Communities of Practice and Situated Learning in Health Care

Abstract

In this chapter we examine the origins, nature and practical implications of the idea of “community of practice”. We argue that the concept has been used both to illuminate the challenges of creating a “learning culture” in health care and to establish initiatives promote knowledge transfer and sharing. After clarifying some of the key concepts under discussion, the chapter illustrates the general features of this broad family of interventions, discusses their characteristics and summarizes their key success factors. It also shows how the ideas of community of practice and situated learning have been applied in diverse ways by health care organizations and funders, how theses ways of knowing and learning have been inserted into the established institutional order, and the mixed, but sometimes promising, outcomes which have flowed from them.

System change through situated learning: Pre-evaluation of the Health Innovation Network's Communities of Practice

“…Strengthening learning and reinforcing the capacity to act on lessons learned (Nicolini et al 2016). …”

“…Identifying that poor learning is a problem has proved to be easier than solving it, and efforts to do so have been frustrated by fragmentation associated with disciplinary specialism and organisational separation (Nicolini et al 2016). By working around the disciplinary and organisational boundaries, CoPs have gained a growing reputation as a valuable means to improve knowledge sharing and collective learning (Wenger 2010).…”

“…Finally, because of the variety of approaches taken and the complex circumstances in which CoPs operate, and despite a growing interest in evaluation over description, it was not possible from the available evidence to attribute observed changes to the CoP itself. Nicolini and colleagues (Nicolini et al 2016) argue that over the past two decades, CoPs have especially been associated with initiatives to achieve multi-professional learning and access forms of knowledge and learning that cut across established professional and organisational boundaries. They go on to argue:…”

“…The idea of communities of practice has thus achieved widespread currency internationally, both as tools for understanding how learning unfolds in health care settings and as a tool for promoting knowledge transfer and sharing, with studies on interventions reported in Australia, Canada, Denmark, the UK and the US… (Nicolini et al 2016) The wider evidence about CoPs therefore most frequently situates them as a response to the Berwick challenge: 'The most important single change in the NHS…would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end' (Berwick 2013).…”

“…As Nicolini et al (2016) write, 'In short, situated learning is associated with engagement, belonging, inclusiveness and developing identities rather than acquiring concepts and theories while sitting in a class'.…”