Communities of practice for supporting health systems change: a missed opportunity

Abstract

BackgroundCommunities of practice (CoPs) have been used in the health sector to support professional practice change. However, little is known about how CoPs might be used to influence a system that requires change at and across various levels (i.e. front line care, organizational, governmental). In this paper we examine the experience of a CoP in the Canadian province of Ontario as it engages in improving the care of seniors. Our aim is to shed light on using CoPs to facilitate systems change.MethodsThis paper draws on year one findings of a larger multiple case study that is aiming to increase understanding of knowledge translation processes mobilized through CoPs. In this paper we strategically report on one case to illustrate a critical example of a CoP trying to effect systems change. Primary data included semi-structured interviews with CoP members (n = 8), field notes from five planning meetings, and relevant background documents. Data analysis included deductive coding (i.e. pre-determined codes aligned with the larger project) and inductive coding which allowed codes and themes to emerge. A thorough description of the case was prepared using all the coded data.ResultsThe CoP recognized a need to support health professionals (nurses, dentists) and related paraprofessionals with knowledge, experience, and resources to appropriately address their clients’ oral health care needs. Accordingly, the CoP led a knowledge-to-action initiative that involved a seven-part webinar series meant to transfer step-by-step, skill-based knowledge through live and archived webinars. Although the core planning team functioned effectively to develop the webinars, the CoP was challenged by organizational and long-term care sector cultures, as well as governmental structures within the broader health context.ConclusionThe provincial CoP functioned as an incubator that brought together best practices, research, experiences, a reflective learning cycle, and passionate champions. Nevertheless, the CoP’s efforts to stimulate practice changes were met with broader resistance. Research about how to use CoPs to influence health systems change is needed given that CoPs are being tasked with this goal.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-015-0023-x) contains supplementary material, which is available to authorized users.

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

“…An alternative use of PARIHS in empirical studies involved focusing on one of the three PARIHS elements (n = 17) and investigating them in greater depth, most notably context (n = 10) (e.g., [155,232]) and facilitation (n = 7) (e.g., [307,312]). A total of 25 opinion/theoretical articles [144,351,[359][360][361][366][367][368][369][370][371][372][373][374][375][376][377][378][379][380][381][382][383][384][385] reported using the PARIHS framework in some other way, including a discussion about PARIHS as part of presenting a general overview of theories and frameworks to inform implementation (e.g., [369,376,378,384]), using PARIHS to augment, develop, or evaluate other implementation models and frameworks (e.g., [318,359,367,374,382]), and informing education and learning and teaching initiatives [144,372].…”

Examining the Disconnect Between Communities of Practice Learning Theory and Educational Practices in the PharmD Program in Qatar

“…The importance of governmental support for communities of practice initiatives was emphasized by Kothari and colleagues who indicated that communities of practice efforts to stimulate practice changes should be supported by the health system, health institutions, and the government. 40 All challenges to the successful implementation of communities of practice within an academic program, or academic institution were evident in the QU PharmD program. The different interpretation of communities of practice learning theory and a dearth of communication about its outcomes (CH1) has prevented the development of several aspects of the educational process pillars.…”

Erratum to: Communities of practice for supporting health systems change: a missed opportunity

“…After publication of the original article [ 1 ] it came to the publisher’s attention that references 32 and 33 were cited in the incorrect positions in the text. These errors have been corrected in the original article.…”