American Association for Physician Leadership

Problem Solving

Culture and Communities of Practice in Changing Times

Peter B. Angood, MD, FRCS(C), FACS, MCCM, FAAPL(Hon)


Defining the culture for any organization or institution can be markedly difficult, occasionally framed simply as “the way we do things around here.” But the pandemic has created evolving differences in how our healthcare industry considers its cultures and the communities of practice. Physician leaders have the opportunity to help reshape these healthcare cultures.

As we grow and age, we engage with or aspire to become a part of a multitude of cultures and communities. Do you have a current community or culture vital to your well-being and identity? Do you remember your initial awareness of culture or community?

Familial and ethnic cultural backgrounds are clearly important, but what I am considering here are the cultures and communities separate from our heritages that provide us with a place of learning, personal happiness, and individual character.

For example, beyond medicine, I most often identify with the outdoors or athletic communities and the cultural habits within them. This manifests itself in the types of activities I learn, follow, or participate in and includes the style or brands of clothing and equipment I purchase. And I must say there is way too much equipment in my gear closet nowadays as a result. But that story is for another day... .

The medical profession is both a culture and a community of practice, and within our profession, there are numerous sub-cultures and unique communities of practice. The pandemic has significantly shifted our culture, our profession, our industry, and our communities of practice. Similarly, the non-medical society has shifted its view of healthcare and its expectations for receiving optimal care.

How we now adapt and change is foundational for future directions of physician leadership.

What Is A Culture?

Says Nicki Lisa Cole, PhD,(1) “Culture is one of the most important concepts within sociology because sociologists recognize that it plays a crucial role in our social lives. It is important for shaping social relationships, maintaining, and challenging social order, determining how we make sense of the world and our place in it, and in shaping our everyday actions and experiences in society.”

Culture, Cole says, is a term that “refers to a large and diverse set of mostly intangible aspects of social life. It is composed of both non-material and material things…”

Sociologists, Cole says, define the non-material aspects of culture as “the values and beliefs, language, communication, and practices that are shared in common by a group of people.” Further, she says, “Material culture is composed of the things that humans make and use. This aspect of culture includes a wide variety of things, from buildings, technological gadgets, and clothing, to film, music, literature, and art, among others….”

Cole explains that culture is important to sociologists because it plays a significant role in the production of social order. “Social order refers to the stability of society based on the collective agreement to rules and norms that allow us to cooperate, function as a society, and live together (ideally) in peace and harmony. Culture is distinct from social structure and economic aspects of society, but it is connected to them — both continuously informing them and being informed by them.”

Community Vs. Community of Practice

A community is a social group whose members have something in common, such as a shared government, geographic location, culture, or heritage. More generally, according to, community can refer to a group that shares some trait or quality that separates it from the wider population.

Social theorists Etienne and Beverly Wenger-Trayner(2) describe a community of practice as a group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. These communities have been around for as long as human beings have learned together. They explain, “at home, at work, at school, and through hobbies, we all belong to communities of practice. In some, we are core members, but in many we are merely peripheral. And we participate with numerous communities over the course of our lives.”

Anthropologists Jean Lave and Etienne Wenger coined the term while studying apprenticeship as a learning model. People usually think of apprenticeship as a relationship between a student and a master, but studies of apprenticeship reveal a more complex set of social relationships through which learning takes place, mostly with journeymen and more advanced apprentices. Think initially of how your own medical school and residency training programs were similar.

The concept of community of practice has found several practical applications in business, organizational design, government, education, professional associations, development projects, and civic life. Communities of practice are everywhere. They are a familiar experience, so familiar, perhaps, that they often escape our attention. Yet when given a name and brought into focus, a community of practice becomes a perspective that can help us better understand our world. It allows us to see past more obvious formal structures such as organizations, classrooms, or nations and perceive the structures defined by engagement in practice and the informal learning that comes with it.

The Wegner-Trayners say three characteristics are crucial, and it is their combination that constitutes a community of practice:

The domain. A community of practice is not merely a club of friends or a network of connections between people. It has an identity defined by a shared domain of interest. Membership implies a commitment to the domain and, therefore, a shared competence that distinguishes members from other people.

