INSPIRE-PHC Applied Health Research Question (AHRQ) Final Report- Lee, March 31, 2014

Communities of Practice Rapid Literature Review A community of practice (CoP) is generally regarded as a community of professionals from the same field of work who connect regularly to solve problems, share ideas and knowledge. Characterized by a shared domain of interest; a community that pursues the shared interest; and practice or shared repertoire of common knowledge, tools and resources that the group shares and builds. This rapid response literature review was undertaken to provide background information about CoPs for members of the Collaborative Mental Health Network (CMHN) and Medical Mentoring for Addiction and Pain (MMAP) Steering Committee members in order to inform their strategic planning discussions. The findings of the review do not represent an exhaustive search but are intended to inform discussion about the following questions: • How can network theory and social network analysis be applied to a

mentoring network? • What are some of the challenges in developing CoPs? • How to best build and cultivate a CoP? • What are the key elements required to nurture/support a CoP? • How does information technology (information technology) impact a CoP? Authors: Lena Salach, Centre for Effective Practice; Patricia Rockmam, Jose Silveria, Arun Radhakrishnan, Eilyn Rodriguez , Ontario College of Family Physicians Knowledge User: Patricia Rockmam, Jose Silveria, Arun Radhakrishnan, Eilyn Rodriguez, Ontario College of Family Physicians

2014

7/29/2014

Funded as an Applied Health Research Question through the INSPIRE-PHC Program supported by a grant from the Government of Ontario [#06547] The views expressed are those of the author and do not necessarily reflect those of the funder.

For more information please contact the INSPIRE-PHC Program, phcs@uwo.ca

Communities of Practice

Rapid Literature Review

Prepared for the

Ontario College of Family Physicians’

CMHN and MMAP Steering Committee

July 28, 2014

Submitted by:

Lena Salach Director Centre for Effective Practice 203 College Street, Suite 402 Toronto, Ontario M5T 1P9 T: 647-260-7886 www.effectivepractice.org

 

 

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Table  of  Contents  PROJECT DETAILS  .............................................................................................  3  

EXECUTIVE SUMMARY AND KEY FINDINGS  ...............................................  4  

INTRODUCTION  ..................................................................................................  7  

REVIEW OF THE LITERATURE  ......................................................................  8  

Methodology  ........................................................................................................  8  FINDINGS  ......................................................................................................................  9  How can network theory and social network analysis be applied to a medical mentoring network?  ............................................................................  9  How are CoPs best built and cultivated?  ......................................................  10  What are the key elements to nurture/support communities of practice?  .......................................................................................................................  10  

Member characteristics  ................................................................................................  11  Organizational and administrative characteristics  ............................................  11  

What are some of the challenges in developing CoPs?  ..........................  11  How does information technology impact a CoP?  ....................................  12  

IMPLICATIONS FOR CMHN/MMAP NETWORKS  ..................................  13  

CANADIAN EXAMPLES OF CoPS  .................................................................  14  

ENDNOTES  ...........................................................................................................  16    

                                   

 

 

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PROJECT DETAILS    

1. Project name/title: Communities of Practice: Rapid Literature Review

2. Principal investigator/co-investigators: • Lena Salach, Centre for Effective Practice • Patricia Rockmam, Ontario College of Family Physicians • Jose Silveria, MD, Ontario College of Family Physicians • Arun Radhakrishnan, Ontario College of Family Physicians • Eilyn Rodriguez, Ontario College of Family Physicians

3. Knowledge User(s) Involved:

• Patricia Rockmam, Ontario College of Family Physicians • Jose Silveria, MD, Ontario College of Family Physicians • Arun Radhakrishnan, Ontario College of Family Physicians • Eilyn Rodriguez, Ontario College of Family Physicians

4. Final report submitted on: July 29 1014

5. Have you received other funding for this project? If so, please list and explain relevance: CEP received funding from the Ontario College of Family Physicians (OCFP) to assist with conducting a comprehensive evaluation of two of its educational programs (Collaborative Mental Health Network and Medical Mentoring for Addictions and Pain)

6. What publications, abstracts, presentations or other materials (if any) have resulted from this study so far? Please list: Not applicable

   

 

 

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EXECUTIVE SUMMARY AND KEY FINDINGS  A community of practice (CoP) is generally regarded as a community of professionals from the same field of work who connect regularly to solve problems, share ideas and knowledge. Characterized by a shared domain of interest; a community that pursues the shared interest; and practice or shared repertoire of common knowledge, tools and resources that the group shares and builds. This rapid response literature review was undertaken to provide background information about CoPs for members of the Collaborative Mental Health Network (CMHN) and Medical Mentoring for Addiction and Pain (MMAP) Steering Committee members in order to inform their strategic planning discussions. The findings of the review do not represent an exhaustive search but are intended to inform discussion about the following questions:

• How can network theory and social network analysis be applied to a mentoring network?

• What are some of the challenges in developing CoPs? • How to best build and cultivate a CoP? • What are the key elements required to nurture/support a CoP? • How does information technology (information technology) impact a CoP?

Methodology  In June 2014, the Centre for Effective Practice (CEP) Librarian, Kelly Lang-Robertson, searched Ovid Medline for papers focusing on key features of a CoP, how to build and support a CoP, challenges, and the use of IT in CoPs. The search was limited to English language publications published between 2009 and 2014. The search strategy identified 197 abstracts, of which 45 results were included for consideration based on preliminary title and abstract review. Pertinent grey literature was obtained through a Google search. Researchers also examined sources, a thesis and reference lists recommended by project team members.

How can network theory and social network analysis be applied to a medical mentoring network?  A CoP in the healthcare sector is a social network in which practitioners interact with colleagues and mentors to share knowledge in order to improve practice. Social network theories examine the patterns of connections between individual

 

 

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members of a network. Key concepts in understanding social networks include centrality, embeddedness, density, strength of ties, diversity of connections and relationships between core, active and peripheral members. By analyzing social networks, practitioners and program administrators can develop strategies for supporting effective communities of practice.

How are CoPs best built and cultivated?  Communities of practice have life-cycles that emerge and grow through different stages of development. A facilitating factor in one group (e.g. face-to face meetings) may hinder another group working towards a different goal or working under different circumstances. Building and cultivating CoPs requires paying attention to each of the three key elements: domain, community and practice as well as to the life cycle of the CoP.

What are the key elements to nurture/support communities of practice?  A review of 13 primary studies identified the following characteristics of successful CoPs:

• Members appeared to be supportive of each other’s learning. • Member diversity was valued. • Members demonstrated mutual respect. • Facilitators in these groups played a key role in providing administrative

support and in connecting members to each other. • Continuing practical and political support was provided to the CoP

including practical resources (e.g. sample information forms for patients, point-of-practice tools and procedures provided the structure and framework (“how to’s”).

What are some of the challenges in developing CoPs?  Challenges outlined in the literature include:

• Achieving optimum size—too large precludes strong connections. • Balance of between too many new members (affects cohesiveness) and

failure to attract new members (may lead to dormancy). • Workload and time constraints. • Lack of protected time for frontline professionals. • Resistance to change from staff. • Sustaining members’ participation, burnout.

 

 

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• Lack of clarity in the responsibilities of CoP facilitators and how power dynamics should be handled within a CoP group.

• Problems with usability of technology. • Weak sense of ownership and unclear purpose.

How does information technology impact a CoP?    In 16 of 31 primary research studies, CoP members met face-to-face on at least one occasion although it was not clear whether they used other means of communication (such as email) as well. None of the studies examined communication in relation to the impact of the CoP in achieving its objective.

Online CoPs can enhance knowledge development, strengthen social ties and build social capital in a cost-effective way. Potential benefits include:

• Time efficiency, • Networking capabilities, • Mentoring opportunities, • Access to information, and • Convenience, unrestricted by geography or physical conditions.

Challenges include concerns about:

• Privacy and confidentiality, • Insufficient time, and • Technical issues involving usability.

     

 

 

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INTRODUCTION  The Collaborative Mental Health Network (CMHN) and the Medical Mentoring for Addictions and Pain (MMAP) programs are designed to support family physicians by providing case-by-case support and ongoing continuing professional development regarding mental health, addictions and pain care. They are in effect, communities of practice. A community of practice (CoP) is generally regarded as a community of professionals from the same field of work who connect regularly to solve problems, share ideas and knowledge. The group may include beginners and experts.1 Successful communities of practice are characterized by three elements that function together to support innovation and learning. These elements are:

• Community of people who voluntarily come together to build relationships, exchange knowledge and learn from one another in an environment of trust and shared sense of purpose.2

• Domain of interest on which the CoP members focus and which provides an incentive for them to come together to share ideas, knowledge and stories.

• Practice or shared repertoire of common knowledge, tools and resources that the group shares and builds.3  

The members of a CoP, “share a concern or a passion for something they do and learn how to do it better as they interact regularly.”4 In practice, it is challenging to determine the right number and composition of members of a CoP and to develop supportive structures and processes that encourage active participation and learning between members.5 A systematic review of literature on CoPs in the healthcare sector found that communities of practice vary in composition, intended purpose, and means by which members exchange information and knowledge. 6 CoPs are used for a range of purposes including mentoring new practitioners, facilitating learning and knowledge exchange, improving clinical practice and facilitating the implementation of evidence-based practice. 7

 

 

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REVIEW OF THE LITERATURE A rapid response literature review was undertaken to provide background information for members of the CMHN and MMAP Steering Committee members in order to inform their strategic planning discussions. The findings of the review do not represent an exhaustive search but are intended to inform discussion about the following questions:

• How can network theory and social network analysis be applied to a mentoring network?

• What are some of the challenges in developing CoPs? • How to best build and cultivate a CoP? • What are the key elements required to nurture/support a CoP? • How does information technology impact a CoP?

