Acquiring experiential knowledge: how knowledge brokering practices support patient-centered innovation

Over the past decade, healthcare has embraced patient-centric models of care (Epstein and Street, 2011; Patrício et al., 2020), shifting from traditional clinician-centered, disease-focused approaches to engaging patients as informed, empowered partners in both care management and innovation (Bombard et al., 2018; McColl-Kennedy et al., 2017b). This paradigm recognizes that patients possess unique experiential knowledge gained from living with their conditions, complementing clinicians’ expertise (Castro et al., 2019; Prior, 2003). As a result, researchers and policymakers increasingly advocate involving patients as “experts by experience” (Jones and Pietilä, 2020, p. 810) in the co-design of healthcare services, digital solutions and policy frameworks (Mishra and Jain, 2025; Trischler et al., 2019), thereby enhancing their clinical effectiveness and sustainable adoption (Bird et al., 2021; Fusco et al., 2023). Within this evolving landscape, the pharmaceutical industry faces mounting regulatory and economic pressures to shift from a product-centric mindset toward a more holistic orientation (Malerba and Orsenigo, 2015). In response, firms are reconfiguring their offerings to deliver integrated products and services that address patient needs across the care continuum: from prevention to treatment to long-term well-being (Fleissig et al., 2025; Ruiz-Alba et al., 2018; Wenzel et al., 2014).

In pursuing patient-centricity, pharmaceutical companies must navigate a stringent regulatory framework governing patient engagement (Fleissig et al., 2025). In most countries, these regulations significantly restrict direct patient involvement outside of controlled clinical trials (Magistretti et al., 2021), limiting opportunities for meaningful interaction and collaboration (Pop et al., 2018). Given restrictions on direct engagement, pharmaceutical companies often lack firsthand understanding of patients’ daily challenges and needs. As a result, they must rely on compliant solutions like third-party-mediated patient advisory boards to integrate patient insights without breaching regulatory boundaries (Getz, 2019; Smeding et al., 2025). While this “highly contextualized and intimate personal knowledge that comes from individual end users is key to the creation of a usable healthcare innovation” (Bird et al., 2021, p. 10), it is difficult to codify. However, it is increasingly recognized as a crucial driver because it encompasses psychosocial, cultural and contextual dimensions beyond biomedical data (Dumez and L’Espérance, 2024; Le Chaffotec et al., 2026). In this sense, frontline personnel, such as medical science liaisons and sales representatives, play a critical role. Through their daily interactions with a wide range of healthcare professionals (HCPs), who themselves engage with numerous patients, they occupy a unique boundary-spanning position (Rapp et al., 2014; Theron et al., 2021). As knowledge brokers, these employees facilitate the circulation of tacit insights among disconnected actors in the healthcare ecosystem, enabling pharmaceutical companies to bridge critical knowledge gaps (Bonney et al., 2022; Rapp et al., 2014). Through brokering, they stimulate innovation by integrating dispersed information and connecting diverse perspectives, consistent with theories of social capital and network brokerage (Burt, 2004; Hargadon and Sutton, 1997; Obstfeld, 2005).

Although the literature on knowledge brokers is extensive, this empirical setting highlights an under-theorized dimension. Studies have primarily focused on brokers’ network positions and benefits of linking disconnected individuals, particularly regarding the access and translation of knowledge across organizational boundaries (Burt, 2004; Hargadon, 2002). While this perspective explains how brokerage fosters innovation by linking otherwise disconnected pools of expertise (Noviaristanti et al., 2023), most contributions focus on the brokerage of explicit, identifiable knowledge, overlooking contexts in which knowledge is tacit, sticky and socially embedded (Currie and White, 2012). Furthermore, the dominant unit of analysis has been the organizational level, with relatively limited attention to the micro-level processes through which individuals acquire and interpret external knowledge before brokering it in practice (Ter Wal et al., 2017). In our case, this gap is particularly evident. Sales force members interact with HCPs, who act as custodians of patients’ experiential knowledge (Le Chaffotec et al., 2026; Wall, 2018), making the brokerage process relational and practice-based. Against this backdrop, we investigate how pharmaceutical sales forces leverage their interactions with HCPs to broker patient knowledge, thereby enabling the design of patient-centered innovations. Specifically, we address the research question: How do knowledge brokers in pharmaceutical companies acquire experiential knowledge to foster patient-centered innovation?

