chairpersons of the other member networks and they discussed this in their local meetings. Then they reported their point of view and possible findings in the next meeting.” In one network, such local meetings are institutionalized as topic specific sub-groups with the local focus [CO-N1-5]: “local aspects are considered in the regional subgroups. […] where people talk about how things work in their organisations and how they have solved a specific problem […] that is very important because [legal bodies] have no idea how businesses are running.” Additionally, new solutions are investigated by contacting experts and via experimentation. One agent said [CO-N2-2] “the experimental construction in our workshops results in new solutions […] and the results from the experiments are prepared and adapted afterwards.” Another agent explained the involvement of external experts [CO-N1-2] “firstly we try to evaluate the issue internally, however in the extreme case we involve external experts […] in one case we had to contact the legal departments […], insurance companies […] and all different partners from the supply chain” and another agent points out [HC-N3-1] “trying to get, trying to involve people who we know have a different view. So you do get different views of things rather than just relying on the people who, you know, potentially always think the same.” The senior representatives of the roof network organisation want to answer the question raised by network members. Therefore, the roof organisation can spent resources to engage external expertise. One agent said [CO-N3-1]: “we have two domain experts. They can provide a solution within 36 hours […] Hence, the most important and most relevant [requests] are collected and prepared by the service provider.” We also found that evaluation and problem solving can be an iterative process, especially in the network where subgroups serve to evaluate the applicability of new knowledge and solve problems. Here, the results can also be escalated back to those who introduced a new work context, new materials or new machines and a new iteration of this phase starts again.

3. Formalization

The outcome of the prior phase needs to be consolidated and formalized so that it can be applied in the network. One agent explains [CO-N2-1] “the challenge is to aggregate the knowledge and to formalize the different insights in a way that we can distribute it in a formalized and quality proved way. This means that we have knowledge on a good level, which ensures that we avoid mistakes and which is checked and evaluated.” The roof organisation is responsible for the formalization of knowledge supported by internal as well as external domain experts. Frequently mentioned in this context are lawyers to evaluate the legal consequences. One lawyer said [CO-N1-2] “I always recommend one solution in an information letter and the balancing of yes or no is included.” Finally, network members need a clear recommendation to reduce their insecurities. Hence the final goal of the formalization process is a piece of formalized knowledge which is rigorously evaluated, for which the network takes the responsibility and which gives clear advices how the knowledge can be applied in a safe way.

4. Distribution

After formalizing the knowledge, it is adapted to the target groups. One agent said [CO-N3-1]: “We had a new wood protection standard last year. In this case, we had to adapt the details accordingly. […] we try to focus on the crucial aspects and we say pay attention to this and that aspect […] because you cannot prepare everything.” Finally, the knowledge is distributed via newsletters, info mails, presentations or also formal training sessions. One agent explains [CO-N1-2]: “new results which need to be distributed quickly are sent via e-mail newsletter and we have also a portal with all attachments […] the other important distribution channel are events.” Another agent explains [HC-N1-2] “Most of its built up with there’s an educational component so that we’d have experts talking or we have an educational session where we do presentations, discussion groups, etc.”


Take-home Messages
Summary of Work



Send ePoster Link