Background
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What was the purpose of establishing CoPs in healthcare?
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What was the composition of these CoPs?
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How have members of health sector CoPs interacted and communicated with each other and exchanged information or knowledge? and
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Have CoPs demonstrably improved performance of healthcare organisations?
Methods
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Studies reporting on CoPs in sectors other than healthcare.
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Studies reporting on CoPs whose members were not directly involved in delivering healthcare, such as those focussed on activities presented as medical education; community based learning; classroom and undergraduate teaching, learning and curriculum development; student residential learning communities; or the pharmaceutical industry.
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Records with no abstracts, unless it was clear from the title that the paper was relevant.
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News-style or opinion articles, theses and dissertations, and abstracts of conference proceedings without full peer-reviewed papers.
Results
Country of origin
Composition and intended purpose of establishing CoPs in healthcare
Year paper published | Settings | Why was the CoP established or what relevance did the CoP have to the research?†
| Reference |
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A. Multi-organisation or multi-professional (n = 25) | |||
a. Learning, information and knowledge exchange (n = 12)
| |||
1999 | Ten hospital and community-based healthcare organisations | The CoP concept was used to explore the process by which novice clinicians acquired competencies. | [27] |
2002 | Urologists, radiation oncologists, physicians and nurses delivering in-hospital cancer treatment. | CoPs were used as a tool to enrol key professionals and create, mobilise, diffuse and integrate knowledge relating to a radical innovation. | [24] |
2002 | Agencies involved in the delivery of local services for the elderly, and providers of dental and ENT services. | CoPs were established to help facilitate inter-agency collaboration. | [20] |
2003 | Members from agencies involved in delivering local services for the elderly, and service users. | The construction and work of two multi-stakeholder CoPs was facilitated to understand the acquisition and use of knowledge to help improve services. | [16] |
2004 | General practitioners, practice nurses and associated medical staff in two general practices | Researchers set out to understand how clinicians derive and use knowledge in practice. The fact that clinicians relied on their CoPs to obtain information was a finding. | [17] |
2005 | Anaesthetic teams consisting of novice or trainee nurses and doctors, and experienced operation-department practitioners and consultants. | The concept of legitimate peripheral participation in CoPs was used to explore the distribution of work and knowledge within anaesthetic teams. | [18] |
2006 | Researchers, practitioners, and policy makers with interests in web-assisted tobacco interventions. | A group of diverse professionals from geographically-dispersed locations were brought together to lay the foundations for a CoP. | [45] |
2006 | Anaesthetists from ten anaesthetic departments. | The online system created a CoP within which participants could anonymously post critical incidents for discussion. | [22] |
2007 | Collaborative relationship between the Society of Obstetricians and Gynaecologists, hospital insurance provider, and/or the provincial government and participating hospital. | The obstetric patient-safety program was based on principles of team effort, CoPs and organisational behaviour. | [32] |
2008 | Clinical nurse consultants, educators and managers of intensive care units. | The email Listserv led to a sense of community and the creation of a CoP, facilitating the exchange of information. | [42] |
2008 | Senior clinical managers | Emergence of CoPs was one of many effects on clinical practice reported in the paper. | [23] |
(Note: Reference number 23 has been included in the multi-organisation or multi-professional category for the following reasons: i) The authors stated that the general composition of the clinical leadership program was 10% allied health professionals and 90% senior clinical nursing staff; ii) The authors also stated that the leadership program had, over three years, supported over 100 staff working for NHS Lanarkshire. Given that there is more than one hospital within this county, it is possible that the program participants were not necessarily co-located within the one service unit.) | |||
2009 | Clinicians working in nine rural and two urban paediatric emergency departments. | A virtual community of practice was established to facilitate knowledge exchange. | [29] |
b. Sharing and promoting good practice/evidence-based practice (n = 13)
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2004 | Healthcare workers and researchers with an interest in evidence-based care. | Virtual CoPs emerged spontaneously as people identified common interests. | [21] |
