Communities of Practice in Acute and Forensic Psychiatry: Lessons Learned and Perceived Effects

Abstract

In the Netherlands, two new approaches have been developed for acute and forensic psychiatry, called High and Intensive Care (HIC) and Forensic High and Intensive Care (FHIC). The models provide standards for temporary high-quality clinical care for patients in crisis and combine practices to reduce seclusion. To support the implementation of these approaches, Communities of Practice (CoPs) were created, including peer providers, mental health nurses, psychiatrists and managers. CoPs are increasingly used in healthcare. However, CoPs vary greatly in form and objective, and more insight is needed in the organisation and facilitation of CoPs. Therefore, the aim of this study is to gain insight into the lessons learned and perceived effects of the CoPs. A qualitative approach was used. Data were collected through focus groups (n = 3) with participants in the CoPs, feedback meetings with teams implementing HIC (n = 78) or FHIC (n = 23), and observations by the researchers. Data were analysed thematically. Lessons learned are: 1) create an ambassador role for CoP participants, 2) organize concrete activities, 3) take care of a multidisciplinary composition, and 4) foster shared responsibility and work on sustainability. Perceived effects of the CoPs were: 1) support of HIC and FHIC implementation, 2) creation of a national movement, and 3) further development of the HIC and FHIC approaches. The audits served as an important vehicle to activate the CoPs, and stimulated the implementation of HIC and FHIC. The findings may help others in creating a CoP when it comes to the implementation of best practices and improving healthcare.

How to combine rules and commitment in fostering research integrity?

“…Using bureaucracy to further the community's shared goals can help the research community to become intrinsically motivated to engage in responsible research practices, rather than doing so because of potential punishments, and might thereby prevent a 'check-box' mentality . For instance, audits can serve as a valuable communicative tool for learning, exchanging knowledge, and exploring mutual goals, rather than policing (Gerritsen et al, 2021). At the TSB, the audits are focused on education and reflecting on data handling and RI more generally, and this has helped to increase awareness of RI.…”

“…processes, but also use momentum when there is increased attention for RI Implementation of new policies and initiatives can take time, not only due to procedural issues, but also due to the need for reflection on the values behind the policies and their relationship to community goals and culture (Gerritsen et al, 2021;Vasconcelos et al, 2015). Changing attitudes towards RI and forming agreements with stakeholders across the network about what measures to take can be a slow process (Coates, 2014).…”

How to combine rules and commitment in fostering research integrity?

“…Approach RI rules and regulations to further the research community's goals, rather than as ends in themselves which need stringent enforcement 14 Using bureaucracy to further the community's shared goals can help the research community to become intrinsically motivated to engage in responsible research practices, rather than doing so because of potential punishments, and might thereby prevent a 'check-box' mentality . For instance, audits can serve as a valuable communicative tool for learning, exchanging knowledge, and exploring mutual goals, rather than policing (Gerritsen et al, 2021). At the TSB, the audits are focused on education and reflecting on data handling and RI more generally, and this has helped to increase awareness of RI.…”

Developing guidelines for research institutions

“…Using bureaucracy to further the community's shared goals can help the research community to become intrinsically motivated to engage in responsible research practices, rather than doing so because of potential negative sanctioning, and might thereby prevent a 'check-box' mentality . For instance, audits can serve as a valuable communicative tool for learning, exchanging knowledge, and exploring mutual goals, rather than policing (Gerritsen et al, 2021). At the TSB, the audits are focused on education and reflecting on data handling and RI more generally, and this has helped to increase awareness of RI.…”

“…Implementation of new policies and initiatives can take time, not only due to procedural issues, but also due to the need for reflection on the values behind the policies and their relationship to community goals and culture (Gerritsen et al, 2021;Vasconcelos et al, 2015). Changing attitudes towards RI and forming agreements with stakeholders across the network about what measures to take can be a slow process (Coates, 2014).…”