Volume 8 no 3

Development of a provincial medical affairs community of practice

Daniel P. Edgcumbe, MB BChir, and Lisa Harper

Daniel P. Edgcumbe, MB BChir, and Lisa Harper

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Development of a provincial medical affairs community of practice

Daniel P. Edgcumbe, MB BChir, and Lisa Harper

 

The term “medical affairs” describes functions undertaken by health care organizations in Canada in support of their relations with credentialed staff, such as physicians, dentists, midwives, and certain extended-class nurses. These credentialed staff are generally appointed by the board of directors of their organizations and operate under their own bylaws, rules, and regulations. Despite the importance of medical affairs, in Ontario, little has been done to connect these functions across health care organizations, even though there are significant potential benefits from doing so. In this paper, we describe the development of a provincial community of practice (CoP) for medical affairs. We briefly review fundamental concepts relating to CoPs, consider their relevance to health care and medical affairs in particular, and discuss the use of technology to support CoP development. The intention is to share our learning with others, so that they might consider establishing their own CoP, as well as to offer some practical advice on the implementation of virtual CoPs.

 

KEYWORDS: community of practice, medical affairs, medical administration, virtual, technology

 

Edgcumbe DP, Harper L. Development of a provincial medical affairs community of practice. Can J Physician Leadersh 2022;8(3):94-98

https://doi.org/10.37964/cr24755

 

Communities of practice (CoPs) are “groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis.”1 According to Wenger,2 there are three fundamental elements of a CoP: the domain (“the area of knowledge that brings the community together”), the community (“the group of people for whom the domain is relevant”), and the practice (“the body of knowledge, methods, tools, stories, cases, documents, which members share and develop together”). For any CoP, there is an emphasis on practical application in the real world.2

 

Key characteristics shared by CoPs include: a purpose to develop members’ capabilities and to build or exchange knowledge; a self-selected membership group, who are bound together by passion, commitment, and identification with the group’s expertise; and an indefinite timescale that lasts as long as there is interest in maintaining the group.3 These features distinguish them from other forms of organizing work, such as formal work groups, project teams, and informal networks.

 

In health care there is significant variation in how and why CoPs are established. However, their common goals can be considered in terms of exchanging learning, information, and knowledge or sharing and promoting good practice-/evidence-based procedures.4 CoPs can use technology in support of these goals, to “create a sense of togetherness over time and across distances.”5 Although technology can be an enabler, its use alone does not create a CoP. As Smith et al.6 point out, although current advances in technology are an asset to the endeavour, “merely establishing an electronic site to host distributed members of an existing or aspiring CoP to engage with each is no guarantee of its success.” Nevertheless, certain features, such as enabling asynchronous discussion through online forums, can support reflective practice, problematizing, and the generation of communal knowledge and resources.6

 

The ability to create a virtual CoP is particularly valuable in circumstances where potential members are geographically distant from each other, where competing priorities mean that synchronous collaboration is challenging, or where there are restrictions limiting face-to-face meetings (such as during the COVID-19 pandemic). All of these are relevant to the province of Ontario.

 

The Ontario context

 

In Ontario, formal responsibility for the quality of care in hospitals rests with hospital boards.7 Hospital care is delivered by hospital corporations, which, according to Tenbensel et al.,8 remain as “private, albeit mostly not-for-profit entities with their own independent board.” The same authors argue that Ontario has historically had a “highly disaggregated structure of Local Health Integration Networks, independent hospitals, multiple organisational and funding models of primary care.” As of 2014, there were 155 public, private, and psychiatric hospital corporations in Ontario operating on 238 sites.9 Corporations range in size and scope from large, multi-site academic hospitals to single, small rural sites.

 

Within these corporations, physicians (along with dentists, midwives, and certain extended-class nursing staff) usually form a group of “credentialed staff”, who are given privileges to use hospital resources in return for providing care to hospital patients.10 Credentialed staff are not typically employees of the hospital but are appointed by the board of directors. Appointment processes operate in accordance with the Public Hospitals Act11 as well as each corporation’s bylaws, rules, and regulations. Following initial appointment, credentialed staff are subject to an annual reappointment process. In contrast, other members of the staff are employed by the hospital and managerial control is exercised through organizational policies and procedures, under the umbrella of broader employment legislation. Because credentialed staff typically operate under an entirely different framework from other staff associated with the hospital, they require a specialized management function, commonly termed “medical affairs” or “medical administration”.

 

As care providers, credentialed staff are critical to the delivery of patient care. It is increasingly recognized that their experience as care providers is also important to ensure that they can provide high-quality care. The Triple Aim concept proposed that, for health systems to be effective, they need to improve patient experience of care, the health of populations, and reduce the per capita cost of health care.12 Sikka and colleagues13 contend that unless care providers experience joy and meaning at work, the objectives of the Triple Aim can be undermined; this led them to formulate a Quadruple Aim, incorporating the additional concept of provider well-being.