2004 | State and local public health agencies engaged in child health-information system-integration projects. | A CoP was created to bring together a diverse group of professionals from geographically-dispersed agencies to learn from each other, to capture best practices and to collaboratively address challenges. | [39] |
2005 | Practising nurses in gerontology and academics (Nursing Demonstration Project). | The CoP provided a tool to bridge the divide between practising nurses and academics. The CoP was also involved in developing best-practice statement methodology and in designing a virtual college. | [19] |
2005 | Practising nurses in gerontology and academics (Nursing Demonstration Project). | The potential of the CoP and the virtual college to accelerate the achievements of evidence-based practice was explored. | [46] |
2006 | Nine healthcare systems and ten hospitals represented. | The intervention to reduce hospital-acquired infections was multifaceted and included developing a CoP. | [37] |
2007 | Emergency department clinicians from multiple hospitals. CoP is partnership between the ED clinicians and the National Institute of Clinical Studies, which provides implementation expertise and support. | An emergency department (ED) collaborative was established and was successful in engaging clinicians from 47 hospital ED teams from across the country. This led to a network of clinicians interested in improving uptake of evidence, leading to the establishment of an ED CoP. The CoP acted as a mechanism that built on the knowledge and expertise of the clinicians to implement evidence-based practice. | [40] |
2007 | Representatives from the family physician, physiotherapy and occupational therapy licensing Boards; and clinician associations, observers from the compensation board and its research institute. Experts and opinion leaders on low back pain. Scientific committee. | A CoP approach was used to develop clinical guidelines. | [34] |
2007 | Researchers and program providers who work on improving telephone-based counselling for smoking cessation. | The CoP model was used to improve telephone-based counselling for smoking cessation. | [31] |
2008 | Journal club and case conferences attended by physicians and other clinicians from Internal Medicine, Neuroradiology, Anaesthesiology, Otology/Head and Neck Surgery, Dermatology, And Ophthalmology Departments. | The CoP concept was used to structure continuous medical education accredited journal clubs and case conferences to be interactive and problem-based, with the objective of increasing the likelihood of physicians implementing evidence-based care. | [36] |
2008 | Diverse stakeholders, including hospitals, non-profit organisations and city agencies, working together to improve cancer screening in community health centres. | The community health centres did not have the capacity to provide care for people with abnormal screening tests and cancer diagnosis, nor did they have partnerships with available community resources. Local CoPs were established to address this gap. Regional CoPs were established to provide forums on a wider scale geographically, for sharing ideas, identifying resources, and encouraging action on local community building efforts. | [38] |
2008 | Five acute hospital wards, six home-care, and seven day hospitals. | The intervention to promote evidence-based practice included membership of a CoP. | [26] |
2009 | Health and social-care communities to address problems with discharge planning and transfer of care. | CoP was established to test whether the bringing together of a wide range of staff, with a shared interest, would make a meaningful contribution to sustainable service improvement. | [15] |
2009 | Children's mental health practitioners (frontline social workers, child and youth workers) working in six service-provider organisations, newly-mandated to use the standardised outcome measurement tool. | Support structure provided to help implement the adoption of an electronic version of a standardised outcome measurement tool included access to a CoP. | [28] |
B. Single-organisation or single profession (n = 6)
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a. Learning, information and knowledge exchange (n = 2)
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2000 | Nurses with little research experience | The workshop provided the nurses access to a CoP where they could work with experienced researchers. | [35] |
2002 | Small group of physicians | The concept of CoP was used to examine the learning that occurred within small groups of physicians. | [33] |
b. Sharing and promoting evidence-based practice/promoting innovation in clinical practice/supporting clinical practitioners (n = 4)
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2007 | Occupational therapists working in a large metropolitan hospital. | The CoP was proposed as a tool to support occupational therapists reflecting on how their profession is conceptualised and described, and to define their unique contribution to patient care within a biomedically-dominated institutional context. | [43] |
2007 | Hospital setting. | The clinical planning group had characteristics of CoPs. | [44] |
2008 | Cancer surgery. | The CoP was established and endorsed as a means of facilitating quality improvement. | [30] |
2009 | General practitioners. | CoP was established to address the quality of referral letters. | [41] |
C. Systematic reviews (n = 2)
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2009 | Healthcare sector. | Systematic review of CoPs in business and healthcare sectors. | [11] |