Methodology In June 2014, the Centre for Effective Practice (CEP) Librarian, Kelly Lang-Robertson, searched Ovid Medline for papers focusing on key features of a CoP, how to build and support a CoP, challenges, and the use of IT in CoPs. Review papers or papers that addressed multiple aspects of interest were included. Papers, which looked at CoPs, related to providing care for mental health and addictions, or papers addressing Canadian initiatives were given special consideration for inclusion even if they were less relevant, or were papers of lesser quality. The search was limited to English language publications published in the past 5 years (2009-2014), and study protocols and letters were excluded. The search strategy identified 197 abstracts, of which 45 results were included for consideration based on preliminary title and abstract review. Review of the manuscripts eliminated a further 13 papers that did not meet inclusion criteria, leaving 32 papers for detailed review. Pertinent grey literature was obtained through a Google search yielding additional sites of interest. Researchers also examined sources, a thesis and reference lists recommended by project team members.

 

 

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One researcher reviewed all identified abstracts using the selection criteria, and shortlisted abstracts more detailed review. Papers were assessed for:

• Intended purpose of CoP. • Means of communication of CoP. • Assessment of effectiveness in achieving purpose. • Challenges. • Study limitations.

FINDINGS

How can network theory and social network analysis be applied to a medical mentoring network?  A CoP in the healthcare sector is a social network in which practitioners interact with colleagues and mentors to share knowledge in order to improve practice.8 CoPs are based on the idea that learning happens in a relational process where practitioners are actively involved in the social construction of knowledge and practice. 9 These relational ties are the points where resources and information are transferred between members. Social network theories examine the patterns of connections between individual members of a network. Key concepts in understanding social networks include:

• Centrality—how much does the network pattern extend from one or two people?

• Embeddedness—how connected is an individual in the network? • Density—how many ties or connections does the network have? A highly

dense network may eventually result in less access to new ideas while a network with more gaps may provide opportunities to seek out new resources or information.

• Strength of ties—degree of personal closeness, or frequency of communication. Strong ties develop trust, require a lot of management but may lead people to think alike over time.

• Diversity of connections to other social networks. 10 • Relationship between core (coordinators, managers, experts), active

(contributors) and peripheral (interested people who may bring in outside information) members. 11

 

 

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By analyzing social networks, practitioners and program administrators can develop strategies for supporting effective communities of practice.

How are CoPs best built and cultivated?  Communities of practice have life-cycles that emerge and grow through different stages of development. The stages may be described as: potential, coalesce, mature and stewardship but some groups may not progress and some may spend longer times at one stage or another. 12 Each stage requires different kinds of design, facilitation and support strategies. 13 In the early stages of the development of a CoP, efforts to build a CoP should focus on promoting and strengthening the community of members while at a later stage, efforts should be focused on promoting changes in practice. 14 A facilitating factor in one group (e.g. face-to face meetings) may hinder another group working towards a different goal or under different circumstances.15 Building and cultivating CoPs requires paying attention to each of the three key elements: domain, community and practice 16 and to the life cycle of the CoP. Parboosingh et al argue that building a CoP requires expert interpersonal and knowledge management skills and that these skills can and should be taught to CME providers. In particular, CME educators need to learn to build and facilitate a trusting community in order to encourage dialogue and shared story-telling among practitioners. Unlike a traditional education session, which “pushes” best practice information to the audience, they recommend well-facilitated CoP sessions in which best practice is “pulled through conversations, helping members collectively create and agree to a ‘best fit’ approach.“17

What are the key elements to nurture/support communities of practice?

 Li et al identified four characteristics that were present in CoP groups:

• Social interaction among members, • Knowledge sharing, • Knowledge creation, and • Identity building. 18

 

 

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Because CoP is a relatively new concept in healthcare, they recommend optimizing these specific characteristics.19 In a review of 13 primary studies, they identified the following characteristics of successful CoPs:

• Members appeared to be supportive of each other’s learning. • Member diversity was valued. • Mutual respect. • Facilitators in these groups played a key role in providing administrative

support. • A skilled facilitator and support staff served an important role in linking

members with the same interests. 20

Member characteristics  

• Personal commitment to the aim of the CoP. • Commitment to knowledge-sharing and knowledge-seeking with others. • Effective management of personal relationships. • Understanding the roles of other members. 21 • Leaders or champions who could help communicate research findings and

facilitate knowledge translation and exchange (KTE).22, 23

Organizational and administrative characteristics

• Good fit between CoP purposes and aims of organizations employing the members.

• Sufficient funding of the work of CoP members. • Facilitation of innovation within the CoP. 24 • Professional development opportunities with time to reflect, time and

opportunity to interact and share with peers, 25 • Continuing practical and political support to the CoP including practical

resources (e.g. sample information forms for patients, point-of-practice tools and procedures provided the structure and framework (“how to’s”). 26, 27, 28,

Cambridge, et al argue that the “social architecture” of a CoP enlivens the experience for participants and creates a “rhythm” of expectation about how and when to participate in the community.29

What are some of the challenges in developing CoPs?  Communities of practice are often cultivated as a knowledge management strategy. The success of these efforts is dependent on bringing together three interconnected components of knowledge management: people,

 

 

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process/structure and technology. Understanding the barriers that prevent active participation in CoPs and the factors that promote their effective functioning can enhance the likelihood of successfully nurturing a CoP. 30 Parboosingh et al argue that “the presence of networking, trusted relationships and practitioner interactivity” might explain why some groups respond favorably to practice improvement initiatives while the absence of these behaviors might partially explain less favourable outcomes in other groups. 31 Challenges outlined in the literature include:

• Size—too large precludes strong connections. 32 • Balance of between too many new members (affects cohesiveness) and

failure to attract new members (may lead to dormancy). 33 • Workload and time constraints. 34,35, 36, • Lack of protected time for frontline professionals. 37 • Resistance to change from staff. 38 • Sustaining members’ participation, burnout.39 • Lack of clarity in the responsibilities of CoP facilitators and how power

dynamics should be handled within a CoP group. 40 Problems with usability of technology 41,42,43

• Weak sense of ownership and unclear purpose.44  

How does information technology impact a CoP?      If the social architecture of a CoP enlivens the experience, the technical architecture of a program “supports” the community’s relationships and work. 45 A systematic review looked at the ways members of CoPs communicate, interact and share information and knowledge but found that a lack of consistency in reporting made it difficult to identify and compare the various methods. In 16 of 31 primary research studies, CoP members met face-to-face on at least one occasion although it was not clear whether they used other means of communication (such as email) as well. 46 The next most commonly used method of communication was email and web-based systems. Most CoPs used a combination of methods. None of the studies examined communication in relation to the impact of the CoP in achieving its objective. 47

A systematic review found that online or virtual communities of practice can enhance knowledge development, strengthen social ties and build social capital in a cost-effective way. 48, 49 Potential benefits include:

 

 

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• Time efficiency, • Networking capabilities, • Mentoring opportunities, • Access to information, • Convenience, unrestricted by geography or physical conditions.50,

Challenges include concerns about:

• Privacy and confidentiality51 • Insufficient time 52, 53 • Technical issues involving usability 54

An evaluation of InspireNet, a BC nursing health services research network found that essential support for an electronic CoP includes instruction in the use of Web-based activities and time management, a biweekly e-Newsletter, regular communication from leaders, and an annual face-to-face conference. 55

A survey of physicians in Ontario and Nova Scotia found that a majority of respondents (85.0%) used email to support discussions and 69.8% found it to be valuable in learning about chronic pain management. 56

IMPLICATIONS FOR CMHN/MMAP NETWORKS This rapid response literature review was undertaken to provide background information about CoPs for OCFP administration and members of the CMHN and MMAP steering committee in order to inform their strategic planning discussions. Although the findings of the review do not represent an exhaustive search, they do suggest some guiding principles to inform future development of the mentoring networks. The steering committee should:

• Analyze the CMHN and MMAP networks through a lens of key network concepts in order to develop strategies for supporting effective communities of practice.

• Build and cultivate networks by paying attention to fostering effective collaboration between members.

• Support membership with political and practical resources including funding, leadership and sufficient time for participation.

• Continue to explore innovative uses of technology to support the participation members and the functioning of networks.  

 

 

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CANADIAN EXAMPLES OF CoPS  • ASaP Community of Practice (Alberta) - provides support for facilitators, to

share ideas and techniques for practice facilitation related to quality improvement and to celebrate successes.

Retrieved June 18, 2014 from http://www.topalbertadoctors.org/file/asap--alberta-pc-improvement-community-of-practice-guide.pdf

• C17 Council - an organization of sixteen pediatric hematology,

oncology, and stem cell transplant programs across Canada. Major initiatives include: research,  education, promoting development of evidence-based guidelines

Retrieved June 18, 2014 from http://www.c17.ca/

• Communities of Practice - web-based communities in support of Canadian

Patient Safety Institute and Safer Health Care Now! programs and initiatives.

Retrieved June 18, 2014 from http://tools.patientsafetyinstitute.ca/Pages/welcome.aspx

   • Canadian Knowledge Transfer and Exchange Community of Practice

(KTECOP) -- network of KTE practitioners and researchers who share KTE practices and experience, build peer relationships for information exchange and support, build KTE capacity, advance knowledge of KTE effectiveness, and share KTE events, job opportunities and other related KTE activities.

Retrieved June 12, 2014 from http://www.ktecop.ca/

 • InspireNet-- network of over 3,200 researchers, practitioners, policy-makers,

educators and students working together to improve health services in British Columbia.

Retrieved June 12, 2014 from http://www.inspirenet.ca/

• Seniors Health Knowledge Network "network of networks”. Launched in

2005 in Ontario to improve the quality of health care provided to seniors. Funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC)

 

 

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through a contract with the Ontario Neurotrauma Foundation in Toronto. Three organizations (The Alzheimer's Knowledge Exchange, The Ontario Research Coalition, The Senior's Health Research Transfer Network Knowledge Exchange) banded together to form this network.

