Seeding Structures for a Community of Practice Focused on Transient Ischemic Attack (TIA): Implementing Across Disciplines and Waves

Abstract

BACKGROUND: The Community of Practice (CoP) model represents one approach to address knowledge management to support effective implementation of best practices. OBJECTIVE: We sought to identify CoP developmental strategies within the context of a national quality improvement project focused on improving the quality for patients receiving acute transient ischemic attack (TIA) care. DESIGN: Stepped wedge trial. PARTICIPANTS: Multidisciplinary staff at six Veterans Affairs medical facilities. INTERVENTIONS: To encourage site implementation of a multi-component quality improvement intervention, the trial included strategies to improve the development of a CoP: site kickoff meetings, CoP conference calls, and an interactive website (the "Hub"). APPROACH: Mixed-methods evaluation included data collected through a CoP attendance log; semi-structured interviews with site participants at 6 months (n = 32) and 12 months (n = 30), and CoP call facilitators (n = 2); and 22 CoP call debriefings. KEY RESULTS: The critical seeding structures that supported the cultivation of the CoP were the kickoffs which fostered relationships (key to the community element of CoPs) and provided the evidence base relevant to TIA care (key to the domain element of CoPs). The Hub provided the forum for sharing quality improvement plans and other tools which were further highlighted during the CoP calls (key to the practice element of CoPs). CoP calls were curated to create a positive context around participants' work by recognizing team successes. In addition to improving care at their local facilities, the community created a shared set of tools which built on their collective knowledge and could be shared within and outside the group. CONCLUSIONS: The PREVENT CoP advanced the mission of the learning healthcare system by successfully providing a forum for shared learning. The CoP was grown through seeding structures that included kickoffs, CoP calls, and the Hub. A CoP expands upon the learning collaborative implementation strategy as an effective implementation practice.

The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance

“…It is generally appreciated that provider education and guideline dissemination are not sufficient to change practice [ 25 , 26 ]. In contrast, learning collaboratives are evidence-based implementation approaches that have had success in other clinical areas [ 27 , 28 , 29 ]. Learning collaboratives operate via building stakeholder interrelationships and employing modeling, education, and support to promote behavior changes.…”

Acceptability of a complex team-based quality improvement intervention for transient ischemic attack: a mixed-methods study

“…PREVENT employed a bundle of three primary implementation strategies which were previously reported: [ 14 , 15 ] (1) team activation via audit and feedback [ 16 ], reflecting & evaluating, planning, and goal setting [ 17 ]; (2) external facilitation (EF) [ 16 , 18 ]; and (3) building a community of practice (CoP) [ 19 , 20 ]. In addition, PREVENT allowed for local adaptation of its intervention components with a high degree of flexibility.…”

The Perils of a “My Work Here is Done” Perspective: A Mixed Methods Evaluation of Sustainment of an Intervention to Improve Quality of Transient Ischemic Attack Care

“…(23,24) PREVENT employed a bundle of three primary implementation strategies: (1) team activation via audit and feedback, re ecting and evaluating, planning, and goal setting; (2) external facilitation (EF); and (3) building a community of practice. (25,26) In addition, PREVENT allowed for local adaptation of the intervention components. External facilitation was provided by the study team to participating site team members primarily by a nurse with experience in quality improvement and a physician with experience in both cerebrovascular disease and quality improvement.…”

“…(26) The teams joined monthly PREVENT virtual collaborative conferences (conducted by telephone or videoconferencing) during which the teams shared progress on action plans, articulated goals for the next month, and reviewed any new evidence or tools. (25)…”