We conducted an in-depth case study of a pharmaceutical company operating in Italy, a context marked by stringent regulatory constraints and complex healthcare dynamics (Bastone et al., 2023; Magistretti et al., 2021; Schiavone and Simoni, 2019). Using semi-structured interviews with sales representatives and managers, and secondary data such as internal reports and documents, we identify five distinct brokering practices that sales representatives use to acquire patient knowledge during face-to-face interactions with HCPs. Our findings indicate that knowledge brokering is a relational, practice-based and socially embedded process rather than merely a structural position within networks (Halevy et al., 2019; Kwon et al., 2020; Ritala et al., 2023). Brokers actively support HCPs in surfacing and articulating the experiential knowledge they hold. By conceptualizing this as mediated externalization, in which knowledge moves from embedded to surfaced to articulated across two relational spaces, the study advances knowledge creation theory (Nonaka and Takeuchi, 1995; Nonaka and Von Krogh, 2009), showing how tacit knowledge can be brokered when it is not codified or even consciously recognized by its holder, and reframing the broker’s role as a catalyst. In doing so, it also contributes to the patient-centered innovation literature, clarifying how firms that cannot engage patients directly can nonetheless access the experiential knowledge on which such innovation depends.

From a managerial perspective, the study suggests that pharmaceutical companies can repurpose their existing sales force into an infrastructure for acquiring patient knowledge, which requires dedicated training, aligned incentives and a culture that legitimizes brokering (Kislov et al., 2017).

This study investigates how pharmaceutical companies access patient knowledge, an experiential and relationally embedded form of knowledge, by leveraging their sales force as knowledge brokers. To frame this inquiry, we draw on two streams of literature: patient-centered innovation and knowledge brokering.

Historically, the pharmaceutical industry has been product-centered, with business models and market strategies organized around the development, production and distribution of drugs (Malerba and Orsenigo, 2015). Within this paradigm, HCPs were regarded as the primary customers and decision-makers, given their role in prescribing therapies. Patient needs and lived experiences were acknowledged, but rarely treated as direct inputs into innovation processes or organizational strategy (Fleissig et al., 2025). In recent years, however, patient-centered care has emerged as a foundational principle, emphasizing patient involvement in decision-making to ensure that healthcare systems are responsive to patients’ needs and preferences (Kim et al., 2022). This shift challenges traditional models that privilege medical expertise over patient perspectives, advocating instead for integrating clinical knowledge with patients’ lived experiences (Pomey et al., 2024). Such integration extends beyond identifying functional problems or practical needs. It also requires capturing the “inner voice” of patients, including their emotions, attitudes and perceptions, which shape both their experience of illness and interactions with HCPs (Kim et al., 2022). Accordingly, policymakers and scholars emphasize the importance of understanding patient experience, defined as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care” (Wolf et al., 2014, p. 10). Patient experience is now widely recognized as a valid indicator of healthcare quality and performance, and a lever for service improvement (Gallan et al., 2019). It reflects patients’ lived trajectories across the care continuum, encompassing interactions with providers, institutions and treatments (McColl-Kennedy et al., 2017a). Inherently contextual, patient experience is shaped by medical, interpersonal and subjective dimensions, including social, emotional, cognitive and sensory responses (Gallan et al., 2019; McColl-Kennedy et al., 2017a). Consistent with patient-centric principles, patients are regarded as “experts of their own experiences,” possessing forms of lay knowledge derived from everyday life (Prior, 2003).

Patient-centeredness also aligns with a broader view of innovation as a collaborative process grounded in the exchange of knowledge, information and experiences among multiple stakeholders (Cirella and Murphy, 2022). Innovation opportunities frequently arise from user input, as patients and caregivers possess unique insights into inefficiencies and shortcomings of existing products and services (Cannavale et al., 2022; Schiavone et al., 2020). Integrating these perspectives can enhance both the usability and the legitimacy of pharmaceutical innovations (Fleissig et al., 2025). Central to patient-centered innovation is experiential knowledge, defined as the “wisdom and know-how gained from a personal experience with a phenomenon such as a disease or disability” (Castro et al., 2019, p. 309). This knowledge is distinct from yet complementary to the codified, evidence-based knowledge held by clinicians. While clinical knowledge is explicit and transferable across cases, experiential knowledge is situated, subjective and embedded in personal illness narratives (Halloy et al., 2023). Consequently, patient-centered practices require mobilizing experiential knowledge across the care continuum to improve service design and delivery (Slomic et al., 2016). However, the tacit and embodied nature of this knowledge makes it both highly valuable and difficult to access (Dumez and L’Espérance, 2024). As Castro et al. (2019) illustrate through the cycling analogy, experiential knowledge is easy to enact but difficult to articulate. Thus, experiential knowledge could be described as a component of tacit knowledge (Le Chaffotec et al., 2026). The literature on tacit knowledge underscores the importance of making such knowledge explicit for organizations seeking to leverage it for innovation and continuous improvement (Nonaka and Takeuchi, 1995; Nonaka and Toyama, 2003).