 Retrieved June 12, 2014 from http://seniorshealthknowledgenetwork.ca/community/communities-practice

 

 

       

     

 

 

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ENDNOTES                                                                                                                  1  Evidence Exchange Network (EENet). What’s the Difference? Community of Interest (CoI) vs Community of Practice (CoP). www.eenet.ca 2 Wenger, E. (2006). Communities of practice: A brief introduction. Retrieved July 16, 2014 from: http://wenger-trayner.com/theory/ 3 Bentley C, Browman GP, Poole B. Conceptual and practical challenges for implementing the communities of practice model on a national scale--a Canadian cancer control initiative. BMC Health Services Research 2010;10:3 4 Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 5 Paas, L., Parry, J-E. Understanding Communities of Practice: An overview for adaptation practitioners. Adaptation Partnership, 2012. Retrieved July 16, 2014 from http://www.adaptationpartnership.org. 6 Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 7 Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 8 Parboosingh IJ, Reed VA, Caldwell Palmer J, Bernstein HH. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education. J.Contin.Educ.Health Prof. 2011;31(2):122-127 9 Parboosingh IJ, Reed VA, Caldwell Palmer J, Bernstein HH. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education. J.Contin.Educ.Health Prof. 2011;31(2):122-127 10 Garland,M. and Alestalo,S.Faculty Mentoring in a Networked World. Syracuse, NY: Syracuse University, 2014. Retrieved July 16, 2014 from http://suadvance.syr.edu/pdfs/Fac%20Mentoring%20Networks%20Sec%206%20Social%20Network%20Theory.pdf

 

 

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                                                                                                                                                                                                                                                                                                                                          11 Paas, L., Parry, J-E. Understanding Communities of Practice: An overview for adaptation practitioners. Adaptation Partnership, 2012. Retrieved July 16, 2014 from http://www.adaptationpartnership.org. 12 Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 13 Cambridge, D., Kaplan, S., & Suter, V. (2005). Community of Practice Design Guide, p2. Retrieved June 5, 2014, from http://net.educause.edu/ir/library/pdf/nli0531.pdf 14 Ranmuthugala, G., Plumb, J. J., Cunningham, F. C., Georgiou, A., Westbrook, J. I., & Braithwaite, J. (2011). How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research, 11, 273. 15 Ranmuthugala, G., Plumb, J. J., Cunningham, F. C., Georgiou, A., Westbrook, J. I., & Braithwaite, J. (2011). How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research, 11, 273. 16 Briard, S.; Carter, c. (2013). Communities of Practice and Communities of Interest: Definitions and evaluation considerations. Ontario Centre of Excellence for Child and Youth Mental Health. 17 Parboosingh IJ, Reed VA, Caldwell Palmer J, Bernstein HH. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education. J.Contin.Educ.Health Prof. 2011;31(2):122-127 18 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 19 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Evolution of Wenger's concept of community of practice. Implementation Science 2009;4:11 20 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27

 

 

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                                                                                                                                                                                                                                                                                                                                         21 Gibson J, Meacheam D. (2009). The individual and organizational commitments needed for a successful diabetes care community of practice. Health Services Management Research 2009 Aug;22(3):122-128. 22 Mitton C, Adair CE, McKenzie E, Patten S, Waye-Perry B, Smith N. Designing a knowledge transfer and exchange strategy for the Alberta Depression Initiative: contributions of qualitative research with key stakeholders. International Journal of Mental Health Systems 2009;3(1):11 23 Mancini MA, Miner CS. (2013). Learning and change in a community mental health setting. Journal of Evidence-Based Social Work Oct;10(5):494-504 24 Gibson J, Meacheam D. (2009). The individual and organizational commitments needed for a successful diabetes care community of practice. Health Services Management Research 2009 Aug;22(3):122-128. 25 Meagher-Stewart D, Solberg SM, Warner G, MacDonald JA, McPherson C, Seaman P. Understanding the role of communities of practice in evidence-informed decision making in public health. Qual.Health Res. 2012 Jun;22(6):723-739 26 Briard, S.; Carter, c. (2013). Communities of Practice and Communities of Interest: Definitions and evaluation considerations. Ontario Centre of Excellence for Child and Youth Mental Health. 27 Lee, Linda; Hillier, Loretta M. and Weston, W. Wayne. (2014). Ensuring the Success of Interprofessional Teams: Key Lessons Learned in Memory Clinics. Canadian Journal on Aging / La Revue canadienne du vieillissement, 33, 49-59 28 Meagher-Stewart D, Solberg SM, Warner G, MacDonald JA, McPherson C, Seaman P. Understanding the role of communities of practice in evidence-informed decision making in public health. Qual.Health Res. 2012 Jun;22(6):723-739 29 Cambridge, D., Kaplan, S., & Suter, V. (2005). Community of Practice Design Guide. Retrieved June 5, 2014, from http://net.educause.edu/ir/library/pdf/nli0531.pdf 30 Paas, L., Parry, J-E. Understanding Communities of Practice: An overview for adaptation practitioners. Adaptation Partnership, 2012. Retrieved July 16, 2014 from http://www.adaptationpartnership.org. 31 Parboosingh IJ, Reed VA, Caldwell Palmer J, Bernstein HH. Enhancing practice improvement by facilitating practitioner interactivity: new roles for

 

 

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                                                                                                                                                                                                                                                                                                                                         providers of continuing medical education. J.Contin.Educ.Health Prof. 2011;31(2):122-127 32 Paas, L., Parry, J-E. Understanding Communities of Practice: An overview for adaptation practitioners. Adaptation Partnership, 2012. Retrieved July 16, 2014 from http://www.adaptationpartnership.org 33 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 34 Jeffs LP, Lo J, Beswick S, Campbell H. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses. Nurs.Adm.Q. 2013 Jul-Sep;37(3):222-230 35 Meagher-Stewart D, Solberg SM, Warner G, MacDonald JA, McPherson C, Seaman P. Understanding the role of communities of practice in evidence-informed decision making in public health. Qual.Health Res. 2012 Jun;22(6):723-739 36 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 37 Jeffs LP, Lo J, Beswick S, Campbell H. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses. Nurs.Adm.Q. 2013 Jul-Sep;37(3):222-230 38 Jeffs LP, Lo J, Beswick S, Campbell H. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses. Nurs.Adm.Q. 2013 Jul-Sep;37(3):222-230 39 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 40 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 41 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27

 

 

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                                                                                                                                                                                                                                                                                                                                         42 Barnett S, Jones SC, Bennett S, Iverson D, Bonney A. Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice. Journal of Medical Internet Research 2013;15(5):e92 43 Frisch N, Atherton P, Borycki E, Mickelson G, Cordeiro J, Novak Lauscher H, et al. (2014). Growing a professional network to over 3000 members in less than 4 years: evaluation of InspireNet, British Columbia's virtual nursing health services research network. Journal of Medical Internet Research 2014;16(2):e49 44 Paas, L., Parry, J-E. Understanding Communities of Practice: An overview for adaptation practitioners. Adaptation Partnership, 2012. Retrieved July 16, 2014 from http://www.adaptationpartnership.org 45 Cambridge, D., Kaplan, S., & Suter, V. (2005). Community of Practice Design Guide. Retrieved June 5, 2014, from http://net.educause.edu/ir/library/pdf/nli0531.pdf 46 Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 47 Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 48 Swift L. Online communities of practice and their role in educational development: a systematic appraisal. Community Practitioner 2014 Apr;87(4):28-31 49 Mairs K, McNeil H, McLeod J, Prorok JC, Stolee P. Online strategies to facilitate health-related knowledge transfer: a systematic search and review. Health Information & Libraries Journal 2013 Dec;30(4):261-277 50 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 51 Barnett S, Jones SC, Bennett S, Iverson D, Bonney A. Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice. Journal of Medical Internet Research 2013;15(5):e92 52 Barnett S, Jones SC, Bennett S, Iverson D, Bonney A. Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of

 

 

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                                                                                                                                                                                                                                                                                                                                         practice. Journal of Medical Internet Research 2013;15(5):e92 53 Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 54 Mairs K, McNeil H, McLeod J, Prorok JC, Stolee P. Online strategies to facilitate health-related knowledge transfer: a systematic search and review. Health Information & Libraries Journal 2013 Dec;30(4):261-277 55 Frisch N, Atherton P, Borycki E, Mickelson G, Cordeiro J, Novak Lauscher H, et al. (2014). Growing a professional network to over 3000 members in less than 4 years: evaluation of InspireNet, British Columbia's virtual nursing health services research network. Journal of Medical Internet Research 2014;16(2):e49 56 Radhakrishnan, AK. The use of Information and Communication Technologies for Knowledge Translation in a Mentoring Network of Physicians to Optimize Roles in the management of Chronic Pain. Thesis submitted to the Institute of Health Policy, Management and Evaluation, University of Toronto, 2013.

 

 

 

 

 

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APPENDIX A

Search  Results   Topic: Communities of Practice in Healthcare Librarian: Kelly Lang-Robertson Search Date: June 6, 2014 Resources Used: Ovid Medline Limits: English language, published between 2009-2014, letters and study protocols excluded.

(1) Barnett S, Jones SC, Bennett S, Iverson D, Bonney A. Usefulness of a virtual community of practice and web 2.0 tools for general practice training: experiences and expectations of general practitioner registrars and supervisors. Australian Journal of Primary Health 2013;19(4):292-296 General practice training is a community of practice in which novices and experts share knowledge. However, there are barriers to knowledge sharing for general practioner (GP) registrars, including geographic and workplace isolation. Virtual communities of practice (VCoP) can be effective in overcoming these barriers using social media tools. The present study examined the perceived usefulness, features and barriers to implementing a VCoP for GP training. Following a survey study of GP registrars and supervisors on VCoP feasibility, a qualitative telephone interview study was undertaken within a regional training provider. Participants with the highest Internet usage in the survey study were selected. Two researchers worked independently conducting thematic analysis using manual coding of transcriptions, later discussing themes until agreement was reached. Seven GP registrars and three GP supervisors participated in the study (average age 38.2 years). Themes emerged regarding professional isolation, potential of social media tools to provide peer support and improve knowledge sharing, and barriers to usage, including time, access and skills. Frequent Internet-using GP registrars and supervisors perceive a VCoP for GP training as a useful tool to overcome professional isolation through improved knowledge sharing. Given that professional isolation can lead to decreased rural work and reduced hours, a successful VCoP may have a positive outcome on the rural medical workforce.

