Communities of Practice |
The Social Fabric of a Learning Organization |
| by Etienne Wenger, PhD |
(This article first appeared in the Healthcare Forum Journal, July-August 1996) |
|
It is lunchtime at Memorial Hospital. A nurse from the kidney dialysis unit and a medical student are discussing Mr. R, or "Sam," a patient with end-stage renal disease who has recently become blind as a result of diabetes and who is new to ambulatory peritoneal dialysis. The nurse is concerned about his ability to remember to take his medication before he has his lunch. Soon they are joined by an occupational therapist and an aide from rehab. "I guess I don't understand what is so worrisome," says the medical student. "Just talk to his daughter; she lives with him and she can make sure he takes it." "But she may not always be available at lunchtime," explains the occupational therapist, "and besides, that means making someone else responsible for his care. The point is to keep patients as self-reliant as possible for as long as possible." "You don't have to convince Sam to take care of himself," laughs the nurse. "He's fiercely independent-almost to a fault. It's hard for him to accept help, even in areas where he needs it." "We had a woman coming in for treatments who kept forgetting to take her pills," the aide from rehab recalls. "The nurses asked her to go through the exact story of how she took her lunch, every detail-open the box, take the napkin, and so on-so that she could imagine it in her mind, and 'see' herself taking the pills as part of it." "That's right," muses the nurse. "We used a similar technique with someone else on outpatient dialysis, and it worked really well." By now they had been joined by another nurse, this one from the ICU, who had been listening quietly to the conversation. "I used to work as a home health nurse," she says, "and we sometimes used audio recordings for blind patients. Maybe you could produce a tape for this man, and he could use it to remind himself of his meds-and other things as well." "Yes," responds the dialysis nurse. "Maybe he could make the tape himself. And that kind of tape could be useful for other patients as well." The conversation becomes animated. "Why not ask Sam what he'd like to do?" "Why not ask other patients, too?" "We could do a survey of all 30 patients on ambulatory peritoneal dialysis, collect their mealtime stories and their techniques for remembering to take their pills, and then share those stories." "That would be something to put in the newsletter." |
Questionable assumptions
This kind of informal problem-solving happens in every healthcare organization, but in a
learning organization, it is the norm. One difference between a true learning organization and
one that gives lip service to the idea is the degree to which such informal learning activities are
recognized, respected, and encouraged. Unfortunately, in most institutions this conversation
would not be recognized as part of a process of learning, mostly because of the assumptions that
are commonly held about learning.
Our institutions are largely based on the assumption that learning is an individual process, that it has a beginning and an end, that it is best separated from the rest of our activities, and that teaching is required for learning to occur. So we arrange classrooms where students-free from all the distractions of their participation in the world-can pay attention to a teacher or focus on exercises. We design computer-based training programs that walk students through individualized sessions covering reams of information and drill practice.
We assess learning with tests with which students struggle in a one-on-one combat, where knowledge has to be demonstrated out of context, and where collaborating is cheating.
The result is that much of our institutionalized teaching and training is perceived by would-be learners as irrelevant and most of us come out of this treatment feeling that learning is boring, arduous, and that we are not really cut out for it.
To understand what constitutes a learning organization, it is important first to consider carefully the assumptions that we bring to the task, assumptions not only about how to build a learning organization, but, more fundamentally, about what learning is in the first place. In fact, given the magnitude of the task, inspecting our assumptions is more crucial than devising techniques or collecting best practices. Understanding what constitutes a learning organization is particularly relevant to the healthcare industry. In a fundamental way, healthcare is about learning. It is learning how to care for the sick. It is learning how to create an infrastructure to make care possible. It is also, more generally, learning how to live in a more healthy manner, as individuals, as communities, as organizations, as societies.
If a new perspective on learning can help us learn more effectively, it is relevant to all these areas. In healthcare, in fact, it is almost a business imperative: Effective learning that integrates all these areas may well be, in the final analysis, the greatest cost-cutting measure of all. And with the industry in the process of reinventing itself, those who can translate a workable perspective on learning into an integrated healthcare system are likely to chart the future.
What if.....
So, what if we adopted a different perspective, one that places learning in the context of our
lived experience of participation in the world? What if we assumed that learning is as much part
of our human nature as eating or sleeping, that it is both life-sustaining and inevitable, and that
given a chance, we are quite good at it? And what if, in addition, we assumed that learning is, in
its essence, a fundamentally social phenomenon, reflecting our own deeply social nature as
human beings capable of knowing?
What kind of understanding would such a perspective give us on how learning takes place, on what is required to support it, and thus on what constitutes a learning organization? The basic elements of such a perspective on learning can be laid out as a series of seven principles:
1. Learning is inherent in human nature. Learning is not a separate activity. It is not something we engage in when we do nothing else or stop engaging in when we do something else. Teaching does not cause learning, and indeed what ends up getting learned may or may not be what was taught. We learn all the time, whether or not we see our learning, and whether or not we learn what is expected of us or what is good for us or our organizations.
In this sense, we already have learning organizations. What is needed is not to create learning, but rather to create circumstances that make learning empowering and productive.