Recently, Dumez and L’Espérance (2024) proposed a broader concept of patient knowledge integrating different perspectives on experiential knowledge. They emphasize that this knowledge stems not only from personal lived experience but also from interactions with the system (institutions and professionals) and the community (collective patient groups and advocacy organizations). This view shows that patient knowledge, while tacit and embedded throughout the patient journey (Gallan et al., 2019), is also relational and co-constructed through continuous engagement with healthcare systems and providers (Dumez and L’Espérance, 2024). Clinical encounters are thus key opportunities for experiential knowledge to surface and inform service improvement (McColl-Kennedy et al., 2017b), as they provide a socialization space (Nonaka and Takeuchi, 1995) in which such knowledge emerges, often unconsciously and unintentionally, through spontaneous expression of experiences, emotions and mental models (Le Chaffotec et al., 2026). Rich interactions that foster trust, empathy and shared understanding facilitate knowledge flow by encouraging openness and a willingness to share personal insights (Castellani et al., 2021), enabling HCPs to better absorb and interpret knowledge (Ferrer-Serrano et al., 2022; Reagans and McEvily, 2003). In this framework, HCPs are both knowledge givers and receivers, learning from patients’ narratives and perspectives (Pomey et al., 2024). This challenges traditional hierarchies of expertise and reframes the physician-patient relationship as a partnership in which knowledge circulates (Dumez and L’Espérance, 2024; Gallan et al., 2019) (Figure 1).

Salespeople are increasingly recognized as intermediaries between organizations and the market (Bonney et al., 2022; Rapp et al., 2014). Beyond selling products, they sense, interpret and transmit information that shapes strategy and drives innovation (Gonzalez and Claro, 2019). Through sales activities, they acquire and synthesize knowledge by engaging customers in information exchange (Bonney et al., 2022; Kuester et al., 2017). In this capacity, they act as knowledge brokers, identifying both expressed and latent needs and translating them into actionable intelligence that is shared with internal functions such as product development, marketing and strategy (Bonney et al., 2022; Gonzalez and Claro, 2019; Haas, 2015; Kuester et al., 2017). This knowledge-brokering role has become increasingly important as firms operate in dynamic environments where customer-centric innovation is a key differentiator. The concept of the broker is well-established in the management and social network literature, traditionally associated with a structural position in a network (Halevy et al., 2019; Kwon et al., 2020; Soda et al., 2018). Brokers span “structural holes” – gaps between otherwise disconnected actors – creating opportunities for new connections, information flows and recombination (Burt, 2004; Hargadon and Sutton, 1997). Leveraging their position, brokers facilitate the exchange of knowledge between producers and users, enabling the diffusion of ideas and innovations (Castro, 2015; Haas, 2015). Importantly, brokers are not passive conduits; they interpret, reframe and recombine knowledge for their audiences (Hargadon, 2002; Hargadon and Sutton, 1997; Howells, 2006). Spithoven et al. (2011) describe brokers as “knowledge intelligence units” that monitor the environment through labor-intensive search processes. Ter Wal et al. (2017) highlight proactive environmental scanning to support the firm’s absorptive capacity – its ability to recognize, assimilate and exploit external knowledge (Colombo et al., 2015; Tortoriello, 2015; Tortoriello et al., 2012). However, much of the literature focuses on the brokerage of explicit, codified knowledge, such as technical information or best practices (Currie and White, 2012), while overlooking the role of brokers in capturing tacit knowledge, which is experiential, context-dependent and difficult to formalize (Nonaka, 1994; Nonaka et al., 2006). Tacit knowledge cannot be transferred through documents; it requires interaction, interpretation and trust-based relationships to be externalized and shared (Castellani et al., 2021; Thomas and Gupta, 2021). Consequently, our understanding of brokerage in contexts where knowledge is socially constructed and deeply situated, such as clinical practice, remains limited.

Recent scholarship has also questioned purely structural accounts of brokerage. While a bridging position can create opportunities, a structural position alone does not guarantee brokering (Kwon et al., 2020; Quintane and Carnabuci, 2016). Brokerage depends on individuals’ behaviors and motivations and on the relational context in which they operate (Halevy et al., 2019; Kwon et al., 2020). This has prompted a shift from viewing brokerage as a static position to viewing it as a dynamic, relational and practice-based process (Halevy et al., 2019; Kwon et al., 2020; Ritala et al., 2023). From this perspective, brokering involves actively managing relationships, exercising social influence and engaging in situated practices that allow knowledge to be exchanged, reframed and integrated (Castro, 2015). Recognizing brokerage as relational provides insights into mobilizing tacit knowledge (Currie and White, 2012), as the strength and quality of relationships significantly impact its sharing (Phelps et al., 2012; Reagans and McEvily, 2003). Brokers who cultivate trust-based, collaborative partnerships are more effective at eliciting and transmitting tacit knowledge because mutual trust fosters openness and reciprocity (Holste and Fields, 2010).