(2) Barnett S, Jones SC, Bennett S, Iverson D, Bonney A. Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice. Journal of Medical Internet Research 2013;15(5):e92

 

 

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                                                                                                                                                                                                                                                                                                                                          BACKGROUND: Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training. OBJECTIVE: This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable. METHODS: A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia's 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4). RESULTS: Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network. CONCLUSIONS: General practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness.

(3) Barnett S, Jones SC, Bennett S, Iverson D, Bonney A. General practice training and virtual communities of practice - a review of the literature. BMC Family Practice 2012;13:87 BACKGROUND: Good General Practice is essential for an effective health

 

 

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                                                                                                                                                                                                                                                                                                                                         system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. METHODS: Major online databases Scopus, Psychlit and Pubmed were searched for the terms "Community of Practice" (CoP) AND (Online OR Virtual OR Electronic) AND (health OR healthcare OR medicine OR "Allied Health"). Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. RESULTS: The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders rather than single company VCoPs. Specific goals are important, but in specialised health fields sometimes less important than in business. Boundary spanning can involve the interactions of different professional groups, as well as using external experts seen in business VCoPs. There was less use of measurement in health VCoPs. Environments must be supportive as well as risk free. Additional findings were that ease of use of technology is paramount and it is desirable for VCoPs to blend online and face-to-face involvement. CONCLUSIONS: The business themes of leadership, sponsorship, objectives and goals, boundary spanning, risk-free environment and measurements become, in the health literature, facilitation, champion and support, objectives and goals, a broad church, supportive environment, measurement benchmarking and feedback, and technology and community.General Practice training is under pressure from isolation and virtual communities of practice may be a way of overcoming isolation. The health literature supports, with some variation, the business CoP framework developed by Probst. Further research is needed to clarify whether this framework is an effective method of health VCoP development and if these VCoPs overcome isolation and thus improve rural retention of General Practice registrars.

(4) Barnett S, Jones SC, Caton T, Iverson D, Bennett S, Robinson L. Implementing a virtual community of practice for family physician training: a

 

 

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                                                                                                                                                                                                                                                                                                                                         mixed-methods case study. Journal of Medical Internet Research 2014;16(3):e83 BACKGROUND: GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation. OBJECTIVE: The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation. METHODS: The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation. RESULTS: Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%). CONCLUSIONS: The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications

 

 

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                                                                                                                                                                                                                                                                                                                                         for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context.

(5) Bartunek JM. Intergroup relationships and quality improvement in healthcare. BMJ Quality & Safety 2011 Apr;20(Suppl 1):62-66 BACKGROUND: Intergroup problems among physicians, nurses and administrators in healthcare settings sometimes retard such settings' ability to foster enhanced quality of care. Without knowledge of the social dynamics that generate the difficulties, it is impossible to address some crucial issues that may affect quality initiatives. METHODS: This paper reviews three types of dynamics, social identity, communities of practice and socialisation into particular professional identities that affect relationships among professional groups in healthcare settings. RECOMMENDATIONS: A suggestion is made for the creation of cross-boundary communities of practice, socialisation into them and dual, superordinate identities as a means to foster more effective intergroup dynamics and, thus, contribute to a greater quality of care.

(6) Barwick MA, Peters J, Boydell K. Getting to uptake: do communities of practice support the implementation of evidence-based practice?. Journal of the Canadian Academy of Child & Adolescent Psychiatry = Journal de l.Acade.mie canadienne de psychiatrie de l.enfant et de l.adolescent 2009;18(1):16-29 INTRODUCTION: Practitioners are increasingly encouraged to adopt evidence-based practices (EBP) leading to a need for new knowledge translation strategies to support implementation and practice change. This study examined the benefits of a community of practice in the context of Ontario's children's mental health sector where organizations are mandated to adopt a standardized outcome measure to monitor client response to treatment. METHOD: Readiness for change, practice change, content knowledge, and satisfaction with and use of implementation supports were examined among practitioners newly trained on the measure who were randomly assigned to a community of practice (CoP) or a practice as usual (PaU) group. CoP practitioners attended 6 sessions over 12 months; PaU practitioners had access to usual implementation supports. RESULTS: Groups did not differ on readiness for change or reported practice change, although CoP participants demonstrated greater use of the tool in practice, better content knowledge and were more satisfied with implementation supports than PaU participants. CONCLUSION: CoPs present a promising model for translating EBP knowledge and promoting practice change in children's mental health that requires further study.

(7) Bentley C, Browman GP, Poole B. Conceptual and practical challenges for implementing the communities of practice model on a national scale--a Canadian cancer control initiative. BMC Health Services Research 2010;10:3

 

 

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                                                                                                                                                                                                                                                                                                                                          BACKGROUND: Cancer program delivery, like the rest of health care in Canada, faces two ongoing challenges: to coordinate a pan-Canadian approach across complex provincial jurisdictions, and to facilitate the rapid translation of knowledge into clinical practice. Communities of practice, or CoPs, which have been described by Etienne Wenger as a collaborative learning platform, represent a promising solution to these challenges because they rely on bottom-up rather than top-down social structures for integrating knowledge and practice across regions and agencies. The communities of practice model has been realized in the corporate (e.g., Royal Dutch Shell, Xerox, IBM, etc) and development (e.g., World Bank) sectors, but its application to health care is relatively new. The Canadian Partnership Against Cancer (CPAC) is exploring the potential of Wenger's concept in the Canadian health care context. This paper provides an in-depth analysis of Wenger's concept with a focus on its applicability to the health care sector. DISCUSSION: Empirical studies and social science theory are used to examine the utility of Wenger's concept. Its value lies in emphasizing learning from peers and through practice in settings where innovation is valued. Yet the communities of practice concept lacks conceptual clarity because Wenger defines it so broadly and sidelines issues of decision making within CoPs. We consider the implications of his broad definition to establishing an informed nomenclature around this specific type of collaborative group. The CoP Project under CPAC and communities of practice in Canadian health care are discussed. SUMMARY: The use of communities of practice in Canadian health care has been shown in some instances to facilitate quality improvements, encourage buy in among participants, and generate high levels of satisfaction with clinical leadership and knowledge translation among participating physicians. Despite these individual success stories, more information is required on how group decisions are made and applied to the practice world in order to leverage the potential of Wenger's concept more fully, and advance the science of knowledge translation within an accountability framework.

(8) Braithwaite J, Westbrook JI, Ranmuthugala G, Cunningham F, Plumb J, Wiley J, et al. The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks. BMC Health Services Research 2009;9:162 BACKGROUND: Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will

 

 

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                                                                                                                                                                                                                                                                                                                                         produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. METHODS AND DESIGN: Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks. DISCUSSION: Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application.

(9) Brehaut JC, Eva KW. Building theories of knowledge translation interventions: use the entire menu of constructs. Implementation Science 2012;7:114 BACKGROUND: In the ongoing effort to develop and advance the science of knowledge translation (KT), an important question has emerged around how theory should inform the development of KT interventions. DISCUSSION: Efforts to employ theory to better understand and improve KT interventions have until recently mostly involved examining whether existing theories can be usefully applied to the KT context in question. In contrast to this general theory application approach, we propose a 'menu of constructs' approach, where individual constructs from any number of theories may be used to construct a new theory. By considering the entire menu of available constructs, rather than limiting choice to the broader level of theories, we can leverage knowledge from theories that would never on their own provide a complete picture of a KT intervention, but that nevertheless describe components or mechanisms relevant to it. We can also avoid being forced to adopt every construct from a particular theory in a one-size-fits-all manner, and instead tailor theory application efforts to the specifics of the situation. Using audit and feedback as an example KT intervention strategy, we describe a variety of constructs (two modes of reasoning, cognitive dissonance, feed forward, desirable difficulties and cognitive

 

 

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                                                                                                                                                                                                                                                                                                                                         load, communities of practice, and adaptive expertise) from cognitive and educational psychology that make concrete suggestions about ways to improve this class of intervention. SUMMARY: The 'menu of constructs' notion suggests an approach whereby a wider range of theoretical constructs, including constructs from cognitive theories with scope that makes the immediate application to the new context challenging, may be employed to facilitate development of more effective KT interventions.

(10) Cassidy L. Online communities of practice to support collaborative mental health practice in rural areas. Issues Ment.Health Nurs. 2011;32(2):98-107 The provision of quality mental health services in rural areas continues to be an ongoing challenge for nurses and the patients they serve. The use of computer mediated communication to construct collaborative learning environments similar to those suggested in Wenger's community of practice framework has the potential to mitigate a number of the difficulties faced by rural health care providers. The author presents a brief discussion of social learning theories, the communities of practice framework, and related concepts. Examples of current online communities of practice used as a means for knowledge construction in various professional disciplines are presented in building the case for the fit between online communities of practice and the needs of nurses in rural mental health. Nurses providing mental health care in rural areas have documented needs for interdisciplinary teamwork, access to a collaborative learning environment, and ongoing contact with expert resources. The construction of online communities of practice could potentially address a multitude of concerns identified by nurses practicing mental health care in rural areas.

