This study is set against the backdrop of the evolving order of a health care system in a province implementing a set of concurrent reforms. The study investigates how 'knowledge work' of multi-disciplinary health care teams is actually done and how it is co-ordinated across sites. Knowledge work involves three processes: the creation of new knowledge during the transfer of knowledge, in the context of the application of knowledge to their collective clinical decision-making. Institutional ethnography is used to explore the social and institutional forces that shape the knowledge work of health care providers in and across multi-disciplinary teams by way of examining how the texts trans-locally organise the formation and functioning of multi-disciplinary teams. The study confirms that in the course of their collective clinical decision-making, teams' dialogical exchange facilitates the articulation of tacit knowledge and opens up the communicative space for the creation of new knowledge. In addition to this confirmatory finding, the study contributes to the existing health-related knowledge management by illustrating the importance of the social, communicative aspects of the knowledge processes, and in particular, the relationship between knowledge and the social organisation of power.