1. Communities of Practice What, Why and How Leann Merla CAOT June 4, 2009

2. Outline What: Definitions and structure What: Definitions and structure Why:Benefits and relevance to OT Why:Benefits and relevance to OT Our experience Our experience How:Different structures How:Different structuresRequirementsTemplate

3. Definitions 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 regularly. Wenger, 2008 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 regularly. Wenger, 2008 Individuals engaged in mutual endeavors, associated with a joint enterprise, with a shared repertoire and history Lave & Wenger, in Davis, 2006 Individuals engaged in mutual endeavors, associated with a joint enterprise, with a shared repertoire and history Lave & Wenger, in Davis, 2006

4. Benefits New competencies and procedures learned McDonald and Viehbeck, 2007; Garcia and Dorohovich, 2005 New competencies and procedures learned McDonald and Viehbeck, 2007; Garcia and Dorohovich, 2005 Exchange of tacit knowledge and “histories of learning” Parboosingh, 2002 Exchange of tacit knowledge and “histories of learning” Parboosingh, 2002 Development of professional identity Davis, 2006, Plak, 2006 Development of professional identity Davis, 2006, Plak, 2006 Cost effective Parboosingh, 2002 Cost effective Parboosingh, 2002 Enhanced job satisfaction Enhanced job satisfaction Recruitment and retention Recruitment and retention

5. LHSC Experience Multi site tertiary care teaching hospital Multi site tertiary care teaching hospital Inpatient and Outpatient physical and mental health Inpatient and Outpatient physical and mental health 32 FTE OT’s and 6.5 OTA’s 32 FTE OT’s and 6.5 OTA’s Matrix model of management with a 1.0 Professional Practice Leader and 1.0 Clinical Specialist Matrix model of management with a 1.0 Professional Practice Leader and 1.0 Clinical Specialist

6. LHSC Experience Hospitals amalgamated in 1995 Hospitals amalgamated in 1995 Program management introduced 1998 Program management introduced 1998 Staff identified concern regarding loss of “OT identity”, fragmentation of profession Staff identified concern regarding loss of “OT identity”, fragmentation of profession Key issues identified at all staff retreat in 1998 Key issues identified at all staff retreat in 1998 Communication Communication Professional development Professional development Professional identity Professional identity Working relationships Working relationships

7. Structure developed to offer “meaning, learning, and a sense of community to peers in the midst of organizational change” Structure developed to offer “meaning, learning, and a sense of community to peers in the midst of organizational change” Combination of formal QM structure and strategies to provide opportunities for informal communication, sharing of information Combination of formal QM structure and strategies to provide opportunities for informal communication, sharing of information

8. Quality Management Structure - LHSC Used a QM focus to ensure support Used a QM focus to ensure support Professional Practice Steering Committee Professional Practice Steering Committee Task Teams Task Teams Practice Standards, Practice Development, Evidence Based Practice Practice Standards, Practice Development, Evidence Based Practice Ad Hoc Working Groups Ad Hoc Working Groups Infomed, OT Month, Website, Communication Infomed, OT Month, Website, Communication

9. Additional Strategies OT newsletter OT newsletter Joint staff meetings 2x/year Joint staff meetings 2x/year Monthly staff meetings each site Monthly staff meetings each site Preceptorship program Preceptorship program Journal clubs Journal clubs Inservices Inservices

10. Development of a Community of Practice Qualitative study completed in 2007 Qualitative study completed in 2007 Staff identified COP as an important component of their job satisfaction and ability to practice in desired manner. Staff identified COP as an important component of their job satisfaction and ability to practice in 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

11. “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

12. Developing a Community Geographic proximity does not ensure development of a Community of Practice Geographic proximity does not ensure development of a Community of Practice Cannot be mandated by administration Sharpe, 1997 Cannot be mandated by administration Sharpe, 1997

13. Variations on a Theme Informal or spontaneous Proximity Proximity Culture of environment Culture of environment Critical mass Critical mass Need Need Open membership Open membership Activity will wax and wane Activity will wax and wane Formal or “mandated” Specific issue or need Specific issue or need Explicit support Explicit support Formal structure and expectations Formal structure and expectations Often closed membership Often closed membership Proximity not essential Proximity not essential

14. Basic Requirements Mutual engagement Mutual engagement Joint enterprise Joint enterprise Shared repertoire Shared repertoire Wenger, 1998 in Macdonald & Viehbeck, 2007

15. Requirements Facilitator – not expert but enthusiastic Facilitator – not expert but enthusiastic Relevance; clear goals and purpose Relevance; clear goals and purpose Opportunities for collaboration Opportunities for collaboration Involvement of front line staff Involvement of front line staff Trust; critical thinking and open debate Trust; critical thinking and open debate Support Support Evaluation Evaluation

16. Creating a Community of Practice Introduce Concept Determine Interest Identify Stakeholders, Participants, Champion Contact list Assign responsibility for 1 st meeting Initial Workshop Confirm understanding Generate list of concerns Discuss general principles Identify key members

17. CharterPurpose Ground rules Format and frequency Expectations of members Evaluation method Identify 1 st priority Relevance/urgencyResources Desired outcome

18. Identify needs and resources HumanWrittenDocumentsExternalTechnology Ongoing management Establish responsibility Ensure focus remains Seek opportunities Problem solve

19. EvaluateSatisfactionParticipationMembership Do more/continue/do less/stop Documents produced Market Celebrate achievements and build on success

20. Conclusion Communities of practice provide a viable and cost effective way for OT’s to engage in professional development, strengthen their professional identity and enhance their professional practice. Communities of practice provide a viable and cost effective way for OT’s to engage in professional development, strengthen their professional identity and enhance their professional practice. Communities of practice may involve a variety of formats but are a “good fit” for our profession with its strong body of tacit knowledge and history of learning through shared experience. Communities of practice may involve a variety of formats but are a “good fit” for our profession with its strong body of tacit knowledge and history of learning through shared experience. Contact: Leann.Merla@lhsc.on.ca

21. References Confessore, S.J. (1997). Building a learning organization: communities of practice, self-directed learning, and continuing medical education. The Journal of Continuing Education in the Health Professions 17, 5-11. Davis, J. (2006). The importance of the community of practice in identity development. The Internet Journal of Allied Health Sciences and Practice 4,1-8 Garcia, J. & Dorohovich, M. (2005). The truth about building and maintaining successful communities of practice. Defense Acquisition Review Journal, 10, 18-33. McDonald, P.W. & Viehbeck, S. (2007). From evidence-based practice making to practice-based evidence making: creating communities of (research) and practice. Health Promotion Practice, 8, 140-144.

22. References Parboosingh, J. T. (2002). Physician communities of practice: Where l earning and practice are inseparable. The Journal of Continuing Education in the Health Professions 22, 230-236. Plak M.M. (2006). The development of communication skills, interpersonal skills, and a professional identity within a community of Practice. Journal of Physical Therapy Education, 20 37-46. Sharp, J. (1997). Communities of practice; a review of the literature. http://www.tfriend.com/cop-lit.htm Retrieved May 21, 2009. http://www.tfriend.com/cop-lit.htm Wenger, E. Communities of practice. A brief introduction. http://www.ewenger.com/theory. Retrieved April 22, 2009. http://www.ewenger.com/theory 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.