The community. In pursuing their interest in their domain, members engage in joint activities and discussions, help each other, and share information. They build relationships that enable them to learn from each other; they care about their standing with each other.

The practice. A community of practice is not merely a community of interest — people who like certain kinds of movies, for instance. Members of a community of practice are practitioners. They develop a shared repertoire of resources: experiences, stories, tools, ways of addressing recurring problems — in short, a shared practice.

Now consider how this concept influences your own approach to ongoing clinical skills acumen, as well as your unique approaches toward physician leadership development.

The AAPL Community

Here at the American Association for Physician Leadership, we are indeed a community of practice as it relates to physician leadership, but AAPL is so much more!

AAPL is a community with a culture unto itself. The AAPL network and culture impact individual physicians and their practices, non-physician practitioners and administrators, as well as hospitals and healthcare delivery systems. In addition, AAPL is a thought leader and influence group whose impact is recognized across other industry sectors and the vendor community.

AAPL manifests both non-material and material aspects of its culture. The non-material values and beliefs, language, communication, and practices developed and disseminated by AAPL are shared by a highly committed group of people (AAPL members, client organizations, AAPL staff and board members, etc.). The material aspects of culture from AAPL are composed of the tools and methods that facilitate the change physician leaders make in their professional and personal lives, and at the organizations where they work.

Perhaps most importantly, the influences and outcomes emanating from the AAPL community of practice and the culture of AAPL affect patients’ care and their outcomes in a positive fashion.

Consider, however, the many evolving differences in the way our healthcare industry considers its cultures, as well as the communities of practice in which we reside, including workforce migrations and shifting levels of commitment or loyalties toward patient care, for example. Patients themselves have varying expectations for their healthcare, and our payment system continues to create hurdles for all-inclusive care as we attempt to embrace the nuances for social determinants of health. And the list could go on and on…

Embracing change is always important, and physician leadership has the opportunity to reshape these evolving healthcare cultures. I encourage you and each of us to continue embracing the healthy culture of AAPL and its community of practice to create change. It is indeed an exciting time for creating potentially significant shifts in healthcare!

The medical profession is still viewed as a leadership profession, not only by our industry, but also by general society; therefore, as physician leaders, we must embrace the complexities of our industry. We must embrace the reality we chose when transitioning to the culture of this profession, and we can choose to embrace the opportunities where our individual and collective energies can create the positive transformation needed for our industry.

Remember, leading and helping create significant positive change is our overall intent as physicians. AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally.

Through this AAPL community of practice, we all can continue to seek deeper levels of professional and personal development and recognize ways we can each generate constructive influence for one another at all levels. As physician leaders, let us become more engaged, stay engaged, and help others to become engaged. Exploring and creating opportunities for broader levels of positive transformation in healthcare is within our reach – individually and collectively.


  1. Cole NL. So What Is Culture, Exactly? ThoughtCo. August 1, 2019.

  2. Wenger-Trayner E, Wenger-Trayner B. Introduction to Communities of Practice.

Peter B. Angood, MD, FRCS(C), FACS, MCCM, FAAPL(Hon)

Peter Angood, MD, is the chief executive officer and president of the American Association for Physician Leadership. Formerly, Dr. Angood was the inaugural chief patient safety officer for The Joint Commission and senior team leader for the World Health Organization’s Collaborating Center for Patient Safety Solutions. He was also senior adviser for patient safety to the National Quality Forum and National Priorities Partnership and the former chief medical officer with the Patient Safety Organization of GE Healthcare.

With his academic trauma surgery practice experience ranging from the McGill University hospital system in Canada to the University of Pennsylvania, Yale University and Washington University in St. Louis, Dr. Angood completed his formal academic career as a full professor of surgery, anesthesia and emergency medicine. A fellow in the Royal College of Physicians and Surgeons of Canada, the American College of Surgeons and the American College of Critical Care Medicine, Dr. Angood is an author in more than 200 publications and a past president for the Society of Critical Care Medicine.

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The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.


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