A realist evaluation of the role of communities of practice in changing healthcare practice

Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia. .
Implementation Science (Impact Factor: 4.12). 05/2011; 6(1):49. DOI: 10.1186/1748-5908-6-49
Source: PubMed


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 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?
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.
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.

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    • "The exchange between members on the CoP intranet discussion board and CoP facilitator emails will provide frequency counts representing CoP member activity and connectivity. The presence and strength of these connections may assist in comprehending which features of the CoP relate to improvement in falls prevention activity and tacit knowledge exchange (Ranmuthugala et al. 2011a, Gainforth et al. 2014, Yousefi-Nooraie et al. 2014). "
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    ABSTRACT: The aim of this study was to facilitate the implementation and operation of a falls prevention Community of Practice in a residential aged-care organization and evaluate its effect on falls outcomes. Falls are a substantial concern across the residential aged-care sector with half its older population falling annually. Preventing falls requires tailoring of current evidence for reducing falls and adoption into daily activity, which is challenging for diversely skilled staff caring for a frailer population. Forming a community of practice could provide staff with the opportunity to share and develop their expertise in falls prevention and innovate change. A mixed methods design based on a realist approach conducted across 13 residential care facilities (N = 779 beds). Staff will be invited to become a member of the community of practice with all sites represented. The community of practice will be supported to audit falls prevention activity and identify gaps in practice for intervention. The impact of the community of practice will be evaluated at three levels: individual member level, facility level and organizational level. A pre-post design using a range of standardized measures supported by audits, surveys, focus groups and interviews will determine its effect on falls prevention practice. Falls outcomes will be compared at five time intervals using negative binomial regression and logistic regression. The study is funded 2013-2017. Findings from this research will assist residential aged-care providers to understand how to effectively translate evidence about falls prevention into clinical practice. © 2015 John Wiley & Sons Ltd.
    Journal of Advanced Nursing 07/2015; DOI:10.1111/jan.12725 · 1.74 Impact Factor
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    • "Spain Protocol Primary healthcare teams Provision of guidelines, protocols, training and information systems Chouinard et al. 2013 [34] Canada Protocol (RCT) Primary care Implementation of an evidence-based intervention to improve chronic-disease management Seers et al. 2012 [35] Europe Protocol (RCT) Long-term nursing care Facilitation interventions vs. standard dissemination of information in evidence-based practice Ranmuthugala et al. 2011 [36] Australia Protocol Healthcare settings Communities of practice (Note: Communities of practice will be studied using an opportunistic sample) "
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    ABSTRACT: Background In knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. Traditional evaluation efforts that focus on aggregate effectiveness represent an oversimplification of both the environment and the interventions themselves. However, theory-based approaches to evaluation, such as realist evaluation (RE), may be better-suited to examination of complex knowledge translation interventions with a view to understanding what works, for whom, and under what conditions. It is the aim of the present state-of-the-art review to examine current literature with regard to the use of RE in the assessment of knowledge translation interventions implemented within healthcare environments.Methods Multiple online databases were searched from 1997 through June 2013. Primary studies examining the application or implementation of knowledge translation interventions within healthcare settings and using RE were selected for inclusion. Varying applications of RE across studies were examined in terms of a) reporting of core elements of RE, and b) potential feasibility of this evaluation method.ResultsA total of 14 studies (6 study protocols), published between 2007 and 2013, were identified for inclusion. Projects were initiated in a variety of healthcare settings and represented a range of interventions. While a majority of authors mentioned context (C), mechanism (M) and outcome (O), a minority reported the development of C-M-O configurations or testable hypotheses based on these configurations. Four completed studies reported results that included refinement of proposed C-M-O configurations and offered explanations within the RE framework. In the few studies offering insight regarding challenges associated with the use of RE, difficulties were expressed regarding the definition of both mechanisms and contextual factors. Overall, RE was perceived as time-consuming and resource intensive.Conclusions The use of RE in knowledge translation is relatively new; however, theory-building approaches to the examination of complex interventions in this area may be increasing as researchers attempt to identify what works, for whom and under what circumstances. Completion of the RE cycle may be challenging, particularly in the development of C-M-O configurations; however, as researchers approach challenges and explore innovations in its application, rich and detailed accounts may improve feasibility.
    Implementation Science 09/2014; 9(1):115. DOI:10.1186/s13012-014-0115-y · 4.12 Impact Factor
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    • "According to Bredillet (2004), community of practice members 'learn by participating in the community and practicing their jobs'. At the beginning, the concept constituted an analytic aid that let describe how learning occurred in the workplace and then it became the tool for businesses applied to increase the 'knowledge assets' possessed by the employees (Ranmuthugala, et al., 2011). Community of practice is the concept that has been evolving and we can find its multiple forms can be found in reality. "
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    ABSTRACT: Background: A growing interest in the concept of communities of practice (CoP) has been recently observed in several academic fields. They include organizational studies (the topics of knowledge management and organizational learning in particular) and education. However, the notion is used in various contexts. It is sometimes perceived as a social construct, but at some other times as a virtual community or informal group sponsored by an organization for the purpose of making it easier to share knowledge or learn. Objectives: The main aims of the paper are: 1) to identify the main characteristics of the CoP in IT sector, 2) to identify and describe the knowledge management tools used by CoP, 3) and to identify and analyse customer knowledge of CoP. Method: The research assumed an exploratory character. The case study and survey methods with application of structured questionnaire were used. Results: The CoP is little effective form of stimulating business processes and market, despite application of a broad range of activities undertaken for the purpose of creation of the so-called knowledge communities by the entities of IT sector and internet activity declared by respondents. Conclusion: Poor knowledge of CoP as well as the awareness of participation in its structures among the recipients, who are additionally active users of new technologies including mostly the Internet, may also be caused by the lack of experience in the sphere of studied knowledge-based relationships or priority character of ventures of directly measurable business results. Determinants of CoP creation and directions of its development may constitute an interesting area for further studies.
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