The Real Value of Networks Lies Within the Community

There is great value in learning about the science of social networks. As you might imagine, I believe that there is not a single facet of our lives that is not impacted by our social graph. But the greater impact of this social network science, lies in our ability to leverage this science to drive change ― and for our professional purposes – to drive healthcare quality improvement. To achieve this we need to move beyond the science of “networks” and begin to explore the foundational theories of “communities.”

The term “community of practice” was coined by educational theorist and educator Etienne Wenger in his 1998 book, “Communities of Practice: Learning, Meaning and Identity.” Wenger defines it 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 galvanize the community. For our purposes we can simplify “collective intent” as a common vision or goal and we can simplify “shared praxis” as the rules or ethics that are accepted as norms within the community – 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 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 the goals and missions are rarely one-dimensional (there is rarely one single goal in play) we will never be able to engineer the perfect system. As an example, take a quick look at the figure below.

From this social graph you might imagine that in this simple network being in position B is a great place to be 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 to what the network is up to. Fortunately we have new ways of studying the structure of networks which we can talk about in future posts.

Our larger challenge is that infusing a network with a collective intent and framing a shared praxis is far from simple. In fact, turning existing networks into effective communities for a deliberate, specific, and greater purpose may be the greatest challenge faced by our generation.

So how do we prepare for this challenge?

Looking at where our healthcare systems need to go, I can’t think of a more important professional competency than that described above. So clearly, organizations like the Alliance for CEHP, IHI, and AAMC need to quickly get up to speed – this is not the first time I have called for more formal professional development opportunities to be offered by the establishment. But in the meantime, there are countless books, tweetchats, and forums where we can each begin practicing what we need to be preaching.

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 other to get to where we need to be!