 

Despite the importance of medical affairs functions and the clear relationship between credentialed staff and the delivery of patient care, in Ontario, there is a paucity of opportunities for medical affairs departments to learn from each other. Despite the similar nature of the work they do, they often function in isolation. This can lead to departments spending time accomplishing tasks without the benefit of prior learning or experience. It can also result in unnecessary redundancy and duplication of well-worn processes.  Such inefficiency can detract  from the core business of supporting credentialed staff, with consequent impairment of patient care.

 

Therefore, establishing a CoP can bring value to those working in medical affairs and improve the care provided to patients and their families. Through participation in a CoP, organizations will be well placed to provide the best possible support to credentialed staff, which, in turn, will enable them to deliver safe, high-quality care. It is in this context and with these objectives in mind that we sought to establish a CoP to connect those working in medical affairs in the numerous hospital corporations throughout the province.

 

Conception of a medical affairs community of practice

 

LH began working in medical affairs in 2017. She had a background in research and was surprised to find that the interconnectivity and sharing that characterize academia were largely absent in medical affairs. She created a shared list of contacts in Ontario to help medical affairs professionals reach out to one another when they had a question or wanted to know how other organizations addressed a variety of topics. Although this was useful, she concluded that it did not fully meet the needs of medical affairs professionals, particularly with respect to broader sharing of ideas and resources or providing opportunities for collaboration.

 

During recent work on medical leadership development at Halton Healthcare, DE undertook an environmental scan of hospital organizations in Ontario. In conversations with partner hospitals, he soon realized that individual organizations were often left to their own devices, despite a clear appetite on the part of those working in medical affairs to be more connected.

 

Based on LH’s conclusions regarding the contrast with her academic experience and DE’s findings of the views of medical affairs departments, we determined that there could be utility in establishing a CoP for medical affairs. Following discussion with medical affairs leaders at other hospital organizations (Providence, the Ottawa Hospital, Oak Valley Health, and Humber River Hospital), the Ontario Medical Affairs Community of Practice (OMACOP) was conceived.

 

OMACOP has become a network for professionals who are responsible for the administrative management of credentialed staff. In keeping with the principles defining a CoP, it is a grassroots initiative, with no hidden agendas. It was established solely for the benefit of the community and to give members a place to connect, learn together, share resources, ask questions, and explore solutions to challenges. Membership is free and open to anyone working in medical affairs across Canada. Members have access to a lively and active online forum, as well as the opportunity to participate in regular OMACOP meetings. Although the community began with a focus on Ontario, it may be of interest to those in other provinces and territories as well.

 

Development of the community of practice

 

In October 2021, we created a public-facing website and discussion board. The inaugural virtual meeting of OMACOP took place in November 2021, with more than 40 participants from a range of organizations across the province. The director of medical affairs from the Ottawa Hospital presented an approach to medical human resources planning. Breakout sessions on various topics were facilitated by OMACOP members, including hospital on-call coverage, contract management, disruptive physician behaviour, and mandatory education for physicians. In March 2022, a second virtual meeting included presentations on the Ontario Hospital Association’s Credentialing Toolkit, as well as lessons from medical affairs in Alberta. Slide decks from meetings are posted on the discussion board and remain available as a resource to members.

 

Virtual meetings are evaluated using a survey. Participants are asked to provide feedback on meeting duration, time allotted for discussion, quality of discussion, topic coverage and scope, presentations, and documents provided. Participants are also encouraged to suggest other potential topics for future meetings and to provide comments. This process creates a continuous feedback loop, ensuring that future meetings include topics that are timely and relevant to the community.

 

The online discussion forum is evaluated using analytics features built into the forum software. This provides several metrics of engagement, including new user signups, number of discussion topics, number of posts, and number of daily engaged users. Activity metrics include page views, user visits, and time to first response to posted questions.

We currently have 56 members from across the province. In a 30-day period between February and April 2022, there were 128 user visits, 1400 page views, and a time to first response of one hour.

 

Feedback has been positive to date, confirming the value of the CoP. The evaluation approach will continue to evolve to best determine how well the CoP approach is working to build relationships and foster collaborative work between its members.

 

Lessons learned

 

As in the case of any collective, it is helpful to establish a small coalition of those who are willing to work at getting the CoP up and running. Having a shared sense of purpose and vision is essential. Ensuring that the coalition has members who can contribute in diverse ways will also increase the chance of success. For example, LH already had an extensive network of contacts in medical affairs throughout the province, which enabled a fast call out for potential members of the CoP. DE contributed technical expertise, including setting up the online discussion forum and website. All members of the coalition provided unique perspectives, which were essential in considering topics for discussion and in contributing to the broader development of the CoP, including planning and reviewing evaluations and identifying potential speakers for the virtual meetings.