(11) De Micheli C, Galimberti C. Mobile immersive virtual technologies for professional communities of practice. Studies in Health Technology & Informatics 2009;144:66-68 This paper presents the development of an Immersive Virtual Technology (IVT) system serving a community of practice consisting of psychotherapists who use virtual environments for therapy and treatment of anxiety disorders. The psychosocial theoretical background includes the ethnomethodological approach, Situated Action Theory and the Intersubjectivity of the Utterance model. The dialogical importance promoted at each level of the analysis phases becomes the key to a deeper and more fluid understanding of the assumptions and meaning that guide the actions of and interactions between therapists and patients. The entire system design process is inspired by a dialogical perspective, which aims to effectively and non-rigidly integrate the design stages, analysis in context of use, ergonomic evaluation, creation of the virtual reality (VR) system, and final work on the clinical protocol in use.

 

 

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                                                                                                                                                                                                                                                                                                                                         (12) Dearing JW, Greene SM, Stewart WF, Williams AE. If we only knew what we know: principles for knowledge sharing across people, practices, and platforms. Translational Behavioral Medicine 2011 Mar;1(1):15-25 The improvement of health outcomes for both individual patients and entire populations requires improvement in the array of structures that support decisions and activities by healthcare practitioners. Yet, many gaps remain in how even sophisticated healthcare organizations manage knowledge. Here we describe the value of a trans-institutional network for identifying and capturing how-to knowledge that contributes to improved outcomes. Organizing and sharing on-the-job experience would concentrate and organize the activities of individual practitioners and subject their rapid cycle improvement testing and refinement to a form of collective intelligence for subsequent diffusion back through the network. We use the existing Cancer Research Network as an example of how a loosely structured consortium of healthcare delivery organizations could create and grow an implementation registry to foster innovation and implementation success by communicating what works, how, and which practitioners are using each innovation. We focus on the principles and parameters that could be used as a basis for infrastructure design. As experiential knowledge from across institutions builds within such a system, the system could ultimately motivate rapid learning and adoption of best practices. Implications for research about healthcare IT, invention, and organizational learning are discussed.

(13) Diaz-Chao A, Torrent-Sellens J, Lacasta-Tintorer D, Saigi-Rubio F. Improving integrated care: modelling the performance of an online community of practice. International Journal of Integrated Care [Electronic Resource] 2014 Jan;14:e007 INTRODUCTION: this article aims to confirm the following core hypothesis: a Community of Practice's use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated. METHODS: An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adria de Besos Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses. RESULTS: It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on

 

 

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                                                                                                                                                                                                                                                                                                                                         its use. CONCLUSIONS: The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.

(14) Euerby A, Burns CM. Improving social connection through a communities-of-practice-inspired cognitive work analysis approach. Hum.Factors 2014 Mar;56(2):361-383 OBJECTIVE: Increasingly, people work in socially networked environments. With growing adoption of enterprise social network technologies, supporting effective social community is becoming an important factor in organizational success. BACKGROUND: Relatively few human factors methods have been applied to social connection in communities. Although team methods provide a contribution, they do not suit design for communities. Wenger's community of practice concept, combined with cognitive work analysis, provided one way of designing for community. METHOD: We used a cognitive work analysis approach modified with principles for supporting communities of practice to generate a new website design. Over several months, the community using the site was studied to examine their degree of social connectedness and communication levels. RESULTS: Social network analysis and communications analysis, conducted at three different intervals, showed increases in connections between people and between people and organizations, as well as increased communication following the launch of the new design. CONCLUSION: In this work, we suggest that human factors approaches can be effective in social environments, when applied considering social community principles. APPLICATION: This work has implications for the development of new human factors methods as well as the design of interfaces for sociotechnical systems that have community building requirements.

(15) Frisch N, Atherton P, Borycki E, Mickelson G, Cordeiro J, Novak Lauscher H, et al. Growing a professional network to over 3000 members in less than 4 years: evaluation of InspireNet, British Columbia's virtual nursing health services research network. Journal of Medical Internet Research 2014;16(2):e49 BACKGROUND: Use of Web 2.0 and social media technologies has become a new area of research among health professionals. Much of this work has focused on the use of technologies for health self-management and the ways technologies support communication between care providers and consumers. This paper addresses a new use of technology in providing a platform for health professionals to support professional development, increase knowledge utilization, and promote formal/informal professional communication. Specifically, we report on factors necessary to attract and sustain health professionals' use of

 

 

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                                                                                                                                                                                                                                                                                                                                         a network designed to increase nurses' interest in and use of health services research and to support knowledge utilization activities in British Columbia, Canada. OBJECTIVE: "InspireNet", a virtual professional network for health professionals, is a living laboratory permitting documentation of when and how professionals take up Web 2.0 and social media. Ongoing evaluation documents our experiences in establishing, operating, and evaluating this network. METHODS: Overall evaluation methods included (1) tracking website use, (2) conducting two member surveys, and (3) soliciting member feedback through focus groups and interviews with those who participated in electronic communities of practice (eCoPs) and other stakeholders. These data have been used to learn about the types of support that seem relevant to network growth. RESULTS: Network growth exceeded all expectations. Members engaged with varying aspects of the network's virtual technologies, such as teams of professionals sharing a common interest, research teams conducting their work, and instructional webinars open to network members. Members used wikis, blogs, and discussion groups to support professional work, as well as a members' database with contact information and areas of interest. The database is accessed approximately 10 times per day. InspireNet public blog posts are accessed roughly 500 times each. At the time of writing, 21 research teams conduct their work virtually using the InspireNet platform; 10 topic-based Action Teams meet to address issues of mutual concern. Nursing and other health professionals, even those who rated themselves as computer literate, required significant mentoring and support in their efforts to adopt their practice to a virtual environment. There was a steep learning curve for professionals to learn to work in a virtual environment and to benefit from the available technologies. CONCLUSIONS: Virtual professional networks can be positioned to make a significant contribution to ongoing professional practice and to creating environments supportive of information sharing, mentoring, and learning across geographical boundaries. Nonetheless, creation of a Web 2.0 and social media platform is not sufficient, in and of itself, to attract or sustain a vibrant community of professionals interested in improving their practice. Essential support includes instruction in the use of Web-based activities and time management, a biweekly e-Newsletter, regular communication from leaders, and an annual face-to-face conference.

(16) Frisch NC, Borycki EM, Mickelson G, Atherton P, Novak-Lauscher H, Hooker D, et al. Use of social media and web 2.0 technologies to increase knowledge and skills of british columbia nurses. Nursing Informatics ...: Proceedings of the ...International Congress on Nursing Informatics 2012;2012:117 Health professionals' use of social media and Web 2.0 technologies are emerging as a new area of research. We present the experiences of a province-wide network in Canada that was developed using such technologies as a means to increase nurses' capacity in nursing health services research. Our network is

 

 

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                                                                                                                                                                                                                                                                                                                                         based on a model of electronic communities of practice (eCoPs). Network evaluation affirms that nurses do respond to social media, as membership has grown to over 1,400 members in two years. Approaches used for network development and implementation are discussed, and the network's eHealth eCoP is presented as a case of network activities and directions.

(17) Fung-Kee-Fung M, Boushey RP, Morash R. Exploring a "community of practice" methodology as a regional platform for large-scale collaboration in cancer surgery-the Ottawa approach. Current Oncology 2014 Feb;21(1):13-18 Pressing challenges have forced health care providers to rethink traditional silos and professional boundaries. Communities of practice (cops) have been identified as a means to share knowledge across silos and boundaries. However, clarity sufficient to enable their easy and uniform reproducibility is lacking, leading to a gap between cop conceptualization and implementation. This paper explores a cop structure and outlines a framework that is adaptable, measurable, and implementable across health disciplines in a regional cancer surgery program.

(18) Fung-Kee-Fung M, Watters J, Crossley C, Goubanova E, Abdulla A, Stern H, et al. Regional collaborations as a tool for quality improvements in surgery: a systematic review of the literature. Ann.Surg. 2009 Apr;249(4):565-572 BACKGROUND: A systematic review of the literature identifying regional collaborations in surgical practice examining practices related to quality improvement. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases, were searched for published reports of regional collaborations in the surgical community relating to initiatives to enhance quality improvement, quality of care, patient safety, knowledge transfer, or communities of practice. RESULTS: Seven collaborative initiatives met the inclusion criteria and were included in the systematic review of the evidence. Motivations for initiating collaborations were often in response to external demands for performance data. Changes in the processes of clinical care and improvements in clinical outcomes were reported on the basis of the collaborative efforts. Significant improvements in clinical outcomes such as decreases in mortality rates, lower duration of postoperative intubations, and fewer surgical-site infections were reported. Quality improvement process measures were also reported to be improved across all of the collaborative initiatives. Success factors included (a) the establishment of trust among health professionals and health institutions; (b) the availability of accurate, complete, relevant data; (c) clinical leadership; (d) institutional commitment; and (e) the infrastructure and methodological support for quality management. CONCLUSIONS: A community of practice framework incorporating the success elements described in the systematic review of the literature can be used as a valuable model for collaboration amongst surgeons

 

 

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                                                                                                                                                                                                                                                                                                                                         and healthcare organizations to improve quality of care and foster continuing professional development. [References: 35].

(19) Gibson J, Meacheam D. The individual and organizational commitments needed for a successful diabetes care community of practice. Health Services Management Research 2009 Aug;22(3):122-128 Through a qualitative case study of a regional diabetes care programme in New South Wales, Australia, this article examines the phenomenon of communities of practice (CoPs) within organizations, with a specific focus on identifying the commitments required from both individuals and organizations in order to produce a successful CoP. The CoP literature suggests that 'commitment' is essential, yet the exact nature of this 'commitment' has not been identified. This study aims to discover what these commitments are. From the research data, key individual and organizational commitments are identified. The individual commitments needed are (in rank order of significance): a personal commitment to the aim of the CoP; a commitment to knowledge-sharing with others; a commitment to knowledge-seeking from others; effective management of personal relationships with others in the CoP; and understanding of the roles of other members. At the organizational level, the commitments needed are a good fit between the purposes of the CoP and the aims of the organizations employing the CoP members, a commitment to research regarding the CoP's activities, sufficient funding of the work of CoP members, continuing practical and political support to the CoP and facilitation of innovation within the CoP. Recommendations are made relating to the practical significance of the findings of the study. The implications of the findings are assessed relative to other health-service CoPs.