This relational perspective is particularly significant in healthcare contexts, where much valuable knowledge is experiential and deeply embedded in patients’ lived experiences. Through repeated clinical encounters, HCPs accumulate rich insights into patients’ conditions as experiential knowledge emerges in conversations about symptoms, treatment responses, coping strategies and everyday challenges. HCPs act as key gatekeepers and interpreters of patient voices, translating personal and tacit experiences into clinically meaningful understandings (Dumez and L’Espérance, 2024; Le Chaffotec et al., 2026). For pharmaceutical companies, where direct access to patients is tightly circumscribed by regulatory frameworks, this elevates the role of HCPs as central intermediaries in acquiring patient knowledge (Wall, 2018). Within this intermediary space, the pharmaceutical sales force occupies a strategic position due to its ongoing and repeated interactions with HCPs. Although these interactions have traditionally been conceptualized as promotional and oriented toward influencing prescribing decisions, they can be reinterpreted through a knowledge-brokering lens. From this perspective, sales representatives are not merely information transmitters but relational brokers who leverage trust-based relationships with HCPs to surface, interpret and relay patient experiential knowledge across organizational boundaries (Fickweiler et al., 2017).

Schiavone and Simoni (2019) emphasize the strategic importance of channel managers and sales representatives in shaping and maintaining relationships throughout the healthcare system. By operating at the interface between pharmaceutical firms and institutional actors, these professionals serve as boundary spanners, enabling coordination and relational continuity. Nevertheless, prior research has largely focused on their involvement in regulatory compliance and market access interactions with healthcare authorities and providers. Little scholarly attention has been devoted to their capacity to connect pharmaceutical companies with patients. In settings where direct interaction with patients is constrained, sales forces may play an intermediary role by indirectly accessing, interpreting and relaying patient-related knowledge through their ongoing engagement with HCPs. Despite growing attention to practice-based perspectives on knowledge brokering, few studies have examined how individuals carry out brokering activities in daily work (Ter Wal et al., 2017; Ritala et al., 2023). This paper addresses this gap by examining how pharmaceutical sales forces engage HCPs in brokering practices that enable patient knowledge to surface and inform patient-centered innovation.

To address our research question, we adopted a qualitative exploratory case-study approach, identified as the most suitable method for investigating the tacit and situated nature of the phenomenon (Yin, 2009), in line with methodological guidance for practice-based studies (Nicolini, 2011). The unit of analysis is the set of everyday practices used by pharmaceutical employees to identify and access patient knowledge during fieldwork across Italy. We selected this as an extreme case (Siggelkow, 2007; Yin, 2009) because it exemplifies an atypical organizational setting resulting from a profound transformation of the sales force role. This transformation is a distinctive attribute of the case company and aligns with our research objectives (Gaya and Smith, 2016), justifying a single-case study design (Siggelkow, 2007). The case enabled us to gain deeper insight into the phenomenon under investigation, albeit with limited generalizability (Donmoyer, 2000).

Our research was conducted within the Italian division of a multinational pharmaceutical company. In 2018, the company faced a significant challenge when patents of three blockbuster drugs generating nearly 70% of its revenue expired. Simultaneously, the pharmaceutical market became turbulent due to intensified competition, shorter innovation cycles, drug obsolescence and a growing number of informed patients.

Recognizing the limitations of its product-centric model, the company began transforming its business by diversifying its portfolio and redesigning its organization around a patient-centric approach. This involved rethinking the structures, processes and culture across three dimensions: enhancing information gathering and decision-making; adopting a structure that combines technical expertise with disease-area specialization; and fostering a participative culture. This led to the creation of a dedicated business unit within the sales function, tasked with institutionalizing the patient-centric approach and enabling direct, insight-driven interactions with external stakeholders.

In 2020, the company began implementing its new organizational model, starting with repurposing its sales force and redefining representatives’ responsibilities, daily activities and required skills. Traditionally, representatives met physicians in person to discuss research and educational materials as part of their sales tactics (Fickweiler et al., 2017). Over time, these interactions often evolved into relationships of trust and connection, strengthening the ties between HCPs and representatives (Salmasi et al., 2016). Recognizing the value of these relationships, the transformation aimed to reposition the sales force as a knowledge-gathering function generating insights that would inform strategic decisions. Rather than merely providing information, representatives were expected to identify patients’ needs and pain points by engaging with the HCPs involved in their care.

Theoretically, this case offers a unique opportunity to examine how brokers surface and access tacit knowledge in practice. Post-transformation, the company’s portfolio spans multiple disease areas. We focused on the neuroscience division, identified by leadership as the most advanced in transformation. In addition, its pathway involves fewer clinical stakeholders, thereby minimizing contextual variability and providing an ideal setting to observe the phenomenon under study.

We collected data from March to October 2023 through two rounds of interviews and archival documents to support triangulation (Eisenhardt, 1989; Yin, 2009). Table 1 summarizes the collected data and their use in the analysis.

