Knowledge sharing and health-care coordination: the role of creation and use brokers

This paper arises from research that examined a health-care coordination improvement initiative that was focused on increasing knowledge sharing among a network of health-care workers involved in the care of children with complex medical needs. Part of this initiative involved a summary medical note (the Single Point of Care (SPOC)) that was paper-based and carried by parents between the specialists involved in their child’s care. The SPOC’s effectiveness is discussed through a knowledge-as-practice perspective, which focuses on the role of mediators (both material and human). Our analysis demonstrates that the SPOC’s effectiveness can be understood by looking at the combined roles of boundary objects and human brokers. We identify two distinct broker roles: creation brokers and use brokers. In discussing our case, we extend our analysis to suggest how these broker roles may also be useful in thinking about how to improve the effectiveness of (electronic) health record systems more generally – for researchers as well as for practitioners