Review: Talking about alcohol: communities of practice and patient pathways

Abstract

It is encouraging to read a paper that tackles some of the very real and complex issues at the sharp end of delivering health care – working with clients with multi-morbidities, in challenging contexts and receiving care and support from multiple agencies. Integrated care is high on the list of policy priorities (National Collaboration for Integrated Care and Support, 2013); the authors have helped to shed light on the issues and challenges faced in attempting to deliver on this agenda. The paper adopts the theoretical lens of communities of practice to study an initiative set up to try and reduce alcohol-related hospital attendance. The working group established to address this issue is the focus of the inquiry. Reading between the lines, the authors imply that the working group came to function as a community of practice, fulfilling the criteria identified by various authors (e.g. Lathlean and le May, 2002; Wenger, 1998) such as a common purpose, a sense of belonging and shared practice. How a group that was ostensibly set up as a project group made the transition to a functioning community of practice is less clear and is an area that would be interesting to explore in some more detail (Kislov et al., 2011). A real challenge to working effectively in an inter-professional, inter-agency setting is managing the boundaries that exist and which act as barriers to knowledge sharing and joint action. The literature on communities of practice (Wenger, 1998) discusses various boundary-spanning activities that can help in this process, including, for example, the use of knowledge brokers, boundary objects and boundary interactions. Again, specific examples of how the group being studied addressed boundary issues during the course of their work would have provided some useful insights. Towards the end of the paper, the authors indicate that organisational changes to primary health care in the National Health Service had an impact on the community of practice, which raises an important question about the relationship between communities of practice and the organisational and health system context in which they are embedded. Increasingly, collaborative approaches are being proposed to tackle a range of issues facing health care systems in the present day. These include large-scale collaborations to accelerate and ease the translation of best evidence into service delivery and clinical practice,