By: Veronica Carey, PhD, CPRP (College of Nursing and Health Professions, Drexel University); Rita Adeniran, DRNP, RN, CMAC, NEA-BC, FNAP, FAAN (College of Nursing and Health Professions, Drexel University); Kimberly McClellan, EDD, MSN, CRNP, WHNP-BC, FNP-BC (College of Nursing and Health Professions, Drexel University)

Communities of Practice (Lave & Wenger, 1998) are groups of varied persons who share community through a passion or concern for what they do, what they learn, and how to do it better. The learning occurs with intentionality and surprise. Lave and Wenger (1998) shared that a Community of Practice (COP) cannot occur without a domain, community, nor practice. The 2021 Mandela Washington Fellows are competent and lauded professionals, from various parts of Africa, who came together to share their experiences, build a sense of camaraderie, and dialogue about how to meet the needs of the marginalized individuals in their respective countries. The Fellows typified domain, community, and practice.

Experienced and emerging leaders must continuously acquire new knowledge and competencies to enhance their ability to innovate and successfully address their workplace and society's challenges (Case & Śliwa, 2020; Sonnino, 2016). While no leader can accurately predict the future, all leaders must prepare to deliver excellence in the ever-evolving, fast-paced, and complex healthcare and business environments. Preparation includes developing the skills to think strategically within local and global contexts, acquiring the ability to inspire and articulate a shared vision,  crossing cultures, and boundaries with competence, and making intelligent choices amid everyday constant uncertainty. The 2021 Mandela Washington Fellows who participated in the Health COP were offered varied learning opportunities and exercises to strengthen their capacity to exert leadership. While the lessons focused on the healthcare industry, the concepts are relevant to other business environments.  Content of the exerting leadership section of the program  included the operationalization of the below four concepts:

• Making Leadership Happen
• Collective intelligence
• Boundary Spanning Leadership
• Polarity Management

One of the primary responsibilities of a leader is to make leadership happen by creating and sustaining an environment that maximizes collaboration among all stakeholders (McCauley, 2014). Leaders can make it possible for individuals to collaborate willingly and effectively through inclusive strategies, decisions, and actions (Rosen et al., 2018). The lessons on collective intelligence, boundary-spanning leadership, and polarity management equipped the 2021 Mandela Washington Fellows with new leadership tools and a framework to inspire teams to think collaboratively and participate more fully in a shared process that often leads to breakthrough greatness.

“People who share a concern…or passion…and who deepen their knowledge and expertise by interaction on an ongoing basis” (Wenger et al., 2002).  This is the scholarly definition of a COP.  It is also the description of the faculty, Fellows and associates of the Mandela Washington Fellowship.  Although 2021, drove us once again into the virtual world, the paramount global issue of inequity in care continues to be a formidable barrier to wellness.  This barrier is one which change-leaders and their faculties must combat with creative solutions, inclusive-community participatory intervention and cultural congruence.  The transition toward a more inclusive definition of wellness and a “heard” community voice must occur.  This was the shared mission of this COP!  It was the pleasure of the faculty of the Health & Medicine COP Sessions to facilitate discussion in the purpose of a community’s self-defined wellness, congruent cultural practice and the importance of each community member’s “story” of safety and hope.  It was also common practice in this COP for participating faculty, Fellows and associates to share their own “story”, meaning and reflection on such phenomena.  However, challenging this work may be, for this faculty member it is the reflection, check on positionality and realized meaning of humanity that keeps it sustainable. 

Social determinates of health impact every nation in the world (CDC, 2021). The determinants are in areas where persons live, learn, work, and socialize and affect the degree of health disparities and health inequities that exist in the world. The determinants impact the quality-of-life risks for persons and the wide range of health outcomes. Behavioral/Mental health is considered a social determinant of health and was a strong consideration in the preparation of the Health COP presentation for the Mandela Washington Fellows to explore for attribution to their respective fields of study. In other words, how does behavioral health impact the roles of surgeons, social workers, registered nurses, domestic violence advocate, gender violence worker, and infectious disease doctors to say the least. In order to have gains in these, and other fields, attention to family, finance, and infrastructure also must be addressed and these are also social determinants of health. The Upstream/Downstream analogy was used to have Fellows identify why their respective fields are necessary but are viewed differently in the community (Nessa, 2016).  It was the hope of the Health COP presentation to bring to the attention of the Fellows, the social determinants of health, to further the goals for groups such as adolescents, pregnant women, trans persons, children with ostomy, and overall public health scope.

The Mandela Washington Fellows in the Health COP understood that solutions o complex health and healthcare problems encompass effective leadership. Strategies must include but are not limited to recognizing the influence of social determinants of health as the etiology of several disease conditions. Other factors comprise the impact of behavioral health on clinicians, gender inequality, inequities, and barriers to collaborating across sectors. Leaders are responsible for setting direction, creating alignment, and gaining commitments from stakeholders to achieve organizational priorities.  In the same token, leaders must manage complexities, paradoxes, and complex dilemmas that are ever-present in healthcare organizations and delivery systems.  Leaders can maximize outcomes by leveraging the collective intelligence of stakeholders across boundaries.  Boundary-spanning leadership and polarity management offer leaders a framework to break down silos, accelerate collaboration, and strengthen organizations' capacity.  It was encouraging and heartening to listen to the Fellows who attended the  July 22, 2021, synchronous session. Each Fellow confidently shared what and how they are breaking down barriers and numerous inequities and inequalities in their various communities across Africa to advance health and healthcare.  The faculty members who developed the Health COP curriculum for 2021 Mandela Washington Fellows are confident that the content will motivate and empower the Fellows to accelerate their leadership impact.

The Mandela Washington Fellowship is a program of the U.S. Department of State with funding provided by the U.S. Government and administered by IREX.  Drexel University is a sub-grantee of IREX and implemented a Leadership Institute as a part of the 2021 Fellowship.  For more information about the Mandela Washington Fellowship, please visit the Fellowship’s website at www.mandelawashingtonfellowship.org  

References

Case, P., & Śliwa, M. (2020). Leadership learning, power, and practice in Laos: A leadership-as-practice perspective. Management Learning, 51(5), 537-558. doi:10.1177/1350507620909967

CDC (2021). https://www.cdc.gov/socialdeterminants/index.htm

Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. United Kingdom: Cambridge University Press.

Lave, J., & Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. Perspectives on Socially Shared Cognition, 2, 63-82.

McCauley, C. (2014). Making Leadership Happen. https://cclinnovation.org/wp-content/uploads/2020/02/making-leadership-happen.pdf

Nessa, B.S. (2016). What are the definitions of upstream and downstream determinants of public health. Public Health & Community Health, East Carolina University.   https://www.quora.com/What-are-the-definitions-of-upstream-and-downstream-determinants-of-public-health

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American psychologist, 73(4), 433-450. doi:10.1037/amp0000298

Sonnino, R. E. (2016). Health care leadership development and training: progress and pitfalls. Journal of healthcare leadership, 8, 19-29. doi:10.2147/JHL.S68068

Wenger, E., McDermott, R., & Snyder, W. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston, MA: Harvard Business School Press.