2009 | Regional collaborations and CoPs within the surgical settings. | The rationale for undertaking the systematic review was the need to investigate whether the CoP concept could be implemented through collaborative initiatives. | [14] |
Means of interaction, communication and exchanging information or knowledge
Activities and methods of communication/interaction | ||||||
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Reference and year of publication | Workshops | Seminars | Meeting of members | Emails | Web-based systems and blogs | Other |
[27] 1999 | Face-to-face ongoing interactions at place of work. | |||||
[35] 2000 | A one-off workshop based on situated-learning model was organised to engage nurses in research. | |||||
[20] 2002 | Regularly, to move the project goals forward | |||||
[33] 2002 | At least 6 - 10 times a year. | |||||
[24] 2002 | Coordinated information, training and education sessions for medical professionals and other stakeholders. | |||||
[16] 2003 | Each CoP met seven times during the study period. | Members undertook 'homework' to seek information in between meetings. | ||||
[17] 2004 | Meetings of practice staff, GPs, partners, executives, admin staff, partners and practice manager, and practice award nurse team. | Multiple informal gatherings and discussions, patient-doctor consultations, home visits. | ||||
[21] 2004 | Targeted email and networking service for health practitioners and researchers. | |||||
[39] 2004 | Face-to-face meetings. | Listserv | Interactive website. | Site-visits, each lasting 2.5 days; followed by circulation of a newsletter summarising the meeting and a CD compilation of the presentations made during the site visits. Teleconferences. Opportunity to participate in special projects funded by the sponsoring agency. | ||
[18] 2005 | Face-to-face ongoing interactions at place of work. | |||||
[19] 2005 | Met for 2 days at the start of the project, and at months 4, 9 and 14. | Participants were encouraged to participate in virtual workshops to discuss models or descriptions of gerontological nursing identified from the literature. | ||||
[46] 2006 | Virtual college. | |||||
[45] 2006 | The initial bringing together of the group. | Email discussions | ||||
[37] 2006 | Met monthly the project to report and share and effective strategies, contribute to problem reinforce and and to ensure consistency in data collection. | Presentations of evidence-base by experts at the kick-off session. Monthly progress reports posted on bulletin boards. | ||||
[22] 2006 | Online system for posting and discussing critical incidents in anaesthesia. | |||||
[40] 2007 | Not described in detail. The authors make reference to the program functioning predominantly through a virtual platform with opportunity for personal communication and networking. | |||||
[31] 2007 | Regular web-based seminars | Occasional face-to-face meetings | Teleconferences. CoP members were granted access to online resources including policy, program and research aids; including standard research and evaluation protocols. | |||
[34] 2007 | Symposium to discuss the recommendations. | Guidelines were presented to members of the CoP by postal mail, email, and website. Web-based system was offered as a method of communication. | ||||
[44] 2007 | While not explicitly stated in the paper, it is assumed that the activities undertaken by the group would have involved face-to-face interaction. | The clinical planning group was established to plan clinical training, coordinate installation of training versions of EMP, and organise a range of practical tasks. | ||||
[32] 2007 | Multidisciplinary workshops | Web-based platform used to deliver educational content. | ||||
[43] 2007 | Exchanges during routine work. | |||||
[42] 2008 | Email Listserv | |||||
[36] 2008 | Attendance and participation in journal clubs and case conferences. | |||||
[26] 2008 | Knowledge-pooling and translation is facilitated through a virtual practice-development college. | |||||
[30] 2008 | Not described in the paper. | |||||
[38] 2008 | Local and regional meetings. | Teleconferences with community health centre teams. | ||||
[23] 2008 | Leadership program that led to the emergence of CoP included group reflection exercises. | |||||
[15] 2009 | Bi-monthly, half-day workshops to discuss 'hot topics' identified by the 'core' group. | Database of members published on a CoP website. | ||||
[29] 2009 | 12 case-based learning modules with content relevant to clinical topic, and an asynchronous online discussion board. | |||||
[41] 2009 | Project coordinator maintained regular communication with CoP members by email and telephone. | |||||
[28] 2009 | 3-day training program | Face to face meetings, site visits for individualized consultation. | Email support | Web and wiki support. | Reliability and software training, telephone support, information provided on the website, quarterly agency reports. | |
[11] 2009 | Not applicable - systematic review of the literature | |||||
[14] 2009 | Not applicable - systematic review of the literature |
Improving healthcare performance
Reference and year of publication | Study design | Outcome measure | Findings |
