Institutional Health Voids, Learning Myopia, and Counter-Knowledge: Unveiling Blind Spots in Healthcare Decision-Making

This study explores how Institutional Health Voids (IHVs) contribute to the emergence of weak signals, which lead to the spread of counter-knowledge and the formation of blind spots among healthcare stakeholders. Focusing on the Spanish National Health System (SNHS), the research investigates how these voids, characterized by fragmented knowledge and misinformation, hinder effective decision-making and exacerbate crises. The study incorporates the concept of learning myopia, which explains the cognitive limitations in interpreting weak signals, thus reinforcing institutional inefficiencies. The findings suggest that IHVs create gaps in knowledge structures, causing delays in response times and misaligned policies, ultimately compromising the system's ability to adapt and respond effectively to health challenges. This study reveals that addressing these gaps requires the development of knowledge structures that not only improve transparency but also foster inter-organizational trust and promote adaptive decision-making processes. By linking the theoretical frameworks of institutional voids with knowledge management, the study offers a fresh perspective on the impact of weak signals, counter-knowledge, and blind spots within the healthcare system. The research contributes to the understanding of how these factors shape decision-making and governance in healthcare systems, providing valuable insights for policymakers aiming to improve healthcare management, particularly in times of crisis. This work underscores the importance of strengthening knowledge structures within healthcare systems to enhance resilience, trust, and long-term sustainability. We explicitly adopt a conceptual methodology based on systematic literature review and critical analysis to integrate theories, clarifying how institutional voids shape healthcare decision-making through weak signals and counter-knowledge.