Could a CoP work here?
- Interesting summary on the problem solving behavior of nurses. This
research points to quick fixes and 'nearest neighbor' help as the
main way to solve pressing issues. I'm left wondering if there was a
CoP AND a practice to reflect, detect and solve root causes within
that group, this could be a potential solution.
(apologies for the broken link)
My next question or hestitation is: how many CoPs do adopt a
structured approach to root cause analysis?
Recommendations from the article:
1) make rootcause analysis an explicit part of the work & allocate
resorces for this
2) create opportunities for sharing problems and make providing
3) pay proper attention to pobems signals & signs
4) dedicate a personal or part of a role to collecting & tracking
problems to final resolution
5) encourage solution generation, experimenation and a focus on
longer term issues (make the problems go away)
6) Sell your stories to help motivate for this 'extra' work.
Thanks for that article. An interesting case study and I agree that a
community of practice would probably address many of the issues that
are raised. I thought the punch-line of the study was in the
side-bar: "The telltale sign is silence." My question was: "How would
'company leaders' learn to perceive silence (more skillfully)?"
I think that one way to talk about the benefits of a supported
community of practice is that it lengthens attention span (as well as
broadens it). But there's no guarantee that a community will focus on
the issues (much less heuristics or structured approaches) that would
make sense to an outside researcher or consultant. (An attention span
Just how pathological are the hospitals under observation? How
pathological are they assumed to be? The author doesn't say anything
about the organizational context: were doctors, administrators,
trustees or other organizational leaders concerned about the
situation? Or were they interviewed? Maybe the error level was just
right, and the 8 hospitals were ripe for further squeezing of the sort
that would increase the error rates and reduce attention span.
The issue of attention caught my eye in the statement that "The first
author shadowed twenty-two nurses in eight different hospitals for a
total of 197 hours." On one level that's a lot of time. But I wonder
whether she bothered to have lunch with these nurses? Etienne Wenger
wrote an article in Healthcare Forum Journal (that's moved it's web
location several times already) that suggests that lunch is the time
when such a community might convene. (EW, "Communities of Practice;
The Social Fabric of a Learning Organization" in Healthcare Forum
Journal August 1996 that used to be at
I think there are good reasons why understanding knowledge at a
community level is so difficult. Once I asked Etienne about what it
was like to hang out with claims processors for 6 months. He said
that he sometimes had real doubts about whether it would be worth
anything, mentioning that sometimes at the end a week he would find
that he had produced one note that he thought maybe would be worth
--* John D. Smith, 503.963.8229, 2025 SE Elliott Ave, Portland OR
--* http://www.teleport.com/~smithjd ICQ: 72789757 cell: 503-975-7799
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From: Denham Grey [mailto:dgrey@...]
Sent: Tuesday, July 31, 2001 11:06 AM
Subject: [cp] Could a CoP work here?
- Denham points to an article in HBS Working Knowledge (albeit via a
broken link -- which is not a big problem to overcome) and wonders if
a CoP focusing on root causes, etc., might be a solution.
I was interested enough to fix the link and go read the article. I
had two basic reactions: (1) from a different perspective (i.e., that
of human performance technology or "HPT") the nurses' situation is a
classic HPT problem and is amenable to treatment using that approach
(see, for example, the www.ispi.org web site for a basic look at
HPT); and (2) I'd be willing to wager that the nurses already have a
community of practice and it's probably focused on sharing quick
fixes because that's what their "practice" is currently all about.
That takes me to Etienne's study of claims examiners. As it happens,
I spent several years "hanging around" claims examiners - and other
folks whose primary work activities belong to the "adjudication"
class (e.g., insurance underwriters, loan officers and financial aid
assistants). I didn't study their work from the perspective of a
cultural anthropologist; instead, I studied it from the point of view
of someone brought in to make it more productive. In other words, I
was less concerned with how they did or how they learned to do their
work as it was currently defined but with how to redefine their work
to make it more productive (as well as getting them to go along with
the redefined work).
The nurses, like most people in the workplace (or so I would
estimate), are caught up in daily fire-fighting and likely to remain
there. My guess is that they don't see it as their job, either as
assigned to them by hospital management (or as accepted by them as
nursing professionals) to go around fixing all the many dozens or
hundreds or thousands of "glitches" that plague the many processes
making up the work of the hospital. Further, I'd be willing to wager
that any attempt to establish a so-called CoP among the nurses with
the intent of cleaning up or sprucing up the hospital's processes
would "come a cropper" to borrow an old phrase.
What might be viable would be to spend some time identifying what is
almost certain to be an already existing CoP among the nurses, see
what it focuses on (almost sure to be the practice of nursing as seen
by that set of nurses) and, perhaps, seeing if there might be a way
of getting them to incorporate this larger loyalty to the hospital's
efficiency as part of their practice. That said, I wouldn't hold out
much hope for success.
The time horizon of most employees, not just nurses, is pretty darn
short. Their scope of interest is comparably narrow. Fighting fires
and putting on heroic shows is what they do. To be sure, programs
involving incentives and recognition can be crafted and these can
produce a great deal of improvement in organizational and process
efficiency and effectiveness, but to expect employees in general to
focus on fixing root causes and process glitches seems to me to rank
right up there with other "holy grails."
I'm not trying to be cynical or critical here; I'm simply commenting
on what I see as the reality of the workplace. It all strikes me as
rather like asking academic researchers to reflect upon and improve
their project management processes. That's not what they do.