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[37] 2006 | Component of a randomized controlled trial. Intervention = multifaceted. Randomisation determined whether the intervention was to begin in the operating room or in the intensive care unit (and not to assign the patient to a study group). Project leaders and teams were established to implement evidence-based practice to reduce central line infections. | Adherence to evidence-based process indicators, as a proportion of CR-BSI reported during the previous year. Catheter-related blood-stream infections (CR BSI). | Process adherence increased from 0% to 85%. CR BSI dropped by more than 50% (from 1.7 to 0.4 per 1000 line days, p < 0.05). The success of this intervention across nine healthcare systems and ten hospitals was attributed by the authors to the direct involvement of the hospital leadership (within each hospital) in marketing and promoting the intervention and the development of local CoPs. |
[45] 2006 | Case-study of the establishment of a CoP following the bringing together of individuals known to work in the area of web-assisted tobacco intervention. | Potential emergence of a CoP. | Social network methods were used to demonstrate the establishment of networks following the initial meeting. |
[32] 2007 | Intervention trial. Intervention = multifaceted Managing Obstetric Risk Efficiently (MORE) program. Implementation at each of the 28 hospitals was led by a core inter-professional team. | Core clinical knowledge assessment. Culture change assessed using a culture change assessment tool. Frequency of liability claims and liability carrier (hospital) incurred costs. | Clinical core knowledge increased significantly, demonstrated by increase in test scores following completion of training modules. Improvement in the six elements - empowering people, learning, open communication, patient safety, teamwork, valuing individuals - was demonstrated using a culture change assessment tool developed for the program. In all of the 28 hospitals that provided data, the frequency of liability claims dropped over a three-year period, and liability carrier (hospital) costs showed a decreasing trend compared to pre-MORE program. This is in contrast to all other healthcare services, which showed a trend towards increase in costs. The development and annual operating costs were recovered by the end of three years. |
[38] 2008 | Intervention trial. Intervention = Regional cancer-collaborative to implement a regional approach to learning. Care-process leaders worked with teams to plan and implement practice change. Regional CoPs were established as a forum for sharing ideas, identifying resources, and encouraging action. Establishment of regional and local CoPs was encouraged. | Process evaluation of implementation activities. Breast, cervical and colon cancer screening rates. | Some processes were more difficult to implement than others, and implementation was easier at some sites and not others. Three of the four participating organisations implemented local CoPs. Screening documentation increased with all four cancers. Colon cancer screening-rates increased from 8.6% to 21.2%. This increase was seen in 3 of the 4 sites (the 4th showed a drop). Authors concluded that improvements may be achieved in carefully selected organisations. |
[26] 2008 | Intervention trial. Intervention = multifaceted. The Caledonian Model designed to promote evidence-based practice included membership of a CoP. | Impact on nursing practice was assessed by baseline and post-intervention audits of policies, resources and education. The revised nurse-working index was used to explore perceived impact of the model on the nurses' work. | Facilities' audit results demonstrated improved practice through development of local guidelines and policies; use of validated screening tools; implementing guidelines; and ongoing training for staff. Patients' audits demonstrated more relationship-centred approach to care-provision; improved recording of patient and family feelings and expectations; assessment of individual needs; risk-screening; and greater involvement of the patient in decision-making. The authors acknowledge the limitations imposed by their inability to control for confounding events occurring concurrently. |
[41] 2009 | Intervention trial. Intervention = CoP established to improve standards in general practice, focussing specifically on quality of referral letters written to specialists. | Quality of letters written by GPs, scored using benchmarks established by members of the CoP. | Only five of the 15 recruited GPs completed the study; 102 referral letters were submitted by these 5 GPs. Statistically significant improvements in scores were reported from the scoring of the history and examinations components in the referral letters. |
[28] 2009 | Randomised trial. Participants randomised to CoP-supported or practice-as-usual arm of trial. | Content knowledge on assessment tool; self-reported change in practice; use of the Child and Adolescent Functional Assessment Scale (CAFAS) tool; and use of, and satisfaction with, implementation support. | The difference between the CoP and practice-as-usual groups, in terms of self-reported practice change, was not statistically significant. However, the CoP group demonstrated greater knowledge of the assessment tool at the end of the 12 months and greater use of the tool compared to the practice-as-usual group. The authors conclude that CoPs may be a useful strategy for promoting the implementation of evidence-based practice; but caution against generalisation, due to small size of the sample and one-year follow-up period. |