A Self-Organizing Group Within a Hierarchical Organization

Abstract

This study was conducted to discover and describe the characteristics of a community of practice (CoP) and the health care system within which it formed. The study explored the relationship between a CoP of primary care physicians and a health care system that was both a hierarchical organization and a complex adaptive entity. It further examined the impact that relationship may have had on the organization’s sustainability within its environment. A qualitative approach was used for the collection and analysis of data. Semi-structured interviews were conducted with four members of the CoP and three members of their administrative hierarchy. There were two aspects to the data analysis: (a) development of themes emerging from interviews aligned with each of the research questions and (b) application of fractal narrative analysis to examine the degree to which each of the interviewees’ responses contained content that was self-similar such that each contributed to the picture of the whole organization. Findings illustrated the application of numerous complexity characteristics. These included (a) attractors that influenced the formation and continued cohesiveness of the CoP and fostered a dynamic tension in the relationship between the CoP and its administrative hierarchy, (b) sensitive dependence found in retrospect when the impact of the attitude and behavior of administrators was looked at in relation to the evolution and political influence of the CoP, (c) phase transitions and fitness peaks that characterized the journey of the CoP, and (d) fractality which revealed a strong alignment of values and beliefs between CoP members and administrators, creating a cohesive picture of the whole organization, but divergence in the two groups’ approaches to realizing them