 

The use of technology allows for the creation of a virtual CoP that can overcome geographic barriers. With only modest technical expertise, it is possible to use open-source software to establish a virtual platform for a CoP at very low cost. In our case, Wordpress (an open-source content management system) was used to quickly create a public-facing website using existing webhosting. The online discussion forum for members uses Discourse (open-source software), which was deployed on a cloud-based server through DigitalOcean (DigitalOcean, Inc., New York, USA). Discourse provides a secure, user-friendly, and easily administered forum, which has now largely replaced the unwieldy emails with large numbers of copied recipients. It permits the sharing of documents, so that members can exchange policies, procedures, and terms of references with ease. Feedback surveys are created using REDCap (developed at Vanderbilt University), which is available free of charge to institutions for non-commercial research purposes and is widely used in academic centres around the world.

 

Providing a variety of opportunities for engagement can also strengthen a CoP by allowing community members to contribute in the way that best meets their needs. Virtual meetings are helpful in providing a focus for discussion and information-sharing and fostering a sense of community. Many CoP members also benefit from asynchronous discussion through the online forum, which allows them to quickly get answers to questions that arise in their day-to-day work. The online site provides archival value giving members access to thematic data. This is important because members can search previously discussed topics online, eliminating the need to send out large group emails to ask questions that may have been previously answered.

 

It is also important to choose appropriate evaluation techniques for the engagement approaches. Although more traditional methods, such as formal feedback surveys, work well for in-person meetings, a different approach is needed to evaluate the utility of online discussion forums.

 

Conclusion

 

Although a CoP is ultimately dependent on the participation and engagement of its members, it also requires at least some dedicated leadership to get established. The use of technology can facilitate connections between community members, transcending geographic and other barriers. Evaluation metrics should be chosen to reflect the engagement approaches. We hope that others will be able to learn from our experience and consider establishing their own CoPs in areas of common interest.

 

Finally, we invite all medical affairs professionals across Canada to join our community and become active members of OMACOP. In sharing knowledge, expertise, and best practice, we can support the transformation of health care. Interested individuals can learn more and join through the website at https://omacop.ca/

 

References

1.Wenger E, McDermott R, Snyder WM. Cultivating communities of practice. Boston: Harvard Business School Press; 2002.

2.Wenger E. Knowledge management as a doughnut. Ivey Bus J 2004;Jan/Feb. Available: https://tinyurl.com/37sapj88

3.Wenger EC, Snyder WM. Communities of practice: the organizational frontier. Harv Bus Rev 2000;78:139.

4.Ranmuthugala G, Plumb JL, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Serv Res 2011;11.1:1-16. https://doi.org/10.1186/1472-6963-11-273

5.Wenger E, White N, Smith JD, Rowe K. Technology for communities. In Langelier L. (ed.). Working, learning and collaborating in a network: guide to the implementation and leadership of intentional communities of practice. Québec: CEFIRO; 2005. pp. 71–94.

6.Smith SU, Hayes S, Shea P. A critical review of the use of Wenger’s community of practice (CoP) theoretical framework in online and blended learning research, 2000-2014. Online Learn J 2017;21(1):209-37. Available: https://files.eric.ed.gov/fulltext/EJ1140262.pdf

7.Baker GR, Denis JL, Pomey MP, MacIntosh-Murray A. Designing effective governance for quality and safety in Canadian healthcare. Healthc Q 2010;13(1):38-45. https://doi.org/10.12927/hcq.2013.21244

8.Tenbensel T, Miller F, Breton M, Couturier Y, Morton-Chang F, Ashton T, et al. How do policy and institutional settings shape opportunities for community-based primary health care? A comparison of Ontario, Québec and New Zealand. Int J Integr Care 2017;17(2):13. https://doi.org/10.5334/ijic.2514

9.Hospitals. Questions and answers. Toronto: Ontario Ministry of Health and Long Term Care; 2014. Available: https://tinyurl.com/24fpzf2s

10.Dewhirst K. Professional staff credentialing toolkit (2nd ed.). Toronto: Ontario Hospital Association; 2021. Available: https://tinyurl.com/ypksxxjw

11.Public hospitals act, RSO. 1990, c. P40. Available: https://www.ontario.ca/laws/statute/90p40

12.Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff 2008;27(3):759-69. https://doi.org/10.1377/hlthaff.27.3.759

13.Sikka R, Morath JM, Leape L. The quadruple aim: care, health, cost and meaning in work (editorial). BMJ Qual Safe 2015;24(10):608-10. https://doi.org/10.1136/bmjqs-2015-004160

 

Authors

Daniel P. Edgcumbe, MB BChir, is vice president medical affairs, Halton Healthcare, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, and an assistant clinical professor (adjunct) in the Department of Family Medicine, McMaster University.

 

Lisa Harper is senior director of Medical Administration, Strategy and Transformation, Oak Valley Health, Markham, Ontario.

 

Conflicts of interest: The authors have no conflicts of interest to declare. No funding was provided for preparation of this article.

 

Correspondence to:

dedgcumbe@haltonhealthcare.com

 

This article has been peer reviewed.