Cryptic Knowledge in Healthcare: A Case Study of Cultural Silence and Strategic Concealment in Georgian Clinical Practice
Keywords:
cryptic knowledge, healthcare systems, organizational silence, knowledge management, psychological safety, fear-based communication, trust networks, medical error reporting, cultural hierarchyAbstract
In many healthcare systems rooted in traditional, hierarchical cultures, knowledge does not always flow through formal policies or training manuals. Instead, it is filtered through trust, concealed in silence, or buried in unwritten rules. This paper introduces and explores the concept of cryptic knowledge—information that is known but intentionally concealed or selectively shared due to fear, loyalty, or institutional constraints. Using a case study of a state-affiliated (public) hospital in Georgia, the study investigates how medical professionals manage knowledge not just procedurally, but politically and emotionally. Drawing on 18 in-depth interviews conducted in Georgian and English, and supported by a human-centered thematic analysis, the research reveals a system where formal knowledge protocols coexist with underground knowledge networks built on trust, survival, and cultural codes. The findings uncover how silence is often strategic, how loyalty is weighed against truth, and how error reporting is reframed as risk—not reform. The paper proposes a hospital-specific Cryptic Knowledge Network Model, offering a new framework to visualize and understand how knowledge is filtered in emotionally unsafe or culturally rigid medical institutions. The study concludes with practical, interdisciplinary recommendations—spanning human resources, knowledge management, strategic governance, and AI-supported transparency tools—aimed at improving knowledge equity in post-Soviet healthcare environments. Far from theoretical, this study positions cryptic knowledge as one of the most overlooked realities of hospital life—and one of the most urgent to confront.
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