(20) Ho K, Jarvis-Selinger S, Norman CD, Li LC, Olatunbosun T, Cressman C, et al. Electronic communities of practice: guidelines from a project. J.Contin.Educ.Health Prof. 2010;30(2):139-143 The timely incorporation of health research into the routine practice of individual health practitioners and interprofessional teams is a widely recognized and ongoing challenge. Health professional engagement and learning is an important cog in the wheel of knowledge translation; passive dissemination of evidence through journals and clinical practice guidelines is inadequate when used alone as an intervention to change the practices of the health professionals. An evolving body of research suggests that communities of practice can be effective in facilitating the uptake of best practices by individual health professionals and teams. Modern information technologies can extend the boundaries and reach of these communities, forming electronic communities of practice (eCoP) that can be used to promote intra- and interprofessional continuing professional development (CPD) and team-based, patient-centered care. However, examples of eCoPs and examination of their characteristics are

 

 

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                                                                                                                                                                                                                                                                                                                                         lacking in the literature. In this paper, we discuss guidelines for developing eCoP. These guidelines will be helpful for others considering the use of the eCoP model in interprofessional learning and practice.

(21) Hutchings M, Scammell J, Quinney A. Praxis and reflexivity for interprofessional education: towards an inclusive theoretical framework for learning. Journal of Interprofessional Care 2013 Sep;27(5):358-366 While there is growing evidence of theoretical perspectives adopted in interprofessional education, learning theories tend to foreground the individual, focusing on psycho-social aspects of individual differences and professional identity to the detriment of considering social-structural factors at work in social practices. Conversely socially situated practice is criticised for being context-specific, making it difficult to draw generalisable conclusions for improving interprofessional education. This article builds on a theoretical framework derived from earlier research, drawing on the dynamics of Dewey's experiential learning theory and Archer's critical realist social theory, to make a case for a meta-theoretical framework enabling social-constructivist and situated learning theories to be interlinked and integrated through praxis and reflexivity. Our current analysis is grounded in an interprofessional curriculum initiative mediated by a virtual community peopled by health and social care users. Student perceptions, captured through quantitative and qualitative data, suggest three major disruptive themes, creating opportunities for congruence and disjuncture and generating a model of zones of interlinked praxis associated with professional differences and identity, pedagogic strategies and technology-mediated approaches. This model contributes to a framework for understanding the complexity of interprofessional learning and offers bridges between individual and structural factors for engaging with the enablements and constraints at work in communities of practice and networks for interprofessional education.

(22) Jeffs LP, Lo J, Beswick S, Campbell H. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses. Nurs.Adm.Q. 2013 Jul-Sep;37(3):222-230 With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride;

 

 

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                                                                                                                                                                                                                                                                                                                                         and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

(23) Jiwa M, Chan W, Ross J, Shaw T, Magin PJ. Communities of practice - quality improvement or research in general practice. Aust.Fam.Physician 2011 Jan-Feb;40(1-2):72-75 BACKGROUND: A 'communities of practice' (CoP) approach has the potential to address quality improvement issues and facilitate research in general practice by engaging those most intimately involved in delivering services - the health professionals. OBJECTIVE: This article outlines the CoP approach and discusses some of the challenges involved in using this approach to raise standards in general practice and how these challenges might be addressed. DISCUSSION: General practitioner insight needs to be harnessed in order to develop solutions that are conceived in, and informed by, clinical practice. A CoP approach provides control to the practitioners over selection of the most relevant research question and outcome measure. However, the method is challenging as it requires a focus that is suitable, that motivates the participants, and effective management strategies and resources to support the CoP.

(24) Kislov R, Harvey G, Walshe K. Collaborations for leadership in applied health research and care: lessons from the theory of communities of practice. Implementation Science 2011;6:64 BACKGROUND: The paper combines the analytical and instrumental perspectives on communities of practice (CoPs) to reflect on potential challenges that may arise in the process of interprofessional and inter-organisational joint working within the Collaborations for Leaderships in Applied Health Research and Care (CLAHRCs)--partnerships between the universities and National Health Service (NHS) Trusts aimed at conducting applied health research and translating its findings into day-to-day clinical practice. DISCUSSION: The paper discusses seminal theoretical literature on CoPs as well as previous empirical research on the role of these communities in healthcare collaboration, which is organised around the following three themes: knowledge sharing within and across CoPs, CoP formation and manageability, and identity building in CoPs. It argues that the multiprofessional and multi-agency nature of the CLAHRCs operating in the traditionally demarcated organisational landscape of the NHS may present formidable obstacles to knowledge sharing between various professional groupings, formation of a shared 'collaborative' identity, and the development of new communities within the CLAHRCs. To cross multiple

 

 

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                                                                                                                                                                                                                                                                                                                                         boundaries between various professional and organisational communities and hence enable the flow of knowledge, the CLAHRCs will have to create an effective system of 'bridges' involving knowledge brokers, boundary objects, and cross-disciplinary interactions as well as address a number of issues related to professional and organisational identification. SUMMARY: The CoP approach can complement traditional 'stage-of-change' theories used in the field of implementation research and provide a basis for designing theory-informed interventions and evaluations. It can help to illuminate multiple boundaries that exist between professional and organisational groups within the CLAHRCs and suggest ways of crossing those boundaries to enable knowledge transfer and organisational learning. Achieving the aims of the CLAHRCs and producing a sustainable change in the ways applied health research is conducted and implemented may be influenced by how effectively these organisations can navigate through the multiple CoPs involved and promote the development of new multiprofessional and multi-organisational communities united by shared practice and a shared sense of belonging--an assumption that needs to be explored by further empirical research.

(25) Kislov R, Walshe K, Harvey G. Managing boundaries in primary care service improvement: a developmental approach to communities of practice. Implementation Science 2012;7:97 BACKGROUND: Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. METHODS: The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester-a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. FINDINGS: The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups

 

 

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                                                                                                                                                                                                                                                                                                                                         existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic. CONCLUSIONS: In cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation.

(26) Lees A, Meyer E. Theoretically speaking: use of a communities of practice framework to describe and evaluate interprofessional education. Journal of Interprofessional Care 2011 Mar;25(2):84-90 This article uses Wenger's (1998) theory of communities of practice, and in particular his learning design framework, to describe and evaluate the pedagogy of one interprofessional continuing professional development (CPD) programme for health, education and social care professionals. The article presents findings from 27 post-intervention interviews conducted 12 months after the CPD. Key pedagogic features of small group working, action planning, facilitation, continued independent learning and 'safe' learning environment were found to provide facilities for 'engagement', 'imagination' and 'alignment' (Wenger, 1998), with the use of task-focused small group work particularly appreciated by participants. Problems of falling attendance and marginalisation are discussed using Wenger's concept of 'identification/negotiability'. It is suggested that careful selection of delegates and provision of sufficient organisational support may mitigate such problems.

(27) Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Use of communities of practice in business and health care sectors: a systematic review. Implementation Science 2009;4:27 BACKGROUND: Since being identified as a concept for understanding knowledge sharing, management, and creation, communities of practice (CoPs) have become increasingly popular within the health sector. The CoP concept has been used in the business sector for over 20 years, but the use of CoPs in the health sector has been limited in comparison. OBJECTIVES: First, we examined how CoPs were defined and used in these two sectors. Second, we evaluated the evidence of effectiveness on the health sector CoPs for improving the uptake of best practices and mentoring new practitioners. METHODS: We conducted a search of electronic databases in the business, health, and education sectors,

 

 

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                                                                                                                                                                                                                                                                                                                                         and a hand search of key journals for primary studies on CoP groups. Our research synthesis for the first objective focused on three areas: the authors' interpretations of the CoP concept, the key characteristics of CoP groups, and the common elements of CoP groups. To examine the evidence on the effectiveness of CoPs in the health sector, we identified articles that evaluated CoPs for improving health professional performance, health care organizational performance, professional mentoring, and/or patient outcome; and used experimental, quasi-experimental, or observational designs. RESULTS: The structure of CoP groups varied greatly, ranging from voluntary informal networks to work-supported formal education sessions, and from apprentice training to multidisciplinary, multi-site project teams. Four characteristics were identified from CoP groups: social interaction among members, knowledge sharing, knowledge creation, and identity building; however, these were not consistently present in all CoPs. There was also a lack of clarity in the responsibilities of CoP facilitators and how power dynamics should be handled within a CoP group. We did not find any paper in the health sector that met the eligibility criteria for the quantitative analysis, and so the effectiveness of CoP in this sector remained unclear. CONCLUSION: There is no dominant trend in how the CoP concept is operationalized in the business and health sectors; hence, it is challenging to define the parameters of CoP groups. This may be one of the reasons for the lack of studies on the effectiveness of CoPs in the health sector. In order to improve the usefulness of the CoP concept in the development of groups and teams, further research will be needed to clarify the extent to which the four characteristics of CoPs are present in the mature and emergent groups, the expectations of facilitators and other participants, and the power relationship within CoPs.

