Communities of PracticeCommunities of Practice

What, Why and HowWhat, Why and How

Leann MerlaLeann Merla

CAOT June 4, 2009CAOT June 4, 2009

OutlineOutline

What: What: Definitions and structureDefinitions and structureWhy:Why: Benefits and relevance to OTBenefits and relevance to OTOur experienceOur experienceHow:How: Different structuresDifferent structures

Requirements Requirements

TemplateTemplate

DefinitionsDefinitions

Communities of practice are groups of Communities of practice are groups of people who share a concern or a passion people who share a concern or a passion for something they do and learn how to do for something they do and learn how to do it better as they interact regularly. it better as they interact regularly. Wenger, Wenger, 20082008

Individuals engaged in mutual endeavors, Individuals engaged in mutual endeavors, associated with a joint enterprise, with a associated with a joint enterprise, with a shared repertoire and history shared repertoire and history Lave & Wenger, in Lave & Wenger, in Davis, 2006Davis, 2006

BenefitsBenefits

New competencies and procedures New competencies and procedures learned learned McDonald and Viehbeck, 2007; Garcia and Dorohovich, 2005McDonald and Viehbeck, 2007; Garcia and Dorohovich, 2005

Exchange of tacit knowledge and “histories of Exchange of tacit knowledge and “histories of learning” learning” Parboosingh, 2002Parboosingh, 2002

Development of professional identity Development of professional identity Davis, Davis, 2006, Plak, 20062006, Plak, 2006

Cost effective Cost effective Parboosingh, 2002Parboosingh, 2002

Enhanced job satisfactionEnhanced job satisfactionRecruitment and retentionRecruitment and retention

LHSC ExperienceLHSC Experience

Multi site tertiary care teaching hospitalMulti site tertiary care teaching hospital Inpatient and Outpatient physical and Inpatient and Outpatient physical and

mental healthmental health32 FTE OT’s and 6.5 OTA’s32 FTE OT’s and 6.5 OTA’sMatrix model of management with a 1.0 Matrix model of management with a 1.0

Professional Practice Leader and 1.0 Professional Practice Leader and 1.0 Clinical SpecialistClinical Specialist

LHSC ExperienceLHSC Experience

Hospitals amalgamated in 1995Hospitals amalgamated in 1995 Program management introduced 1998Program management introduced 1998 Staff identified concern regarding loss of “OT Staff identified concern regarding loss of “OT

identity”, fragmentation of professionidentity”, fragmentation of profession Key issues identified at all staff retreat in 1998Key issues identified at all staff retreat in 1998

CommunicationCommunication Professional developmentProfessional development Professional identityProfessional identity Working relationshipsWorking relationships

Structure developed Structure developed to offer “meaning, to offer “meaning, learning, and a sense of community to learning, and a sense of community to peers in the midst of organizational peers in the midst of organizational change”change”

Combination of formal QM structure and Combination of formal QM structure and strategies to provide opportunities for strategies to provide opportunities for informal communication, sharing of informal communication, sharing of informationinformation

Quality Management Structure - Quality Management Structure - LHSCLHSC

Used a QM focus to ensure supportUsed a QM focus to ensure supportProfessional Practice Steering CommitteeProfessional Practice Steering CommitteeTask TeamsTask Teams

Practice Standards, Practice Development, Evidence Practice Standards, Practice Development, Evidence Based PracticeBased Practice

Ad Hoc Working GroupsAd Hoc Working Groups Infomed, OT Month, Website, CommunicationInfomed, OT Month, Website, Communication

Additional StrategiesAdditional Strategies

OT newsletterOT newsletterJoint staff meetings 2x/yearJoint staff meetings 2x/yearMonthly staff meetings each siteMonthly staff meetings each sitePreceptorship programPreceptorship programJournal clubsJournal clubs InservicesInservices

Development of a Community of Development of a Community of PracticePractice

Qualitative study completed in 2007Qualitative study completed in 2007 Staff identified COP as an important component Staff identified COP as an important component

of their job satisfaction and ability to practice in of their job satisfaction and ability to practice in desired manner.desired manner.

“the good thing about this particular hospital is that we have a rather large OT department and we have lots of OT colleagues that practice on the same principles and we support one another” Participant C

“We have a great OT department. Like we have great cohesiveness. We have a lot of experience and I think in terms of aiding and implementing a client centred practice, observing colleagues and discussing with colleagues what [practice] should look like … it’s a big help” Participant H

“within the discipline it helps. We talk, we talk a lot. We use each other as resources and sounding boards” Participant J

Developing a CommunityDeveloping a Community

Geographic proximity does not ensure Geographic proximity does not ensure development of a Community of Practicedevelopment of a Community of Practice

Cannot be mandated by administrationCannot be mandated by administration

Sharpe, 1997Sharpe, 1997

Variations on a ThemeVariations on a Theme

Informal or spontaneous ProximityProximity Culture of Culture of

environmentenvironment Critical massCritical mass NeedNeed Open membershipOpen membership Activity will wax and Activity will wax and

wanewane

Formal or “mandated” Specific issue or needSpecific issue or need Explicit supportExplicit support Formal structure and Formal structure and

expectationsexpectations Often closed Often closed

membershipmembership Proximity not Proximity not

essentialessential

Basic RequirementsBasic Requirements

Mutual engagementMutual engagement

Joint enterpriseJoint enterprise

Shared repertoireShared repertoire

Wenger, 1998 in Macdonald & Viehbeck, 2007Wenger, 1998 in Macdonald & Viehbeck, 2007