We conducted 12 semi-structured interviews by purposive sampling (Patton, 2014). We began with three interviews with a manager from the new business unit to understand the company’s transformation objectives and the approach to changing the sales force role, including modifications to daily activities, mindset and performance KPIs. Building on these preliminary insights, and in collaboration with the neuroscience manager, we selected eight sales force members for a second round of interviews. The selection ensured a heterogeneous sample to strengthen robustness. The final sample balanced geographic coverage and experience in organizational change (see Table 2). This heterogeneity allowed us to identify inconsistencies and recognize common patterns, reconstructing situated practices that recur across different histories and field conditions, avoiding overvaluing context- or individual-specific behaviors.

Given the geographical distribution of informants, interviews were conducted via video call and lasted between 45 and 70 min. We adopted a conversational approach, encouraging respondents to freely elaborate on their experiences. To capture everyday practices, we designed the interview protocol following Halkier and Jensen’s (2011) methodological guidelines, incorporating descriptive, structural and contrast questions to elicit narratives about their socially embedded experiences. Descriptive questions encouraged participants to retell specific episodes rather than idealized cases (e.g. “Think about your recent interactions. When did you identify a powerful insight? What occurred then? How did you recognize it? What made you say it was valuable?”). Structural questions explored how participants organize their experiences and knowledge (e.g. “What makes you say you have found valuable information?” or “Can you give me a definition of what insight means to you?”). Contrast questions prompted participants to compare and differentiate concepts (e.g. “When interacting with different stakeholders, what are the differences or similarities between them? Do you approach them all in the same way?”). By prompting participants to recall recent memories and contextual details, we aimed to reduce abstraction in responses, thereby mitigating recall bias (Small and Cook, 2023).

The manager of the new business unit provided access to an extensive archival data set, including training materials used to develop the sales force’s capabilities, and internal reports, presentation documents and executive summaries used to communicate organizational change and the new role of the sales force to other company functions. These archival materials were instrumental in triangulating the company’s expectations and the participants’ real-life activities, complementing and reinforcing emerging concepts from interviews.

The interviews were recorded and transcribed verbatim to ensure accuracy and preserve the richness of the data. We used an inductive analysis approach (Corbin and Strauss, 1998) and an iterative coding process (Saldaña, 2013) to reach consensus through multiple rounds of categorization. Table 3 summarizes the analysis process.

As an initial step, we examined first-round interviews with the manager alongside internal documents to understand the governance of the knowledge acquisition process and identify the primary stages at which insights were expected to emerge during meetings with HCPs (see Table 4). This also familiarized us with recurring organizational terminology, clarifying meanings within the company. Because brokering practices are embedded in organizational routines and culture, this initial understanding of both process and terminology was crucial to developing the subsequent interview phase.

Subsequently, we coded all second-round interview transcripts phrase by phrase using open and in vivo coding (Charmaz, 2014; Corbin and Strauss, 1998) to capture participants’ own descriptions of their actions. We assigned provisional labels to text segments using expressions that closely mirrored the informants’ wording, particularly when referring to interaction dynamics and methods for engaging HCPs. Through iterative comparisons of interviews and training materials, we combined these preliminary codes into first-order codes (Gioia et al., 2013) representing brokers’ daily activities.

Finally, we moved from descriptive coding of brokers’ activities to identifying brokering practices. We reviewed how different activities recurred across the data as recognizable patterns of action, with particular attention to how these activities were enacted during interactions with HCPs and how, collectively, they achieved a recognizable objective within the knowledge brokering process. Through iterative comparison and discussion, we clustered these first-order codes into second-order themes (Gioia et al., 2013) reflecting brokering practices and aggregated them into two dimensions that capture the practice’s teleological orientation (Cirella and Murphy, 2022). This facilitated the development of a theoretical framework representing how brokers externalize patients’ experiential knowledge from HCPs. Figure 2 presents the final data structure.

The findings reveal that the pharmaceutical sales force adopts five brokering practices when interacting with HCPs to acquire experiential knowledge, organized around two primary objectives: grasping subtle cues and capturing transformative insights. Engaging in trust-based dialogue, foregrounding the patient perspective and eliciting the unspoken enable brokers to detect cues as they emerge during interactions. By probing the opportunity and drafting a reflective synthesis, brokers assist HCPs in articulating meaningful insights, formalizing them and generating valuable knowledge to inform patient-centered innovation. The two objectives follow a sequential logic: cue recognition precedes and triggers the inquiry process that converts it into actionable knowledge. Together, these two objectives structure a process through which experiential knowledge progressively shifts from a state embedded in the HCP to an articulated form codified by the broker. However, the overall process is iterative rather than confined to a single encounter. Practices associated with the same objectives frequently overlap and iterate within and across meetings. Similarly, the transition from cue recognition to in-depth inquiry may unfold across successive interactions, as brokers revisit emerging themes over time.

