The search of electronic databases found 1,421 articles, of which 303 were related to CoPs (Additional file 2; Figure 1). A total of 182 articles were identified as primary studies, and a full review was conducted in 18 primary studies from the business sector [10–27] and 13 from the health sector [5, 28–39]. Most of the CoP-related papers were published after 1998, with a publication peak in 2003, after which time the numbers began to decrease (Figure 2). The reason for the decline was unclear, but it should be noted that a few critiques published after 2005 challenged the completeness and usefulness of the CoP for conceptualizing social learning and knowledge management [40–42].
Communities of practice in business
The term CoP emerged in business literature in the mid-1990s, but articles about social learning and knowledge management had already appeared in journals such as Harvard Business Review as early as the early 1990s [43, 44]. Most (77.8%) of the primary studies were conducted in the US (Additional file 3). The earlier studies focused on apprentice training, but the term was later used to describe a variety of groups, including formal training sessions [13], informal learning groups [14–16], multidisciplinary teams [17–19], and virtual communities [20–22]. Most studies cited Wenger [1–3], but one [23] referred only to Brown and Duguid [45], and one did not cite any of the seminal work [10].
In 1996, Henning studied refrigeration service technicians and documented the information exchange and mentoring that took place during informal gatherings [14]. In addition to learning and building a professional identity, new workers gained confidence in making work-related decisions. Similar findings were reported by Attwell on the experience of an apprentice in the train re-servicing industry [10]. Harris et al. also highlighted the importance of the interaction with mentors in the workplace, which helped new tradespersons make sense of contradictory information that they learned in the classroom [11].
A prominent characteristic of the business CoPs is a willingness to invest time and resources to facilitate activities for members to socialize. While some groups were encouraged explicitly by employers to connect with others on and off the job [14, 16, 17, 20, 22], others were provided with communication equipment to enable networking [21, 22]. Also, these groups tended to use a range of formal and informal activities. For example, Henning documented the on-the-job meetings and after-work telephone calls among refrigeration technicians [14], Robey illustrated the mix of formal face-to-face meetings and after-work social activities for workers of a soft goods manufacturing company who worked at different sites [22], and Benner described the organized monthly social outing of women working in the information technology companies [16].
Communities of practice in health care
Most (92.3%) primary studies of health sector CoPs were from the UK or the US. The term 'community of practice' began to surface in this field in the mid-1990s and was often used as a label for groups and teams, rather than a social learning concept. Learning, sharing information, and identity-building were the major focus of these groups, with situated learning and/or legitimate peripheral participation being the guiding concepts.
In 1995, Jenkins and Brotherton published a series of papers on the use of situated learning in the occupational therapy curriculum [46–48]. They argued that occupational therapists consolidate their knowledge and skills most effectively while practising in the clinical setting (i.e. a CoP), and recommended early clinical placements as part of the professional training [46–48]. In a later case study, Lindsay documented the growth of occupational therapy students as they practised applying clinical reasoning skills acquired from a seminar through working with mentors and patients [30]. As students gained experience and confidence in the clinical setting, they were advanced to more complex cases. This process, described by Lave and Wenger as legitimate peripheral participation [1], helped to shape students' career goals and identities as occupational therapists.
In nursing, Cope et al. also promoted the use of legitimate peripheral participation as a theory for students to gain skills and professional identity in their clinical placements [5]. The term 'communities of practice' began to appear in the medical literature around 2002 when Parboosing published an opinion article discussing the use of CoP groups to facilitate continuing professional development for physicians [49]. Also, Winkelman and Choo envisioned a CoP as an intervention for patient empowerment [50].
All the primary studies were published in 2000 or later, and the term CoP was used as a synonym for a group of health professionals who are working together. Some authors even argued that a cohesive multidisciplinary team with a clear sense of identity was a CoP [51]. We found that 12 of the 13 primary studies cited Wenger and colleagues' definition of a CoP; however, the actual structure and function of these groups varied greatly. Examples of CoP groups include (Additional file 4): clinical placements where students interacted with and learned from expert practitioners [5, 30, 52], informal learning groups (e.g. journal clubs [32]), health care agency collaboratives that aimed to achieve a common goal (e.g. to improve primary care for older people [33]), and virtual communities where practitioners from different sites discussed work-related issues [35–38]. Grounded in situated learning and legitimate peripheral participation, studies on clinical placements and apprenticeship tended to focus on students' acquisition of knowledge, skills, and professional identities. However, in groups that focused on information-sharing/-creation, CoP was primarily used as a managerial tool for continuing professional development and improving quality of care, rather than identity development.
