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Abstract
Background A community of practice (COP) is an important element of a learning organisation. The weekly medical postgraduate meeting served as a COP forum in Medway Maritime Hospital, but its effectiveness was limited by low attendance. Published literatures showed barriers against successful COP can occur at multiple levels, therefore these barriers must be understood within the context of a complex organisation. In a complex system, the ’correct answer’ often cannot be deduced, therefore an experimental approach is required for effective leadership.
Aims This project aimed to describe the barriers against attendance at postgraduate meetings within the context of a complex organisation. The project would inform discussion in Trainee-in-action committee meetings, and generate solutions to improve attendance at postgraduate meetings.
Methods The author conducted semi-structured interviews with 11 doctors of various grades. Qualitative thematic analysis was performed, with anticipated themes based on the elements in the McKinsey 7S model (Figure 1a). The themes were modified and merged as driven by narratives from the interviews.
Results Five interconnected themes emerged from the analysis, describing barriers against attendance at postgraduate meeting in this complex system. They were ‘A hospital in crisis’, ‘A stretched workforce’, ‘Unfulfilled learning needs’, ‘Hierarchy and power’, and ‘From conflict to alignment’ (Figure 1b).
Impact A series of interventions were derived to address the identified barriers. These included a poster campaign, lobbying Foundation Programme directors for support, and scrutinising meeting content to ensure its relevance to a general medical audience. The mean monthly attendance doubled between the start of this project (December, 2016) and May, 2017.
Conclusion Using the McKinsey 7S model, this project revealed that barriers against attendance at postgraduate meetings were interconnected to multiple elements of the organisation. This placed the challenge in the complexity domain, prompting leaders to adopt emergent and experimental approaches when formulating action plans.
a) McKinsey7S model b) Final themes after refining, merger, and relabelling