The following sections detail the practices associated with each objective.

The practices related to this objective involve engaging HCPs and creating the conditions that allow valuable information exchange with the knowledge broker and the HCP. To achieve this, the broker engages in three specific practices.

The first is engaging in trust-based dialogue (Table 5). This involves initiating conversations by leveraging long-standing professional relationships built through recurring meetings. Brokers typically begin discussions with HCPs by introducing relevant data and clinical evidence using scientific materials tailored to the specific field and context. Starting with scientific evidence establishes a neutral entry point that does not require immediate personal engagement from HCPs, setting the stage for further interaction. Through regular scientific and professional exchanges over time, brokers cultivate a relationship in which their role evolves from sales representative to a point of reference, a partner, a consultant, a trusted figure. This trusting relationship, built on mutual respect and understanding, is essential for the information-gathering process, encouraging HCPs to openly discuss day-to-day issues:

The quality of the interaction depends on the setting in which it occurs. Usually, interactions take place in person, by appointment, during one-on-one meetings, which foster a more open dynamic. Unexpected circumstances, such as an unplanned meeting or the presence of a third party, can alter the tone, and HCPs tend to be more guarded in sharing their perspectives:

For this reason, the broker must be flexible and able to adapt their approach to the specific situation.

Once the dialogue begins and the HCP opens up, the broker gradually steers the conversation toward the patient, creating opportunities for information to emerge. To accomplish this, the broker foregrounds the patient perspective, while also considering the HCP’s perspective (Table 6). In the new corporate culture, brokers recognize the importance of delivering optimal patient care and understand their role in achieving this goal. This mindset shapes how they interact with HCPs daily, viewing themselves as supporters in the shift toward patient-centricity:

Recognizing patient well-being as the ultimate goal helps the broker redirect the conversation from purely scientific information toward the patient’s lived experience. Due to heavy workloads, clinicians often focus on reviewing data and test results, leaving little time to explore patients’ daily lives. As a result, conversations tend to concentrate on monitoring treatment and identifying potential challenges in clinical management. By asking questions about patient progress and concrete care situations, the broker invites the clinician to reflect on the person behind the disease and establish the context for exploring patient needs:

As the broker engages with a wide range of professionals throughout the care pathway, they draw on prior knowledge of each interlocutor to tailor interactions and gather multiple complementary perspectives on the patient journey. Nurses are an important example, as their proximity to patients in operational care management, in a more informal setting than consultation, gives them access to situated forms of patient knowledge that may never reach the clinician:

Finally, brokers engage in eliciting the unspoken (Table 7). This practice facilitates the emergence of small pieces of information during the conversation, cues that guide HCPs in identifying elements related to patient experience. Crucially, brokers do not direct the discussion but accompany the clinician, positioning themselves as walking alongside the HCP to support reflection. Rather than extracting knowledge, the broker uses subtle prompts to stimulate curiosity, allowing insights to emerge naturally from the HCP’s own reflection:

This strategic approach requires the broker to listen attentively and actively. To accomplish this, they enable the HCP to communicate openly by avoiding interruptions, suspending judgment and setting aside personal assumptions or organizational expectations. One interviewee described this as adopting a tabula rasa mindset, emphasizing that the broker’s mind should be clear and ready to capture signals as the conversation unfolds. At a certain point, the broker identifies a potentially valuable element, often signaling a problem or unmet need, which serves as a cue to guide further inquiry. It represents a turning point, described as the moment a lightbulb turns on:

Recognizing such cues requires the ability to notice and interpret emerging signals. It is a cognitive process that occurs in real time during the interaction, emerging from the interplay among active listening, suspension of judgment and accumulated experience gained through repeated interactions with diverse HCPs.

Once a cue is recognized, the broker initiates the process of exploring it to externalize it into explicit knowledge.

The practices supporting this objective focus on exploring cues to expand the knowledge potential and articulate it. The broker recognizes that an initial cue rarely tells the whole story; it serves as a starting point for deeper inquiry. By systematically probing these emerging cues, the broker aims to reconstruct a complete picture – either confirming their initial intuition and making the knowledge explicit, or determining that the line of inquiry has reached a dead end:

To accomplish this, the broker engages in two specific practices.

The most critical at this stage is probing the opportunity (Table 8). The broker asks open-ended questions and conducts an in-depth inquiry using multiple question types: descriptive questions to understand the situation and broader context, and probing questions to confirm, clarify and refine their interpretation. This allows the broker to develop a nuanced understanding while staying aligned with the interlocutor. Crucially, the broker treats this process as a means of supporting the HCP’s own knowledge elaboration:

This inquiry process is essential for assessing whether emerging knowledge has transformative potential – the capacity to inform or initiate projects within the company. Each year, the company defines specific focus areas aligned with strategic objectives, providing brokers with a lens to evaluate the relevance of what emerges in interactions. To be recognized as valuable, cues should represent what one interviewee defined as first mover:

Within this framework, the broker asks questions to explore opportunities arising from emerging knowledge, keeping patient needs at the center while assessing feasibility and alignment with organizational strategy.

