Communities of Practice as a Professional and Organizational Development Strategy in Local Public Health Organizations in Quebec, Canada: An Evaluation Model

A crucial issue in the public health sector is that of professional development for a workforce in a context of change – change both within public health itself and in the setting in which it operates. New approaches to intervention, emerging problems and new ways of organizing services present challenges that, more than ever, demand updating of practitioners' and managers' skills (Frenk and Gonzalez-Block 2008; Paccaud 2011). Such a changing landscape has significant repercussions for the workforce, and questions are raised about professionals' capacity to adapt (Amodeo 2003; Scharff et al. 2008). For many years, efforts have been made to develop means to support public health professionals within such a context (Calhoun et al. 2008; Gebbie and Turnock 2006; Scharff et al. 2008). Continuing education plays a key role in this regard. Koo and Miner (2010) have presented an analysis of the issues in professional development in public health and provided a framework for guidance based on the latest knowledge in adult education. They point to the need for a number of elements, including access to training outside academic settings; reflexive learning grounded in the day-to-day experience of the workforce and the problems it faces, involving situations as complex as those encountered in practice; and programs focusing on results considered as meaningful and tangible by learners. A number of the points they enumerate are reflected in CoP, a professional and organizational development approach that has already been widely implemented in management and education settings (Fontaine and Millen 2004; Wenger 1998) and that could prove a promising avenue for public health. Drawing on the CoP model, a team from Montreal's Direction de sante publique (DSP; Public Health Department) recently developed and introduced a professional development strategy to support local public health teams in the Centres de sante et de services sociaux (CSSS; Local Health and Social Services Centres) in its territory. In accordance with Quebec's most recent health system reform (2005), CSSSs pertain to the local level of the public health network. They have been assigned responsibility for their population and, accordingly, must formulate local action plans to implement the innovative models put forward in provincial and regional plans (Ministere de la sante et des services sociaux 2004). The regional authority is called upon to establish support systems for the CSSSs in their new public health responsibilities. The purpose of this paper is to describe one such initiative, Health Promotion Laboratories, and to situate them as a type of CoP focused on professional and organizational development. A further purpose is to present the conceptual model that was developed to evaluate the labs and to discuss their potential for the advancement of knowledge and practice in public health.