Conceptual and practical challenges for implementing the communities of practice model on a national scale - a Canadian cancer control initiative

Abstract

BackgroundCancer program delivery, like the rest of health care in Canada, faces two ongoing challenges: to coordinate a pan-Canadian approach across complex provincial jurisdictions, and to facilitate the rapid translation of knowledge into clinical practice. Communities of practice, or CoPs, which have been described by Etienne Wenger as a collaborative learning platform, represent a promising solution to these challenges because they rely on bottom-up rather than top-down social structures for integrating knowledge and practice across regions and agencies. The communities of practice model has been realized in the corporate (e.g., Royal Dutch Shell, Xerox, IBM, etc) and development (e.g., World Bank) sectors, but its application to health care is relatively new. The Canadian Partnership Against Cancer (CPAC) is exploring the potential of Wenger's concept in the Canadian health care context. This paper provides an in-depth analysis of Wenger's concept with a focus on its applicability to the health care sector.DiscussionEmpirical studies and social science theory are used to examine the utility of Wenger's concept. Its value lies in emphasizing learning from peers and through practice in settings where innovation is valued. Yet the communities of practice concept lacks conceptual clarity because Wenger defines it so broadly and sidelines issues of decision making within CoPs. We consider the implications of his broad definition to establishing an informed nomenclature around this specific type of collaborative group. The CoP Project under CPAC and communities of practice in Canadian health care are discussed.SummaryThe use of communities of practice in Canadian health care has been shown in some instances to facilitate quality improvements, encourage buy in among participants, and generate high levels of satisfaction with clinical leadership and knowledge translation among participating physicians. Despite these individual success stories, more information is required on how group decisions are made and applied to the practice world in order to leverage the potential of Wenger's concept more fully, and advance the science of knowledge translation within an accountability framework.

Piloting a Regional Collaborative in Cancer Surgery Using a “Community of Practice” Model

“…What appears to be advantageous within the model is the moderate size of the collaborative in which the comparative evaluation is done and through which transfer of best practices flows easily, unlike the flow in other collaborative models implemented on a state-wide, provincial, or national scale 19 . Although each of those models has been used successfully, most are linear, centralized, labour-intensive, and unable to bridge professional and organizational silos 20 .…”

“…A lack of clear structure in which to work is an important limitation 19 . The development of our regional collaboration in cancer surgery is a "proof of concept" that shows the feasibility and usefulness of the cop approach in supporting large-scale improvement interventions.…”

Communities of Practice as a Professional and Organizational Development Strategy in Local Public Health Organizations in Quebec, Canada: An Evaluation Model

“…A number of authors, noting the often limited effectiveness of traditional strategies to foster improved professional practice in health (Grimshaw et al 2001;Grol and Grimshaw 2003), have highlighted the potential of CoPs as a means of facilitating the updating of practices and the introduction of evidence-based innovations and support for enhanced performance (Andrew et al 2008;Fung-Kee-Fung et al 2008;Mallinson et al 2006;White et al 2008). The Centers for Disease Control and Prevention (CDCP 2011) are thus sponsoring a support network for virtual CoPs, and innovative experiments have been conducted in a variety of contexts, including smoking (McDonald and Viehbeck 2007) and cancer (Bentley et al 2010;Fung-Kee-Fung et al 2008). Still, CoPs are not yet widely used in public health (Bentley et al 2010;Li et al 2009).…”

“…It has also recently been applied in the health sector (Bentley et al 2010;Li et al 2009). A number of authors, noting the often limited effectiveness of traditional strategies to foster improved professional practice in health (Grimshaw et al 2001;Grol and Grimshaw 2003), have highlighted the potential of CoPs as a means of facilitating the updating of practices and the introduction of evidence-based innovations and support for enhanced performance (Andrew et al 2008;Fung-Kee-Fung et al 2008;Mallinson et al 2006;White et al 2008).…”

Challenges in Knowledge Translation: The Early Years of Cancer Care Ontario’s Program in Evidence-Based Care

“…The communities-of-practice model tends to encourage loyalty of members to the group and a sense of identity that fosters effective participation and productivity 15 . Structured guidance and social strategies Structured methods were used to guide panel meetings; features included "time outs" to allow panels to reflect on behaviours and learning opportunities arising from discussions-for example, a predictable comment early in initial meetings was that participants were "experts," knew the literature and therefore didn't need a systematic approach; by allowing the discussion to proceed, we were able in each instance to show how each panel member had a different "biopsy" of "the body of evidence," which they interpreted differently, demonstrating explicitly the need for a systematic approach …”