In recent years, Communities of Practice (CoP) have perhaps become a victim of their own success. Various events have been run under the title of a CoP that bear little resemblance to the approach intended for the model.
Over the past year, I have been lucky enough to be involved in a learning programme focused on Communities of Practice for improvement and to launch and convene a Community of Practice for people involved in Alcohol Assertive Outreach Services.
While the learning programme run by Q and Health Innovation Network, South London, is no longer continuing in that form, I wanted to share my learning and reflections to benefit Q members who may be considering setting up a CoP.
What is a Community of Practice?
Communities of Practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact with each other. Etienne Wenger coined the term with Jean Lave in their book, Situated Learning.
For something to be a Community of Practice, they specify three criteria.
- A shared ‘domain’, interest or expertise.
- A group of people who interact with one another, building relationships that enable them to learn with and from each other – the community.
- The members of the community must be people with a common passion who in coming together, share stories and cases which inform their practice.
During the course, my cohort and I practised a variety of techniques within and outside of group learning sessions.
We were introduced to methodologies such as Time to Think which enables quality decision making through quality thinking and Liberating Structures which enables groups to hear the voices of all members and unearth some of the real issues.
We were able to provide each other with practical and moral support to put our learning into practice.
Designing for launch
Alongside my study of CoP in theory, I launched a CoP to put my knowledge into practice.
In my role as senior advisor on implementation at the NIHR Mental Health Implementation Network, I had the opportunity to work with people involved in Alcohol Assertive Outreach Services who were enthusiastic about the CoP model.
Alcohol Assertive Outreach Treatment (AAOT) offers a creative and flexible approach to engaging and treating patients with alcohol dependence and complex needs through regular proactive support at home or in their local neighbourhood.
This community offered people with a passion for improving the lives of those with problematic alcohol use to meet, share experiences, talk about challenges and support one another.
I focussed on succession planning and we had open discussions about who should join this CoP at the launch meeting. This meant seeking support from senior leaders acting as CoP sponsors, who were able to identify appropriate practitioners to work with me in the early stages of set up. I reported back progress on CoP planning regularly to these sponsors.
The aim of this feedback was to provide insight into the issues being considered by the CoP.
Importantly, the sponsors had no oversight role in the CoP and were not involved in its planning or decision-making. This is a key principle of the model.
In our case, a small group of enthusiastic members soon developed into a dedicated planning group that gradually took more responsibility for planning and convening.
Sustaining a CoP
As the CoP moved from launch stage into practice, there was a shift in focus for the design group. The launch and first session introduced the concept, purpose, membership and practical considerations, such as length, frequency and format of meetings.
From there, members built their confidence in the approach, volunteering to lead planning and to invite experts by experience to take part.
As members move between roles and share responsibilities, it is expected this will support the sustainability of the group, so that no single person bears the inevitable burden of work involved in maintaining such a group.
A Community of Practice will only continue if it is viewed as adding value for the membership. Unlike formal meetings, there is no requirement to attend. There is an expectation that many CoPs will be time-limited, and will come to a natural end.
This could be when one or more enthusiasts move on, when the “work is done” around a specific problem, or when other organisational priorities take over for members.
This should be seen as part of the natural process, and not as a failure of the convenor. Other CoPs, with a related but different focus, may also emerge to take forward new challenges.
Bringing people together
In my experience the CoP model was a powerful tool in bringing together practitioners, experts by experience and researchers – all with a common goal of successful implementation of the Alcohol Assertive Outreach Team model.
As an implementation strategy, it was effective in bringing people together who otherwise may not have connected and as a quality improvement tool, it gave those people the opportunity to think deeply, alone and with others, and to come up with their own decisions about any changes needed to improve the quality of their service.
What next for CoPs in health and care improvement?
Our group would recommend this approach to other teams looking to implement evidence-based practice. However, we would advise that serious consideration is given before setting up multiple new CoPs. They require significant time and effort, especially at the outset, and to be successful, should be explicit about maintaining fidelity to a CoP model.
With the NHS and English Local Authorities in a state of sustained crisis, the need to work together to solve intransigent issues and ‘wicked problems’ is pressing. Communities of Practice offer a valuable structure and methodology to enable and encourage collaboration and to think creatively about these issues.
Share your experiences
Connect with other CoPs and continue the conversation on our Communities of Practice Special Interest Group.
Resources
Learn more about Time to Think.
Find out about Liberating Structures.
Visit the NIHR Mental Health Implementation Network website.