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This paper explores how multidisciplinary teams (MDTs) balance encoded knowledge, in the form of standardised outcome measurement, with tacit knowledge, in the form of intuitive judgement, clinical experience and expertise, in the process of clinical decision making. The paper is based on findings from a qualitative case study of a multidisciplinary in-patient neurorehabilitation team in one UK NHS trust who routinely collected standardised outcome measures. Data were collected using non-participant observation of 16 MDT meetings and semi-structured interviews with 11 practitioners representing different professional groups. Our analysis suggests that clinicians drew on tacit knowledge to supplement, adjust or dismiss 'the scores' in making judgements about a patients' likely progress in rehabilitation, their change (or lack of) during therapy and their need for support on discharge. In many cases, the scores accorded with clinicians' tacit knowledge of the patient, and were used to reinforce this opinion, rather than determine it. In other cases, the scores, in particular the Barthel Index, provided a partial picture of the patient and in these circumstances, clinicians employed tacit knowledge to fill in the gaps. In some cases, the scores and tacit knowledge diverged and clinicians preferred to rely on their clinical experience and intuition and adjusted or downplayed the accuracy of the scores. We conclude that there are limits to the advantages of quantifying and standardising assessments of health within routine clinical practice and that standardised outcome measures can support, rather than determine clinical judgement. Tacit knowledge is essential to produce and interpret this form of encoded knowledge and to balance its significance against other information about the patient in making decisions about patient care.

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There is now increasing evidence that the public has become much more aware of global warming, climate change and environmental risks. This has been repeatedly demonstrated in a number of official surveys and other research. However, the salience of these issues varies; for some social groups, there are other more significant problems and urgent priorities. It has also been found that while expressing strong beliefs about the negative consequences of global warming, or dependence on fossil fuels, or more positive approval of alternative and renewable energy sources, people do not seem to have translated those opinions into practical actions to limit their energy use in their domestic consumption, lifestyles, or travel patterns, for example. It is this apparent 'discrepancy' between stated beliefs (and values) and behaviour, which comprises the so-called 'value-action gap'. Various writers have observed this in different contexts previously, as will be discussed below. In this chapter, we examine the importance of the value-action gap in relation to hydrogen energy and the emerging hydrogen economy. Qualitative and quantitative data are presented from a series of focus groups and a telephone questionnaire survey of selected samples in seven different areas of England and Wales 1 . The chapter first gives a very brief outline of the nature of hydrogen energy and its potential uses as an innovative technology. Secondly, it reviews selected literature about public attitudes towards environmental and energy issues and the apparent valueaction gap. Findings from our recent research are then discussed. Finally, some general conclusions are offered to account for the ambivalence revealed in this case of hydrogen energy, and the disjunction between people's awareness of an energy crisis and their reluctance to change behaviour. Hydrogen energy and the 'hydrogen economy'With the rapid depletion of fossil fuels (coal, natural gas, oil), governments and energy corporations have been increasingly investing in research and development in alternative and sustainable (renewable) energy sources. The Stern