2. Learning is fundamentally social. Contrary to what we are told before a test, working together is not cheating, but is at the very core of learning. What both drives and enables a child to learn to speak is the increasing possibility of participating in the activities of people who speak. In fact, learning is so thoroughly integrated in social participation that you could not stop it even if you tried. The only way to prevent it would be to prevent participation itself.
Apprenticeship works by being integrated in social participation. Whenever high levels of skills are required-whether we are to become a fluent speaker of a language, a neurosurgeon, a nurse, an X-ray technician, a physicist, or a master mechanic-we organize learning in an apprenticeship-like fashion.
The social world, then, is not a distraction, but a rich resource essential to learning. In fact, there is no distinction between learning and social participation, and that is what makes learning possible, enduring, and meaningful.
Assuming that learning is fundamentally social is not denying that it involves neurological processes, but it is placing these processes in the social context in which we experience them as meaningful. Information by itself is not enough. Learning is fundamentally social because we are social beings.
The most private thoughts we think use images, words, and concepts that reflect our social participation. Learning is thus social even when it does not involve interactions with other people directly. You don't stop being a nurse when you step out of the hospital. And what you learn outside the hospital will then be integrated into your being a nurse and your ability to participate in that context.
For all of these reasons, learning is most effective when it is integrated in a form of social participation.
3. Learning changes who we are. The difference between mere activity or entertainment and learning is not that one is fun and the other hard, that one is exciting and the other dry, but that learning changes our ability to participate in the world. By transforming our relations with the world and with others, learning transforms our identities as social beings. Learning to speak is not just acquiring certain skills, it is becoming a person who can participate in conversations.
Learning to be sober, for instance, is not just a matter of gaining new information. It is not even simply acquiring new behaviors. Rather, it is a matter of learning a new identity, of seeing oneself differently: first as a person in trouble who needs to regain control, and then as a person who can live without being drunk. And indeed, organizations such as Alcoholics Anonymous, which have been successful in supporting this very difficult process, are organizations that have been able to understand this perspective and to provide the social infrastructure-the communities, the stories, the shared practices-necessary for such a transformation of the self.
More generally, taking care of oneself, living a healthy life, or facing a serious disease is not just a matter of having information about healthy and unhealthy habits, but of seeing oneself in a new light. What we need is to find an identity as a healthy person-or even as a sick but engaged patient who can make the best of a difficult situation. Similarly, if medical professionals have new roles as the healthcare industry changes, it is not just a matter of acquiring new skills, but of understanding oneself in a different context, so that these skills become part of a meaningful way of being in the world.
4. Learning is a matter of engagement in practice. The experience of identity is not abstract. It is not just a title that can be conferred or a self-image that we can change on our own. It implies the ability to engage in the world in certain ways, so as to recognize oneself and to be recognized as a member of a community. It is a matter of competence, of being able to participate in socially defined activities and to contribute to a community and its enterprise. It is this engagement in practice, not some abstract notion of membership, that determines what we learn and that empowers us to be who we are.
Whether we work on a surgical team, play in a garage band, sit on an executive board, or belong to a street gang, it is our ability to participate in and contribute to a shared enterprise that defines our experience of identity in practice. What we learn and what we don't, what matters and what does not, what we have access to and what we don't, is profoundly shaped by our practical engagement in these communities.
5. Learning reflects our participation in communities of practice. If learning is a matter of engagement in socially defined practices, the communities that share these practices play an important role in shaping learning. The communities that matter are not always the most easily identifiable, because they often remain informal. Their practices live as much around the water cooler as in meetings, as much in local artifacts as in expensive technologies, as much in the pervasive humor that makes daily contact with tragedy bearable as in the protocols that ensure the quality of care.
As people pursue any shared enterprise over time-working, living, playing together-they develop a common practice, that is, shared ways of doing things and relating to one another that allow them to achieve their joint purpose. Over time, the resulting practice becomes a recognizable bond among those involved. It makes sense, therefore, to call such a community a "community of practice."
The concept of community of practice is useful to capture the wide variety of forms that these emergent groups take as people learn together at work, at home, in schools, or in civic life-from an active group of medical professionals concerned with terminal illnesses to a dance studio giving new life to an ancient tradition, from an executive team to a playground clique. Whether their joint learning takes place over centuries or over the course of an intense project, it affects the identities of those involved by changing their sense of how they can engage with the world.
We all belong to many such communities of practice, over the course of our lives, or at any given time. Some have explicit names and a formal status, some are not even identified as communities. Some are harmonious, some are conflictual. In some, we play a central role; in some we belong only peripherally. In some we are old-timers; in some we are newcomers or just on our way out. Some are central to our identity, some are only incidental. Whatever our exact form of membership, learning is both the vehicle and the result of our participation.
Whether a newcomer is becoming a full member, or whether a practice itself evolves to respond to new circumstances, learning is integrated in the experience of participation. In these communities of practice, knowing, belonging, and doing are not separable: What we know, who we are, and what we do seamlessly come together in one experience of participation.
Successful communities of practice provide forms of participation that encompass the past and open the future. The quality of participation is not just defined in terms of activities, but as a trajectory through time. Our identities imply both our connections to communities and a sense of personal history, with a past and a future.
