Social network science can be harnessed to drive change that will improve healthcare. However, to achieve this we need to move beyond the science of “networks” and begin to explore the foundational theories of “communities.”
Educational theorist and educator Etienne Wenger defines the term “community of practice,” which he coined in his 1998 book, Communities of Practice: Learning, Meaning and Identity, this way: “Communities of practice are formed by people who engage in a process of collective learning in a shared domain of human endeavor: a tribe learning to survive, … a clique of pupils defining their identity in the school, a network of surgeons exploring novel techniques, a gathering of first-time managers helping each other cope.”
The common thread shared in the Wenger’s examples above, and the common element at the heart of every community of practice, is that of having a “collective intent” and a “shared praxis” that galvanizes the community. For our purposes, let’s say “collective intent” is a common vision or goal, and “shared praxis” is the rules or ethics that are accepted as community norms. Together, collective intent and shared praxis make up the community’s culture.
The most basic lesson from Wenger’s work is that social networks may or may not be communities of practice, but in most cases a social network could become a community of practice if the culture can be established.
To leverage the real power of a network, we must
(1) understand its underlying network structure, and (2) infuse that network with a culture of improvement. If you can get this far, anything is possible.
But this is far easier said than done. We are quickly learning that there is no one perfect structure for a network and no one perfect structure for a community of practice. In each case the optimal form depends on what you are trying to accomplish, and since there is usually more than one goal, we will never be able to engineer the perfect system. As an example, you might look at the figure below and imagine that position B is a great place to be if you want to ensure ready access to information, but pretty lousy if you are trying to avoid the flu (the concept of contagion has often been used as an analogy for information flow). Conversely, being in position A is marvelous for avoiding infection, but pretty poor if you want to stay informed on what the network is up to. Fortunately we have new ways of studying the structure of networks , which we can explore in future columns.
Our larger challenge is infusing a network with a collective intent and framing a shared praxis, and it is far from simple. In fact, turning existing networks into effective communities for a deliberate, specific, and greater purpose may be the greatest challenge we face for healthcare improvement.
Looking at where this community needs to be in three to five years, I can’t think of a more important professional competency than this. Clearly, organizations like the Alliance for Continuing Education in the Health Professions need to get up to speed—this is not the first time I have called for more formal professional development opportunities to be offered to the CME community. But in the meantime, there are countless TweetChats, and forums where we can begin practicing what we preach. If enabling communities of practice is an essential element of quality improvement in the health professions, then it stands to reason that communities of practice can enable our profession to make needed improvements too. So look out for these opportunities, and when you find a great resource, share it. It will be a lot easier on all of us if we can rely on each to get to where we need to be!
Brian S. McGowan, PhD, has dedicated the past 12 years to medical education as a @BrianSMcGowan.member, mentor, accredited provider, and commercial supporter. The opinions expressed are McGowan’s and do not represent the views of past, current, or future employers. Follow him on Twitter:
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