(28) Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Evolution of Wenger's concept of community of practice. Implementation Science 2009;4:11 BACKGROUND: In the experience of health professionals, it appears that interacting with peers in the workplace fosters learning and information sharing. Informal groups and networks present good opportunities for information exchange. Communities of practice (CoPs), which have been described by Wenger and others as a type of informal learning organization, have received increasing attention in the health care sector; however, the lack of uniform operating definitions of CoPs has resulted in considerable variation in the structure and function of these groups, making it difficult to evaluate their effectiveness. OBJECTIVE: To critique the evolution of the CoP concept as based on the germinal work by Wenger and colleagues published between 1991 and 2002. DISCUSSION: CoP was originally developed to provide a template for examining the learning that happens among practitioners in a social environment, but over the years there have been important divergences in the focus of the concept. Lave and Wenger's earliest publication (1991) centred on the interactions between novices and experts, and the process by which newcomers

 

 

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                                                                                                                                                                                                                                                                                                                                         create a professional identity. In the 1998 book, the focus had shifted to personal growth and the trajectory of individuals' participation within a group (i.e., peripheral versus core participation). The focus then changed again in 2002 when CoP was applied as a managerial tool for improving an organization's competitiveness. SUMMARY: The different interpretations of CoP make it challenging to apply the concept or to take full advantage of the benefits that CoP groups may offer. The tension between satisfying individuals' needs for personal growth and empowerment versus an organization's bottom line is perhaps the most contentious of the issues that make CoPs difficult to cultivate. Since CoP is still an evolving concept, we recommend focusing on optimizing specific characteristics of the concept, such as support for members interacting with each other, sharing knowledge, and building a sense of belonging within networks/teams/groups. Interventions that facilitate relationship building among members and that promote knowledge exchange may be useful for optimizing the function of these groups.

(29) MacPhee M, Suryaprakash N, Jackson C. Online knowledge networking: what leaders need to know. J.Nurs.Adm. 2009 Oct;39(10):415-422 Knowledge networks (KNs) are leadership tools that can increase social capital and innovation in and across organizations. Communities of practice often emerge from successful KNs. Electronic or online KNs can maximize efficiency and effectiveness of communications and collaboration. The authors describe the benefits associated with KNs. They provide an overview of the development, facilitation, and evaluation of online KNs. An example of a nursing leadership online KN illustrates the key considerations involved in the KN process.

(30) Mairs K, McNeil H, McLeod J, Prorok JC, Stolee P. Online strategies to facilitate health-related knowledge transfer: a systematic search and review. Health Information & Libraries Journal 2013 Dec;30(4):261-277 BACKGROUND: Health interventions and practices often lag behind the available research, and the need for timely translation of new health knowledge into practice is becoming increasingly important. OBJECTIVE: The objective of this study was to conduct a systematic search and review of the literature on online knowledge translation techniques that foster the interaction between various stakeholders and assist in the sharing of ideas and knowledge within the health field. METHODS: The search strategy included all published literature in the English language since January 2003 and used the medline, Cumulative Index to Nursing and Allied Health Literature (cinahl), embase and Inspec databases. RESULTS: The results of the review indicate that online strategies are diverse, yet all are applicable in facilitating online health-related knowledge translation. The method of knowledge sharing ranged from use of wikis, discussion forums, blogs, and social media to data/knowledge management tools, virtual communities of practice and conferencing technology - all of which

 

 

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                                                                                                                                                                                                                                                                                                                                         can encourage online health communication and knowledge translation. CONCLUSIONS: Online technologies are a key facilitator of health-related knowledge translation. This review of online strategies to facilitate health-related knowledge translation can inform the development and improvement of future strategies to expedite the translation of research to practice. 2013 Health Libraries Group of CILIP and John Wiley & Sons Ltd.

(31) Mancini MA, Miner CS. Learning and change in a community mental health setting. Journal of Evidence-Based Social Work 2013 Oct;10(5):494-504 This article offers methodological reflections and lessons learned from a three-year university-community partnership that used participatory action research methods to develop and evaluate a model for learning and change. Communities of practice were used to facilitate the translation of recovery-oriented and evidence-based programs into everyday practice at a community mental health agency. Four lessons were drawn from this project. First, the processes of learning and organizational change are complex, slow, and multifaceted. Second, development of leaders and champions is vital to sustained implementation in an era of restricted resources. Third, it is important to have the agency's values, mission, policies, and procedures align with the principles and practices of recovery and integrated treatment. And fourth, effective learning of evidence-based practices is influenced by organizational culture and climate. These four lessons are expanded upon and situated within the broader literature and implications for future research are discussed.

(32) McAllister M, Oprescu F, Jones C. N(2)E: Envisioning a process to support transition from nurse to educator. Contemporary Nurse 2014;46(2):242-250 Abstract Rising health inequities, continuing nursing shortages, and overlooked professional development needs of nurse educators are three important issues facing nursing in Australia. This paper argues for an innovative and proactive strategy that could transform the nurse education workforce into one that is repopulated, reinvigorated and refocused. The problem facing nurse educators, and subsequently affecting nurses' preparation for practice and longevity in the profession, was identified by drawing on findings from the literature, extensive educational experience, and an exploratory study of nurse educators working in universities, colleges and health services. A solution has been devised by drawing together the tenets of critical social theory, transformative learning, communities of practice and social media. Nursing educators, refocused around a social justice agenda, may be the remedy that the Australian Health Care System requires to embark on effective action that can benefit everyone, from the health service staff to our most vulnerable groups in society. This refocusing can be achieved in a structured and strategic process that builds confidence and professional capabilities.

 

 

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                                                                                                                                                                                                                                                                                                                                         (33) Meagher-Stewart D, Solberg SM, Warner G, MacDonald JA, McPherson C, Seaman P. Understanding the role of communities of practice in evidence-informed decision making in public health. Qual.Health Res. 2012 Jun;22(6):723-739 In this article we report on qualitative findings that describe public health practitioners' practice-based definitions of evidence-informed decision making (EIDM) and communities of practice (CoP), and how CoP could be a mechanism to enhance their capacity to practice EIDM. Our findings emerged from a qualitative descriptive analysis of group discussions and participant concept maps from two consensus-building workshops that were conducted with public health practitioners (N = 90) in two provinces in eastern Canada. Participants recognized the importance of EIDM and the significance of integrating explicit and tacit evidence in the EIDM process, which was enhanced by CoP. Tacit knowledge, particularly from peers and personal experience, was the preferred source of knowledge, with informal peer interactions being the favored form of CoP to support EIDM. CoP helped practitioners build relationships and community capacity, share and create knowledge, and build professional confidence and critical inquiry. Participants described individual and organizational attributes that were needed to enable CoP and EIDM.

(34) Mitton C, Adair CE, McKenzie E, Patten S, Waye-Perry B, Smith N. Designing a knowledge transfer and exchange strategy for the Alberta Depression Initiative: contributions of qualitative research with key stakeholders. International Journal of Mental Health Systems 2009;3(1):11 BACKGROUND: Depressive disorders are highly prevalent and of significant societal burden. In fall 2004, the 'Alberta Depression Initiative' (ADI) research program was formed with a mission to enhance the mental health of the Alberta population. A key expectation of the ADI is that research findings will be effectively translated to appropriate research users. To help ensure this, one of the initiatives funded through the ADI focused specifically on knowledge transfer and exchange (KTE). The objectives of this project were first to examine the state of the KTE literature, and then based on this review and a set of key informant interviews, design a KTE strategy for the ADI. METHODS: Face to face interviews were conducted with 15 key informants familiar with KTE and/or mental health policy and programs in Alberta. Interviews were transcribed and analyzed using the constant comparison method. RESULTS: This paper reports on findings from the qualitative interviews. Respondents were familiar with the barriers to and facilitators of KTE as identified in the existing literature. Four key themes related to the nature of effective KTE were identified in the data analysis: personal relationships, cultivating champions, supporting communities of practice, and building receptor capacity. These recommendations informed the design of a contextually appropriate KTE strategy for the ADI. The three-phased strategy involves preliminary research, public workshops, on-going networking

 

 

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                                                                                                                                                                                                                                                                                                                                         and linkage activities and rigorous evaluation against pre-defined and mutually agreed outcome measures. CONCLUSION: Interest in KTE on the part of ADI has led to the development of a strategy for engaging decision makers, researchers, and other mental health stakeholders in an on-going network related to depression programs and policy. A similarly engaged process might benefit other policy areas.

(35) Parboosingh IJ, Reed VA, Caldwell Palmer J, Bernstein HH. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education. J.Contin.Educ.Health Prof. 2011;31(2):122-127 Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers. Copyright 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

(36) Ranmuthugala G, Cunningham FC, Plumb JJ, Long J, Georgiou A, Westbrook JI, et al. A realist evaluation of the role of communities of practice in changing healthcare practice. Implementation Science 2011;6:49 BACKGROUND: Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to

 

 

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                                                                                                                                                                                                                                                                                                                                         understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare? METHODS: The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP. DISCUSSION: Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare.

(37) Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research 2011;11:273 BACKGROUND: Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice. METHODS: Peer-reviewed empirical research papers on CoPs in the healthcare sector were identified by searching electronic health-databases. Information on the purpose of establishing CoPs, their composition, methods by which members communicate and share information or knowledge, and research methods used to examine effectiveness was extracted and reviewed. Also examined was evidence of whether or not CoPs led to a change in healthcare practice. RESULTS: Thirty-one primary research papers and two systematic reviews were identified and reviewed in detail. There was a trend from descriptive to evaluative research. The focus of CoPs in earlier publications was on learning and exchanging information and knowledge, whereas in more recently published research, CoPs were used more as a tool to improve clinical practice and to facilitate the implementation of evidence-based practice. Means by which members communicated with each other varied, but in none of the primary

 

 

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                                                                                                                                                                                                                                                                                                                                         research studies was the method of communication examined in terms of the CoP achieving its objectives. Researchers are increasing their efforts to assess the effectiveness of CoPs in healthcare, however the interventions have been complex and multifaceted, making it difficult to directly attribute the change to the CoP. CONCLUSIONS: In keeping with Wenger and colleagues' description, CoPs in the healthcare sector vary in form and purpose. While researchers are increasing their efforts to examine the impact of CoPs in healthcare, cultivating CoPs to improve healthcare performance requires a greater understanding of how to establish and support CoPs to maximise their potential to improve healthcare.