Once the meeting concludes and the broker has gathered valuable insights, the next step is to formalize the knowledge obtained. This final externalization is captured in the practice of drafting a reflective synthesis (Table 9). The aim is to record the interaction in writing to ensure that the richness of the information is preserved over time. During the interaction, brokers refrain from taking notes to preserve the flow and relational dynamics of the conversation. Live note-taking would shift the HCP’s perception from friendly conversation to formal interview, potentially compromising the openness and trust on which these practices depend. Thus, after the encounter, the broker documents the knowledge, typically through notes and memos, to capture the interaction dynamics, nonverbal cues and their own perceptions and interpretations:

Although avoiding bias is essential during information gathering, the broker’s perceptions become critical at this stage in constructing a complete understanding of the collected information. This includes incorporating contextual elements – subtle details and situational factors – that only the broker can recognize. Note-taking is therefore a reflective process, extending beyond mere transcription. The broker engages in iterative revision and refinement, progressively clarifying and condensing the record until it conveys the gathered knowledge to a potential external reader:

This ensures the information is clearly articulated and ready to be shared with stakeholders, enabling it to be understood and effectively applied.

The case analysis illustrates how pharmaceutical companies acquire patient experiential knowledge when direct patient engagement is unavailable. Prior research has examined salespeople as knowledge brokers (Bonney et al., 2022; Rapp et al., 2014), but it has overlooked how they acquire patients’ experiential knowledge to foster patient-centered innovation. Our study addresses this gap by analyzing brokerage as a relational, practice-based process (Halevy et al., 2019; Kwon et al., 2020; Ritala et al., 2023), thus identifying five brokering practices, organized around two objectives. Through these practices, brokers support the surfacing and articulation of knowledge that would otherwise remain latent (Figure 3).

Experiential knowledge, tacit and sticky (Dumez and L’Espérance, 2024; Halloy et al., 2023), emerges during the clinical encounter, a socialization space (Nonaka and Takeuchi, 1995). However, socialization is a tacit-to-tacit knowledge-sharing process (Nonaka and Takeuchi, 1995), in which HCPs may absorb knowledge unconsciously (Ferrer-Serrano et al., 2022; Le Chaffotec et al., 2026). Patient experiential knowledge remains embedded within the clinical relationship and cannot be acquired for innovation. Our findings reveal that a second space is required to move this knowledge toward explicit form. We conceptualize it as the professional encounter between the broker and the HCP, which functions as an externalization space (Nonaka and Takeuchi, 1995). Within this space, experiential knowledge emerges through a dialogic, situated process that occurs in the dyadic relationship between the broker and the HCPs (Castellani et al., 2021). Thus, the HCP, uniquely positioned between two spaces (Pomey et al., 2024), represents a link in the chain, a knowledge mediator. Those findings show that, in particular cases, the externalization of experiential knowledge is not accomplished by a directly connected actor but requires sequential mediation across actors and encounters, advancing our understanding of knowledge creation theory (Nonaka and Takeuchi, 1995; Nonaka and Von Krogh, 2009).

Notably, our findings show that patients’ experiential knowledge moves through three stages along the externalization process. This sequence reveals what distinguishes brokering tacit, unrecognized knowledge from the brokerage described in prior work. In established literature, the broker mediates knowledge that already exists in explicit, retrievable form from one actor to another (Hargadon, 2002; Hargadon and Sutton, 1997). Here, knowledge enters the externalization space as embedded in the HCP; there is therefore nothing for the broker to retrieve and transfer. It is through brokering practices that this embedded knowledge begins to emerge, leading the HCP to seek words, concepts and phrases to communicate their knowledge, thereby transitioning it to a surfaced state in which knowledge moves toward expression but is not yet entirely explicit (Nonaka, 1994; Nonaka et al., 2006). Only when the broker documents it does the knowledge become articulated and available to others. In other words, the broker does not transfer existing knowledge across a gap; rather, through its practices, it facilitates the emergence of knowledge where it did not yet exist in expressible form. This departs from the structural view of brokerage (Burt, 2004; Obstfeld, 2005), as, in the case of experiential knowledge, the broker’s contribution resides not in the position but in the practices.

The proper enactment of those practices is influenced by factors such as professional legitimacy, mutual recognition and trust (Currie and White, 2012; Halevy et al., 2019). These conditions enable the broker to function as a catalyst, enabling the emergence of knowledge. This extends the relational, practice-based view of brokerage (Halevy et al., 2019; Kwon et al., 2020; Ritala et al., 2023), recognizing that relational quality not only enables the mobilization of tacit knowledge among actors (Currie and White, 2012) but also represents the very condition for that knowledge to emerge in the first place.

