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MANAGING KNOWLEDGE FOR INNOVATION 209

They also highlight four additional features, introduced in Chapter 1, that we
should consider when managing knowledge for innovation – the nested nature
of practices; the stickiness of knowledge; the materiality of innovation and invest-
ment of practices.
Nested practices

As noted in Chapter 1, core to practice-based thinking is the idea that prac-
tices (including innovation practices) unfold within a broader ‘field’ of intercon-
nected practices (Schatzki et al., 2001). Importantly, micro-level practices (e.g.
work practices) help create this broader field of practices (e.g. professional prac-
tices) and, at the same time, are influenced by them. This is what we mean when
we say that practices of innovation are ‘nested’ – change at one level of practice
is both a medium for and an outcome of change at another level of practice.
Take, as in the Medico case, the practice of an individual consultant urologist
deciding on surgery as the treatment for a prostate cancer patient. In practice
terms, this decision (if repeated often) can be understood, both as helping to
form, or create, the professional practices of urologists (i.e. surgery becomes
an integral part of what these professionals do) and also as being influenced by
professional practices (i.e. their professional practices and standards reinforce
surgery as the most legitimate decision to take when treating prostate cancer).
The practice of doing surgery, therefore, occurs within, but also creates, the
broader field of consultant urology.
This view allows us to see why it is that the introduction of what seemed to
be a much better treatment for many patients was so contentious. In particular,
the new brachytherapy treatment moved the practice of deciding treatment for
patients away from consultant urologists and towards radiotherapists. Hence it
threatened to violate a whole system of well-established and collectively agreed
upon practices around medical roles and responsibilities. It was not until the ‘field
of practice’ shifted a little – when new professional standards were triggered by
individual practices in attending a weekend event – that the new brachytherapy
treatment could gather momentum. This helps us to explain a central puzzle in
innovation, noted at the start of this chapter, which is why some apparently suc-
cessful innovations fail to be used while others continue to be used, despite their
success being highly questionable. Consider this explanation, also, in relation to
the failure to diffuse the new cataracts treatment in the Midlands Hospital case
(Chapter 8).

Stickiness of knowledge

By zooming in on actual practices ‘on the ground’, so to speak, practice perspec-
tives also shed light on the micro-challenges of managing knowledge for innova-
tion (Nicolini, 2008). These arise from the ‘stickiness’ of knowledge to practice.
As you will be able to see, if you have a chance to do the role-play at the end of
this chapter, organizations exist precisely so that the work practices (and effort)
can be distributed across individuals and groups. This means, quite naturally,

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