Communities of Practice and Innovation Diffusion in UAE Healthcare

Introduction and Statement of the Problem

"None of us is as smart as all of us." — David R. Bender, 2000, p. 5

Today, healthcare organizations are typically characterized by complexity, an enormous investment in infrastructure, and a multidisciplinary cadre of clinicians. These clinicians may or may not be receptive to innovations in technology and product development, depending in some measure on how their colleagues view those innovations. When efficient networks exist among healthcare practitioners, the data-sharing practices needed to communicate this type of information are improved and innovations may be more readily adopted on a widespread basis. According to Rogers (2003, p. 5), diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system. Communities of Practice are an example of such social systems.

For the diffusion of innovation to be effective in any Community of Practice (CoP) network, the synchronization of the factors of communication channels, rate of adoption, and characteristics of the social system—from both a social and communication structure perspective—must be taken into account. To the extent that these factors are in alignment with each other is the extent to which there is an effective diffusion of innovation (DoI), optimization of resource allocation, and the stability to create an ethical framework. When a CoP has attained this level of efficiency across these three dimensions, the tendency of its structure to create a learning ecosystem also begins to emerge (Chang & Harrington Jr., 937). Learning ecosystems help to minimize resistance to change by concentrating on assimilating knowledge through reciprocal sharing of insights, the creation of process-based taxonomies, and the development of governance frameworks for continual improvement and growth (Grossmeier, 346).

Purpose of Study

The main purpose of this dissertation was to develop timely and informed answers to the following guiding research question and sub-questions concerning the diffusion of innovation and its application in the UAE healthcare system:

RQ: Do social networks and communities of practice (CoP) exist in the UAE healthcare system, and can leaders be identified?

Sub-question 1: How can CoP data be used to improve the diffusion of new innovation between healthcare professionals?

Sub-question 2: How can pharmaceutical companies activate CoP networks to improve their resource allocation?

Sub-question 3: How can pharmaceutical companies harness the benefits of CoP within their ethical framework?

Importance of Study

Improvements in the competitiveness and productivity of nations today depend on the introduction and diffusion of innovation among firms (Vazquez-Barquero, 2002). The diffusion of innovation throughout healthcare organizations often begins in the knowledge management, support services, and decision support systems areas, due to these processes having a direct impact on quality of care (Wong, Legnini, Whitmore, & Taylor, 2000, p. 249). Moreover, researchers, theorists, and practitioners from many fields are interested in and affected by the diffusion of innovations within and across organizations, including organization development, education, management, healthcare and public health, information technology, and sociology. Many of these fields share an interest in organizational improvement, yet there is evidence that innovations often are not diffused within and across organizations to achieve that improvement (Lundblad, 2003, p. 50).

A few examples illustrate the issue and provide background for why diffusion of innovation is an important topic from both theoretical and practice perspectives. In healthcare settings, new clinical and process advancements are continuously developed in research and practice, yet these innovations often take years, if not decades, to spread into wide use (Lundblad, 2003). Process innovations are often low- or no-cost changes that a healthcare delivery organization can make—such as reminder systems, care pathways, and clinical guidelines—yet they still do not find their way into routine practice (Lundblad, 2003).

The propensity of a CoP to serve as the catalyst for creating greater levels of knowledge transfer and corresponding trust is also a key determinant in the productivity of healthcare communities throughout regions (Fuentelsaz, Gomez, & Palomas, 1172). From a more pragmatic perspective, in order for the UAE healthcare community to nurture and grow CoPs, there must be a concentration on knowledge sharing, the evaluation of new medical products (Carter, 20) to more efficiently and completely treat patients, and a recognition that continual improvement will require continual measurement as well (Inamdar, Kaplan, & Reynolds, 179).

Any CoP must also be outward-centered, attending to the unmet needs of professionals in the UAE healthcare community who seek to continually improve and learn. Any CoP, to stay relevant, must maintain this outward-facing set of priorities—not only regarding recently introduced medical technologies (Carter, 20) and their implications for broader technology acceptance and adoption (Bernstein, McCreless, & Cote, 17), but more importantly regarding their diffusion through the UAE medical community (Huesch, 1270). There must also be an element of environmental scanning for best practices and approaches that drive the greatest increases in efficiency in critical healthcare processes if the CoP is to grow in its value to members. In this regard, Lee and Valderrama (2003) note that "CoPs are created to connect individuals with a common interest, so they can exchange knowledge objects, best practices, and lessons learned" (p. 29).

In sum, for any CoP to be effective, there must be constant attention to learning and to allowing for the gradual diffusion of innovation based on the level of acceptance to change within the CoP itself. Inherent in this gradual diffusion of innovation is also the concept of a maturity model. Therefore, for any CoP to continually meet the needs of its members, a maturity model of diffusion must be created and fine-tuned over time so that the CoP will stay relevant, continually accumulating and sharing knowledge with its members.

Rationale of Study

Etienne Wenger provides a useful definition of communities of practice as groups of people who share a concern or a passion for something they do and want to learn how to do it better through regular interactions with each other. Communities of practice can provide the framework in which group members interact effectively with peers through rapid, technology-enabled communications to discuss timely issues of mutual concern in a collaborative effort to solve problems and obtain recommendations (Hemmasi & Csanda, 2009, p. 262). Consequently, mature communities of practice are capable of assisting organizations in making the transition from a traditional multidivisional, or M-form, organization into a more competitive learning, or L-form, organization (James, 2002).

According to Wenger (1991) and Hemmasi and Csanda (2009), the primary characteristics that identify a group as a community of practice include: (a) a recognized domain of interest that group members share and commit to, (b) relationships between group members that allow them to engage in joint activities, share information, and help each other, and (c) the development of a shared practice consisting of experiences, stories, tools, shared resources, and so forth. Likewise, Wesley and Buysse (2001) emphasize that, "Compared to other collaborative research-practice approaches that appear in the literature—such as action research or professional development schools—communities of practice may offer the most promise for altering the linear relationships through which information is handed down from those who discover the professional knowledge to those who provide and receive services" (p. 114).

The ability of practitioners to develop shared knowledge in these environments is not an automatic process; rather, it requires that community members actively engage in information-sharing processes that help consolidate and use available information in ways that define sets of best practices. Since the goal of such communities of practice is not static or restricted to a single area of investigation, the development and maintenance of communities of practice tends to forge enduring relationships among their membership, resulting in viable networks characterized by solid relationships and trust (Buysse, Sparkman, & Wesley, 263).

Moreover, CoPs develop their practice by improving the diffusion of innovation within their active networks; the benefits of such interactions are countless, especially in the field of healthcare. Specialty physician communities present an exemplary case for CoPs because they share the same practice, interest, and professional ethos. It is therefore instructive to study whether those CoP networks exist in the United Arab Emirates, whether they are active, and whether leaders can be identified. Collecting such data enables this project to measure whether the rate of diffusion of new innovations can be improved and, hence, be used by pharmaceutical companies in the UAE to improve their resource allocation—all within healthcare's ethical framework.