Those findings have direct implications for patient-centered innovation. Where regulation restricts direct patient involvement (Magistretti et al., 2021), firms can still pursue innovation leveraging clinical and biomedical data, but they miss the experiential dimensions that give patient-centered innovation both usability and public legitimacy (Fleissig et al., 2025). By enabling embedded experiential knowledge to surface and be articulated, the broker resolves this constraint. It shifts the firm’s innovation ground, from product-centered information toward the patient’s own experiential knowledge. In this sense, the sales force serves as a channel through which the patient’s voice can reach pharmaceutical companies in a form organizations can act on, which is a precondition for patient-centered innovation (Fleissig et al., 2025).

Through an in-depth case study of a pharmaceutical sales force in Italy, the research provides two contributions to the literature on knowledge brokering and patient-centered innovation.

First, the study contributes to the patient-centered innovation literature (Fleissig et al., 2025; Trischler et al., 2019) by demonstrating how patient experiential knowledge can be made accessible to companies that cannot directly engage with patients, thereby providing a basis for innovation grounded in patients’ voice even when direct access is precluded. As this occurs through a mediated process that moves experiential knowledge from embedded to surfaced to articulated across two relational spaces, it also advances understanding of knowledge creation theory (Nonaka and Takeuchi, 1995; Nonaka and Von Krogh, 2009).

Second, the study identifies five brokering practices that brokers enact to enable this knowledge transformation, contributing to scholarly work advocating a practice-based understanding of brokerage (Halevy et al., 2019; Kwon et al., 2020; Ritala et al., 2023). It shows that brokering tacit, unrecognized experiential knowledge leverages relational quality as a condition for knowledge to emerge, and that the value of the broker lies in its role as a catalyst rather than in its network position (Burt, 2004; Obstfeld, 2005).

From a managerial perspective, pharmaceutical companies can leverage their sales force as a strategic infrastructure through which patients’ experiential knowledge reaches the organization, recognizing the trusted, long-standing relationships between sales representatives and HCPs as a valuable asset. By cultivating this capacity and redirecting its focus, companies can seize an underexplored opportunity. Realizing it, however, requires treating brokering as an organizational capability. In doing so, firms should build the capability to broker by developing the five practices we identify. As those practices represent concrete behaviors, they can be taught, shared and supported, thereby making brokering part of organizational know-how. In addition, firms should align their evaluation systems accordingly: this entails extending performance criteria beyond commercial targets to include the quality of the patient knowledge representatives surface and document. This approach enables firms to implement brokerage systematically and legitimizes brokering as a recognized organizational activity (Kislov et al., 2017). However, our findings suggest a risk that companies must actively govern. Because brokering is shaped by a firm’s strategic priorities – which guide how brokers recognize, evaluate and discard knowledge – there is a risk that the patient’s voice may be filtered according to commercial interests rather than genuine patient needs. This could lead brokering to become a selective extraction of organizationally convenient insights, to pursue unethical behaviors, and to undermine its patient-centered purpose. Organizations must consider the ethical implications of prioritizing certain knowledge over others by implementing incentives, evaluation metrics and internal policies that foster a bidirectional relationship between brokering and strategy. While strategic priorities legitimately orient the broker’s attention, the patient knowledge that emerges should in turn inform and shape those priorities. Without such safeguards, brokering risks reinforcing existing strategies, limiting the identification of emerging patient needs, and ultimately reducing both societal value creation and future innovation opportunities.

As with all studies, ours has limitations that open avenues for future research. Methodologically, we relied on a single case study that exemplifies distinctive organizational features (Gaya and Smith, 2016; Siggelkow, 2007). This case represents an atypical setting, and similar configurations may be rare, making replication through multiple-case designs challenging. Moreover, our focus on a single organizational unit (identified as the most mature site of transformation) limits our ability to assess how brokering practices vary across units or phases of the transformation process. Future research could therefore examine multiple domains through comparative case studies to enhance the generalizability of our findings. Finally, although the analysis centers on practices involving the sales force and HCPs, our data derive primarily from broker interviews and secondary sources rather than direct observation. This choice preserved trust and authenticity in interactions, while potentially introducing bias and reducing external validity. Nonetheless, we hope our findings inspire further research to test and extend these insights across diverse organizational and regulatory contexts.

This research is part of the HumanTech Project, which is supported by the Italian Ministry of University and Research (MUR) for the 2023–2027 period as part of the ministerial initiative “Departments of Excellence” (L. 232/2016).

Chiara Esposito is based at School of Management, Politecnico di Milano, Milan, Italy.

Claudio Dell’Era is based at School of Management, Politecnico di Milano, Milan, Italy.