(38) Richard L, Chiocchio F, Essiembre H, Tremblay MC, Lamy G, Champagne F, et al. Communities of practice as a professional and organizational development strategy in local public health organizations in Quebec, Canada: an evaluation model. Healthcare Policy = Politiques de sante 2014 Feb;9(3):26-39 Communities of practice (CoPs) are among the professional development strategies most widely used in such fields as management and education. Though the approach has elicited keen interest, knowledge pertaining to its conceptual underpinnings is still limited, thus hindering proper assessment of CoPs' effects and the processes generating the latter. To address this shortcoming, this paper presents a conceptual model that was developed to evaluate an initiative based on a CoP strategy: Health Promotion Laboratories are a professional development intervention that was implemented in local public health organizations in Montreal (Quebec, Canada). The model is based on latest theories on work-group effectiveness and organizational learning and can be usefully adopted by evaluators who are increasingly called upon to illuminate decision-making about CoPs. Ultimately, validation of this conceptual model will help advance knowledge and practice pertaining to CoPs as well as professional and organizational development strategies in public health. Copyright 2014 Longwoods Publishing.

(39) Sargeant J. Theories to aid understanding and implementation of interprofessional education. J.Contin.Educ.Health Prof. 2009;29(3):178-184 Multiple events are calling for greater interprofessional collaboration and communication, including initiatives aimed at enhancing patient safety and preventing medical errors. Education is 1 way to increase collaboration and communication, and is an explicit goal of interprofessional education (IPE). Yet health professionals to date are largely educated in isolation. IPE differs from most traditional continuing education in that knowledge is largely socially created through interactions with others and involves unique collaborative skills and attitudes. It requires thinking differently about what constitutes teaching and learning. The article draws upon a small number of social and learning theories to explain the rationale for IPE needing a new way of thinking, and proposes

 

 

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                                                                                                                                                                                                                                                                                                                                         approaches to guide development and implementation of IP continuing education. Social psychology and complexity theory explain the influence of the dynamism and interaction of internal (cognitive) and external (environmental) factors upon learning and set the stage for IPE. Theories related to professionalism and stereotyping, communities of practice, reflective learning, and transformative learning appear central to IPE and guide specific educational interventions. In sum, IPE requires CE to adopt new content, recognize new knowledge, and use new approaches for learning; we are now in a different place.

(40) Soubhi H, Bayliss EA, Fortin M, Hudon C, van den Akker M, Thivierge R, et al. Learning and caring in communities of practice: using relationships and collective learning to improve primary care for patients with multimorbidity. Annals of Family Medicine 2010 Mar-Apr;8(2):170-177 We introduce a primary care practice model for caring for patients with multimorbidity. Primary care for these patients requires flexibility and ongoing coordination, and it often must be tailored to individual circumstances. Such complex and flexible care could be accomplished within communities of practice, whose participants are willing to learn from their shared practice, further each other's goals, share their stories of success and failure, and promote the continued evolution of collective learning. Primary care in these communities would be conceived as a complex adaptive process in which the participants use an iterative approach to care improvement that integrates what they learn and do collectively over time. Clinicians in these communities would define common goals, cocreate care plans, and engage in reflective case-based learning. As community members manage their knowledge, gain insights, and develop new care strategies, they can improve care for patients with multiple conditions. Using a mix of methods, future research should explore the conditions that are necessary for collective learning within communities of clinicians who care for patients with multimorbidity and who develop new knowledge in practice. By understanding these conditions, we can foster the development of collective learning and improve primary care for these patients.

(41) Swift L. Online communities of practice and their role in educational development: a systematic appraisal. Community Practitioner 2014 Apr;87(4):28-31 Practice teachers and academics have a role in developing knowledge and promoting evidence-based practice with their students in a supportive and creative learning environment. Recent advances in technology are enabling communities of practice' (CoPs) to be developed online and may present a valuable opportunity to form greater connections between educators. To explore this idea, the author conducted a systematic appraisal of published evidence relating to the impact of using an online CoP (OCoP) to develop knowledge

 

 

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                                                                                                                                                                                                                                                                                                                                         among healthcare educators. Three academic databases were targeted for articles and the search retrieved nine articles that were analysed for quality. The findings identified that an OCoP offers a 'polycontextual' environment that can enhance knowledge development, strengthen social ties and build social capital. Communities that support tacit knowledge development, information sharing and problem solving are most valued and existing information and communication technology (ICT) tools can be used to promote usability and accessibility. Recognising the value of tacit knowledge and using ICT for educational development within workload hours will require a shift in cultural thinking at both an individual and organisational level.

(42) Thomas AU, Fried GP, Johnson P, Stilwell BJ. Sharing best practices through online communities of practice: a case study. Human Resources for Health [Electronic Resource] 2010;8:25 INTRODUCTION: The USAID-funded Capacity Project established the Global Alliance for Pre-Service Education (GAPS) to provide an online forum to discuss issues related to teaching and acquiring competence in family planning, with a focus on developing countries' health related training institutions. The success of the Global Alliance for Nursing and Midwifery's ongoing web-based community of practice (CoP) provided a strong example of the successful use of this medium to reach many participants in a range of settings. CASE DESCRIPTION: GAPS functioned as a moderated set of forums that were analyzed by a small group of experts in family planning and pre-service education from three organizations. The cost of the program included the effort provided by the moderators and the time to administer responses and conduct the analysis. DISCUSSION AND EVALUATION: Family planning is still considered a minor topic in health related training institutions. Rather than focusing solely on family planning competencies, GAPS members suggested a focus on several professional competencies (e.g. communication, leadership, cultural sensitivity, teamwork and problem solving) that would enhance the resulting health care graduate's ability to operate in a complex health environment. Resources to support competency-based education in the academic setting must be sufficient and appropriately distributed. Where clinical competencies are incorporated into pre-service education, responsible faculty and preceptors must be clinically proficient. The interdisciplinary GAPS memberships allowed for a comparison and contrast of competencies, opportunities, promising practices, documents, lessons learned and key teaching strategies. CONCLUSIONS: Online CoPs are a useful interface for connecting developing country experiences. From CoPs, we may uncover challenges and opportunities that are faced in the absorption of key public health competencies required for decreasing maternal mortality and morbidity. Use of the World Health Organization (WHO) Implementing Best Practices Knowledge Gateway, which requires only a low bandwidth connection, gave educators an opportunity to engage in the discussion even in the most Internet access-restricted places (e.g. Ethiopia). In order to sustain an online CoP, funds must come from an

 

 

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                                                                                                                                                                                                                                                                                                                                         international organization (e.g. WHO regional office) or university that can program the costs long-term. Eventually, the long-term effectiveness and sustainability of GAPS rests on its transfer to the members themselves.

(43) Valaitis RK, Akhtar-Danesh N, Brooks F, Binks S, Semogas D. Online communities of practice as a communication resource for community health nurses working with homeless persons. J.Adv.Nurs. 2011 Jun;67(6):1273-1284 AIMS: This study explored community health nurses' viewpoints about a Canadian online community of practice to support their practice with homeless or under-housed populations. BACKGROUND: Community health nurses who specifically work with homeless and marginally housed populations often report feelings of isolation and stress in managing complex problems in resource constraints. To strengthen intra-professional ties and enhance information access, an online community of practice was designed, implemented and evaluated by and for them. METHODS: Q-methodology was used. Sixty-six statements about the community of practice were collected from an online survey and focus groups, refined and reduced to 44 statements. In 2009, sixteen participants completed the Q-sort activity, rating each statement relative to the others. Scores for each participant were subjected to by-person factor analysis. RESULTS: Respondents fell into two groups -tacit knowledge warriors and tacit knowledge communicators. Warriors strongly believed that the community of practice could combat stigma associated with homelessness and promote awareness of homelessness issues, and valued its potential to validate and improve practice. Communicators would have used the community of practice more with increased discussion, facilitation and prompt responses. Generally, nurses viewed the community of practice as a place to share stories, validate practice and adapt best practices to their work context. CONCLUSIONS: Online communities of practice can be valuable to nurses in specialized fields with limited peer support and access to information resources. Tacit knowledge development is important to nurses working with homeless populations: this needs to be valued in conjunction with scientifically based knowledge. 2011 The Authors. Journal of Advanced Nursing 2011 Blackwell Publishing Ltd.

(44) Vinson CA. Using concept mapping to develop a conceptual framework for creating virtual communities of practice to translate cancer research into practice. Preventing Chronic Disease 2014;11:E68 INTRODUCTION: Translating government-funded cancer research into clinical practice can be accomplished via virtual communities of practice that include key players in the process: researchers, health care practitioners, and intermediaries. This study, conducted from November 2012 through January 2013, examined issues that key stakeholders believed should be addressed to create and sustain government-sponsored virtual communities of practice to integrate cancer control research, practice, and policy and demonstrates how

 

 

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                                                                                                                                                                                                                                                                                                                                         concept mapping can be used to present relevant issues. METHODS: Key stakeholders brainstormed statements describing what is needed to create and sustain virtual communities of practice for moving cancer control research into practice. Participants rated them on importance and feasibility, selected most relevant statements, and sorted them into clusters. I used concept mapping to examine the issues identified and multidimensional scaling analyses to create a 2-dimensional conceptual map of the statement clusters. RESULTS: Participants selected 70 statements and sorted them into 9 major clusters related to creating and sustaining virtual communities of practice: 1) standardization of best practices, 2) external validity, 3) funding and resources, 4) social learning and collaboration, 5) cooperation, 6) partnerships, 7) inclusiveness, 8) social determinants and cultural competency, and 9) preparing the environment. Researchers, health care practitioners, and intermediaries were in relative agreement regarding issues of importance for creating these communities. CONCLUSION: Virtual communities of practice can be created to address the needs of researchers, health care practitioners, and intermediaries by using input from these key stakeholders. Increasing linkages between these subgroups can improve the translation of research into practice. Similarities and differences between groups can provide valuable information to assist the government in developing virtual communities of practice.

(45) Williams PM. Integration of health and social care: a case of learning and knowledge management. Health & Social Care in the Community 2012 Sep;20(5):550-560 This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework;

 

 

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                                                                                                                                                                                                                                                                                                                                         clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies.