The importance of translating knowledge across occupational boundaries is frequently identified as a means of generating innovation and improving performance. The creation of the multidisciplinary team is an institutional response to enable such translation and synergy, yet few studies examine the processes of knowledge generation and translation in such teams. This article offers a case study that analyses these processes in decisions about the diagnosis and treatment of patients. Polanyi’s concept of tacit integration is used to reveal how meaning is developed and manifest in team decisions and to examine how the discursive resources embedded in tacit knowledge shape clinical practice. We highlight the foundations and dynamics that privilege the knowledge of some team members to be reconstituted as multidisciplinary group practice. Privileged knowledge then becomes embedded in the practices of the group. We conclude that the creation of a multidisciplinary structure may support rather than challenge existing power hierarchies.

Communities of practice (CoPs) have been identified as important sites of learning. Novices learn from masters whilst participating in situated practice and becoming more central members of the community. Empirical studies highlight the difficulty of learning across CoPs, although few studies specifically examine how learning develops in such a multidisciplinary context. We examine the processes of learning occurring when members of different CoPs, in this case various cancer specialists, are required to meet together as a formally constituted multidisciplinary team, and to establish multidisciplinary collaboration as a basis for decision making and action. Our paper highlights that while learning in CoPs develops through repetition, gaining legitimacy and achieving mastery, learning across CoPs in multidisciplinary contexts emphasizes key boundary processes to negotiate and broaden meaning. As such, multidisciplinary collaboration is not so much to learn from each others' talk, but to learn to talk in this new arena. We identify three practices which facilitate learning across CoPs: organizing discussions, acknowledging other perspectives and challenging assumptions. We also discuss the boundary processes which are promoted through brokers and the use of boundary objects in facilitating multidisciplinary work.

Leadership in public policy making is challenging. There is tension in gaining commitment from competing stakeholder groups, in sustaining public engagement in technically complex areas and securing broad-based support. Our paper illuminates these challenges through a case study of health policy development in the UK. We go beyond individual roles and leader-follower exchange relationships to develop the concept of distributed leadership using a sociomaterial approach to reveal how and why leadership is distributed across sociomaterial practices which together (re)configure policy coalitions and context. In so doing we also show how legitimacy and trust are sociomaterially enacted and shape leadership in public policy.