Compared to the business sector CoPs, the health care CoPs focus mainly on fostering social interactions at the workplace or during task-oriented activities (e.g. a journal club). Four studies described the use of information technology for members to hold informal discussions and formal meetings [35, 36, 38, 53], but we did not find any study that supported off-the-job social outings.
Shared characteristics of communities of practice in business and health care
The structures of CoP groups in business and health sectors are summarized in Additional files 5 and 6 respectively. Learning and sharing information through socialization appeared to be the central characteristic of CoP groups. We found all groups demonstrated, to varying degrees, the following characteristics:
-
1.
Social interaction – Interaction of individuals in formal or informal settings, in person or through the use of communication technologies.
-
2.
Knowledge-sharing – The process of sharing information that is relevant to the individuals involved.
-
3.
Knowledge-creation – The processes of developing new ways to perform duties, complete a task, or solve a problem.
-
4.
Identity-building – The process of acquiring a professional identity, or an identity of being an expert in the field.
The knowledge-sharing/-creation CoPs and apprenticeship CoPs emphasized different points, with the latter being focused more on identity-building (e.g. student nurses learning to be a nurse, or new technicians learning to be an expert). Also, it appeared that the mature and cohesive groups tended to include processes that address all four characteristics [14, 35, 37, 54], while the newer groups tended to invest more in activities that encourage social interaction and knowledge-sharing, but less in identity-development or knowledge-creation activities. Also, knowledge-creation was rarely a focus in the apprentice training because the goal was to learn existing skills rather than to develop new ones. While the process of knowledge-sharing could be observed in all CoP groups, the benchmarks for the other three characteristics were less clear in the emergent and maturing CoPs.
Responsibilities of facilitators
A number of studies from both sectors highlighted the importance of facilitators, and some linked the success and failure of the CoP to this role [15, 16, 20, 24, 30, 32–36, 38, 55]. However, the actual responsibilities of facilitators and the organizational support required for this role were less clear in the literature. For example, some facilitators played a distinct role from that of the leader and conducted their activities under the direction of the group and/or the leader [34, 35, 38], while other groups merged the role of the leader and facilitator [32, 55]. The choice of management structure appeared to depend on the size of the group and the availability of human resources. Which model best suited which type of organization was unclear, but facilitator fatigue was mentioned as something that could lead to the downfall of CoP groups [32].
Power relationships within communities of practice
Ambiguity was observed in the power relationships among CoP members. In the apprenticeship CoPs, the hierarchy of power was usually clearly defined by the roles of mentor-mentee or expert-novice. New practitioners moved from the periphery to a position of full participation as they developed their knowledge and skills by learning from skilled practitioners. Those with full participation would play a greater role, and subsequently had more power to direct the group's activities. In contrast, the power relationship was less clear in the non-apprenticeship CoPs. The inherent assumption was that members of a CoP are naturally collegial, honest, and respectful of each other, and that they put aside their personal agendas for the common good. However, in the non-apprenticeship CoPs, members may not necessarily develop beyond a position of peripheral participation (i.e. they remain as learners/observers rather than contributors), and so learning and negotiation of meaning may continue to be only a reflection of the dominant source of power. This could therefore affect the effectiveness of the group when completing a task or achieving a goal.
One example of people remaining in peripheral participation over the evolution of a CoP group, and therefore of power imbalance, was the multi-stakeholder collaborative in the health sector reported by Gabbay et al. [34]. This group was formed to develop health care policies for elder care. Group members participated in scheduled meetings that were organized and facilitated by an experienced librarian. However, despite the facilitator's best efforts, the discussion was often dominated by the opinion and agenda of only a few members. As the group evolved, members like physicians, experienced nurses, and representatives from the health authority were entrusted with more power, and their opinions were valued more by the rest of the group. This subsequently affected the policy development, and some key decisions were based on individuals' experience and preferences rather than the evidence.
Effectiveness of communities of practice in the health sector
CoP research in the health sector focused mainly on the exploration of how people shared information, created knowledge, and built a professional identity in a social setting. Researchers predominantly used in-depth interviews and participant observations (Additional files 3 and 4). Action research methods, in which participants were involved in the development, growth, and evaluation of the group, were also used [33, 34, 37]. In this review, we did not find any paper in the health sector that met the eligibility criteria for the quantitative analysis (Additional files 3 and 4); and so the effectiveness of CoP in this sector remained unclear.