Sustaining a practice over time provides both depth of knowledge and the potential for the creation of new knowledge. In particular, it takes sustained engagement in practice with old-timers in order for the depth and subtleties of practice to be shared with newcomers and for new generations to develop their own contributions.
6. Learning means dealing with boundaries. As communities of practice form, they create boundaries between those who have been engaged in the practice and those who have not. These boundaries are not the same as organizational boundaries, created by business units and processes. They are created in practice by differences in the perspectives, the languages, the styles-some obvious, some very subtle-that characterize each practice.
These boundaries are relevant to learning in a number of ways. First, they often confront newcomers or outsiders who seek entry into a community of practice. Patients who try to make sense of what is said about them and students who start their internship both have to deal with the boundaries of practice. These boundaries can be experienced in very concrete ways, in as simple a situation as being unable to participate in a conversation.
In addition, boundaries are reflected in our identities. If you are a member of a professional community and belong to a business unit that has to meet bottom-line expectations, learning to function with the conflicting demands between various forms of accountability is more than making discrete decisions. It is finding an identity that can encompass and reconcile these two forms of membership into a way to proceed.
Because we belong to many communities of practice, our learning includes the process of reconciling different forms of membership. These tensions can exist between work life and home life, between becoming good at math and belonging to a clique of friends at school, and between having roots in an underserved community and joining a professional elite. Living the tension of those boundaries is itself a learning process.
Furthermore, boundaries have to be crossed for communities of practice to work together and for their various perspectives to be coordinated. Objects that travel from one community of practice to another-documents, software, food-can take on very different meanings in each. They may or may not create links of communication. People who cross these boundaries have different experiences in different practices. They may or may not broker learning from one community into another.
Thus, for a learning organization, the boundaries of practice may either be liabilities or, if understood properly, learning assets. Indeed, much learning happens when boundaries are rich in interactions, whether they occur formally, as in a multidisciplinary team meeting, or informally at a coffee break.
Boundaries between practices are fertile grounds for innovation. As communities of practice collaborate, clash, merge, diverge, the required process of coordination, translation, and negotiation is also a process of learning.
In fact, out of the interactions of existing practices, boundaries are often places where new practices are created. The cumbersome names of new medical specialties, such as neuropsychoimmunology, reflect their roots at the intersections of more established disciplines.
7. Learning is an interplay between the local and the global. Organizations usually involve more than one practice and thus are constellations of interrelated communities of practice. The relation of individuals to organizations is therefore not direct; it takes place through participation in communities of practice. You may be employed by a large HMO, but whether you are a nursing aide or a CEO, you work in day-to-day practice for and with much smaller circles of people who share your situation and your enterprise. It is in this context that learning takes place.
For instance, in an insurance company where I was doing some research, a medical claims processor had been fired for speaking against the company at a radio show. The local community of practice then went through some informal but intense discussion of the event-Was it right for the company to fire the employee? Was it right for the employee to criticize the company in a public forum?-using this communal process as a resource for making sense of their own relationship with the company.
Communities of practice are not just places where local activities are organized, but also where the meaning of belonging to broader organizations is negotiated and experienced. In healthcare practice, this tension between the local and the global is a daily experience. Protocols, regulations, procedures, and professional standards must be interpreted locally and translated into a practice that addresses the specifics of clinical cases.
Indeed, an important aspect of the work of any community of practice is to create a picture of the broader context in which its practice is located. In this process, much local energy is directed at global issues and relationships. Local practices thus deal with a variety of global categories of membership and identification, some obvious-like profession, age, gender, or institutional affiliation-some less obvious, such as body shapes, accents, styles. Still, it is in the context of specific forms of participation that these broader categories are experienced in practice as a lived identity.
Expand the focus
These observations about learning may seem deceptively simple, but their implications for the
design of effective learning organizations are profound and far-reaching. Taken together, what
they suggest is a shift in perspective that can expand the focus in a wide range of organizational
concerns:
A force to be reckoned with
This shift in perspective is not an either/or choice, but an additional dimension. Rather than a
recipe about what to do, this perspective works as an awareness, as a sensitivity to the subtleties
of practice, as a way of approaching problems and looking for situation-specific solutions.
Communities of practice are not good or bad in themselves. They can be a source of
problems-such as exclusion, inbreeding, narrowness-as much as a key to solutions. But if one is
concerned with learning, they are a force to be reckoned with.
It may be tempting to assume that the learning of an organization either is the sum of the learning of individuals, or that it consists in documentation placed in institutional repositories such as manuals, information systems, or business processes. By overlooking the need for shared practice and the importance of informal communities in sustaining learning, organizations can unwittingly undercut the very processes by which they can become effective learning organizations.
ETIENNE WENGER, PhD is a senior research scientist at the Institute for Research on Learning in Menlo Park, California, and the author of several books and articles on learning. The ideas in this article are drawn from his forthcoming book, Communities of Practice, to be published by Cambridge University Press later this year. The Institute uses concepts and methods derived from anthropology, sociology, psychology, and computer science to understand how learning takes place in organizations.