RequirementsRequirements

Facilitator – not expert but enthusiasticFacilitator – not expert but enthusiasticRelevance; clear goals and purposeRelevance; clear goals and purposeOpportunities for collaborationOpportunities for collaboration Involvement of front line staffInvolvement of front line staffTrust; critical thinking and open debateTrust; critical thinking and open debateSupport Support EvaluationEvaluation

Creating a Community of PracticeCreating a Community of Practice

Introduce Introduce ConceptConcept

Determine InterestDetermine Interest

Identify Stakeholders, Identify Stakeholders, Participants, ChampionParticipants, Champion

Contact listContact list

Assign responsibility for 1Assign responsibility for 1stst meetingmeeting

Initial WorkshopInitial Workshop Confirm understandingConfirm understanding

Generate list of concernsGenerate list of concerns

Discuss general principlesDiscuss general principles

Identify key membersIdentify key members

CharterCharter PurposePurpose

Ground rulesGround rules

Format and frequencyFormat and frequency

Expectations of membersExpectations of members

Evaluation method Evaluation method

Identify 1Identify 1stst priority priority Relevance/urgencyRelevance/urgency

ResourcesResources

Desired outcomeDesired outcome

Identify needs Identify needs and resourcesand resources

HumanHuman

WrittenWritten

DocumentsDocuments

ExternalExternal

TechnologyTechnology

Ongoing Ongoing managementmanagement

Establish responsibilityEstablish responsibility

Ensure focus remainsEnsure focus remains

Seek opportunitiesSeek opportunities

Problem solveProblem solve

EvaluateEvaluate SatisfactionSatisfaction

ParticipationParticipation

MembershipMembership

Do more/continue/do less/stopDo more/continue/do less/stop

Documents producedDocuments produced

MarketMarket Celebrate achievements and Celebrate achievements and build on successbuild on success

ConclusionConclusion Communities of practice provide a viable and Communities of practice provide a viable and

cost effective way for OT’s to engage in cost effective way for OT’s to engage in professional development, strengthen their professional development, strengthen their professional identity and enhance their professional identity and enhance their professional practice.professional practice.

Communities of practice may involve a variety of Communities of practice may involve a variety of formats but are a “good fit” for our profession formats but are a “good fit” for our profession with its strong body of tacit knowledge and with its strong body of tacit knowledge and history of learning through shared experience.history of learning through shared experience.

Contact: Leann.Merla@lhsc.on.caContact: Leann.Merla@lhsc.on.ca

ReferencesReferencesConfessore, S.J. (1997). Building a learning organization: communities of Confessore, S.J. (1997). Building a learning organization: communities of

practice, self-directed learning, and continuing medical education. practice, self-directed learning, and continuing medical education. The The Journal of Continuing Education in the Health ProfessionsJournal of Continuing Education in the Health Professions 17, 5-11. 17, 5-11.

Davis, J. (2006). The importance of the community of practice in identity Davis, J. (2006). The importance of the community of practice in identity development. development. The Internet Journal of Allied Health Sciences and Practice The Internet Journal of Allied Health Sciences and Practice 4,4,1-8 1-8

Garcia, J. & Dorohovich, M. (2005). The truth about building and maintaining Garcia, J. & Dorohovich, M. (2005). The truth about building and maintaining successful communities of practice. successful communities of practice. Defense Acquisition Review Journal,Defense Acquisition Review Journal, 10, 18-33.10, 18-33.

McDonald, P.W. & Viehbeck, S. (2007). From evidence-based practice making McDonald, P.W. & Viehbeck, S. (2007). From evidence-based practice making to practice-based evidence making: creating communities of (research) to practice-based evidence making: creating communities of (research) and practice. and practice. Health Promotion Practice, 8Health Promotion Practice, 8, 140-144., 140-144.

ReferencesReferencesParboosingh, J. T. (2002). Physician communities of practice: Where lParboosingh, J. T. (2002). Physician communities of practice: Where l

earning and practice are inseparable. earning and practice are inseparable. The Journal of Continuing The Journal of Continuing Education in the Health Professions 22, Education in the Health Professions 22, 230-236.230-236.

Plak M.M. (2006). The development of communication skills, interpersonal Plak M.M. (2006). The development of communication skills, interpersonal skills, and a professional identity within a community of Practice. skills, and a professional identity within a community of Practice. Journal of Physical Therapy Education, 20Journal of Physical Therapy Education, 20 37-46. 37-46.

Sharp, J. (1997). Communities of practice; a review of the literature. Sharp, J. (1997). Communities of practice; a review of the literature. http://www.tfriend.com/cop-lit.htm Retrieved May 21, 2009. Retrieved May 21, 2009.

Wenger, E. Communities of practice. A brief introduction. Wenger, E. Communities of practice. A brief introduction. http://www.ewenger.com/theory. Retrieved April 22, 2009.. Retrieved April 22, 2009.

White, C.M, Basiletti, M.C, Carswell, A., Head, B.J. & Lin, L.J. (2008) Online communities of practice: enhancing scholarly practice using web-based technology. Occupational Therapy Now, 10, 6-7.