Family Medicine Residency Learning Networks

Create Your Governance Infrastructure

A governance structure is a framework for accountability. It describes who has authority and how decisions are made.

As you think about who will lead your network, keep in mind the responsibilities of network leadership. Leaders are responsible for:

• Creating value for members, ensuring that participants achieve better results, faster, by being part of the network
• Ensuring that the mission, vision, and values are defined and visible, and are used to guide the network’s activities
• Building a sense of shared responsibility and accountability¹
• Defining goals and objectives for the network
• Leading decision-making on network activities and agendas
• Keeping network projects and activities on time and on track 

Leadership positions might include:

• Chair or director
• Administrative lead/director (or project manager)
• Co-chair or co-director
• Faculty lead(s)
• Principle investigator
• Chairs or directors of various programs or activities

Create role descriptions for each member of your leadership team. See examples from WWAMI Family Medicine Residency Network. Note that WWAMI is a big network. When you're getting started, you will likely need just a few people on your leadership team.

Set terms for your leadership team members and define how successors will be selected.

^{1. Building a Learning Healthcare System Network. Introduction. Cincinnati, OH: James M. Anderson Center for Health Systems Excellence, 2020.} 

Identify Network Participants

A family medicine residency learning network comprises multiple family medicine residency programs working together to accomplish mutually agreed upon objectives and obtain or create new knowledge.¹ 

You can identify network participants and then work together to develop goals and objectives for the network, or you can set goals and objectives and then identify participants who may have similar goals. There are different types of residency learning networks.

1. Geography-based. These networks bring together residency programs within a region for ongoing collaboration and sharing of resources and best practices. These networks may or may work on collaborative improvement projects. An example of this type of network is the WWAMI Region Family Medicine Residency Network.
2. Project-based. These networks are formed to collaborate on improvement. The networks may or may not be geography-based. They may work on a single project or a series of projects over time. An example of this is the FMEC Implicit Network. 

Recruiting for Your Network
If you performed a needs analysis, as described in Step 1, you may have already identified programs that have an interest in joining your network. If you need additional participants, you can post on the AFMRD member listserv and/or the STFM Residency Learning Network Leaders Collaborative listserv. If you're creating a geography-based network, your AAFP chapter may be a resource for recruitment. National meetings, such as the STFM Annual Spring Conference, the AAFP Program Directors' Workshop, and the ACOFP Annual Convention provide opportunities to make personal connections. 

In order to get programs to join your network, you'll need to be able to clearly articulate the value of joining. You'll have to explain how participants will benefit by being part of the network and working together toward common goals.

Membership expectations should be written down, and network participants should sign a membership agreement.

Set Goals and Objectives

Learning networks frequently work collaboratively on a common goal or goals and use incremental tactics and measurements to achieve the desired goal(s). 

A goal is broad. It is what you ultimately want to achieve, which is not the same thing as what you want to do. A goal might be practical, such as exceeding a particular ACGME requirement or addressing a bold ambition, such as increasing racial diversity of family medicine residency graduates. Goals should be easy to understand, motivating, aspirational.

SMART (specific, measurable, achievable, relevant, and time-bound) objectives are smaller, measurable goals you need to meet on the way to achieving your goal. SMART objectives specify who, by how much, and by when. Accomplishment of SMART objectives is a way to measure if you're making progress toward your goal.

Tactics/activities/steps are what you're actually going to do to achieve your SMART objectives and, ultimately, your goal. Examples of tactics are implementing a curriculum, faculty development, and working with experts in your community.

Once you've defined your purpose, created a governance structure, and set goals and objectives, you could document your decisions and next steps in a charter. 

In a charter, you can include:

• What the network is expected to achieve
• A description of the participants
• A description of the team structure and roles
• The timeline for implementation of the activities
• The process for achieving the goals, objectives, and tactics
• Measures to assess progress¹

Learn more about creating a charter from Cincinnati Children's Information about Learning Health Networks.

^{1. Building a Learning Healthcare System Network. Introduction. Cincinnati, OH: James M. Anderson Center for Health Systems Excellence, 2020.}

Secure Funding

Networks will have expenses. Create a budget, factoring in the costs of:

• Administrative support
• Leadership honoraria
• Network meetings - food, A/V, meeting space
• Data collection and storage
• Collaborative communication platforms
• Data analysis

You can start small, and ramp up over time. Consider where you might get funding or resources to support your network operations. Consider:

• Grants from foundations or other philanthropic organizations
• AAFP state chapters (e.g. admin, communication, or IT support)
• State funding 
• Membership fees from participants
• Participating site resources (e.g. meeting space, A/V for meetings, IRB)

If you're going to charge programs or individuals membership fees, you'll need to show the benefit the programs/individuals will receive. The network finances should be transparent to members.

Consider Strategies for Document Sharing

Your residency learning network will need a strategy for sharing communications and resources between network participants.

You may need some or all of the following:

• Listserv or email discussion forum (read a blog about discussion forum software)
• Website (possibly with portions password protected)
• Platform for sharing of and/or collaboration on documents. Examples include Microsoft Teams, Google Workspace, Slack, Dropbox, SharePoint, Google Docs,  and Smartsheet. 

Make sure all network participants understand what can be done with documents that are shared. Create a policy that defines:

• Who owns shared documents
• Which documents can be shared outside the network
• How shared documents can be used and how authors should be recognized

You may need a separate policy and processes for network data. Data that is collected as part of a performance improvement project, for example, should saved on a secure server with limited access. The policy can include who can access the data, how it can be used, and when/how deidentified data can be shared.

Plan Your Meetings

As you're setting up your network, discuss:

• Will meetings be in-person, virtual, or a combination of both?
• How often will we meet?
• How long will meetings last?
• What is the primary objective of these meetings?
• Who is in charge of developing the meeting agenda?
• Who will take care of logistics, such as finding meeting space, ordering food, and communicating meeting logistics to potential attendees?
• Is there an expectation for member attendance? 
• Will meetings be recorded?
• Who will take minutes and how will they be stored and shared?

Each meeting of your residency learning network should have a detailed agenda, which should be distributed well in advance of the meeting. Each meeting should have a clear goal. In other words, "What will we accomplish during our time together?" 

Items included in a typical agenda include:

• Meeting name, date, time
• Information about virtual participation, if applicable (e.g. Zoom link)
• Minutes from the previous meeting
• Topics for discussion. Along with the topic, the agenda should list the allotted amount of time for discussion, the name of the person who will present or lead the discussion, and the objective of the discussion. It should be noted if agenda topics require a decision or an action.
• Links to relevant background information
• Dates and locations of future meetings