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

Lauren S Penney,Sean Baird,Teresa M Damush,Dawn M Bravata,Laura J Myers,Barbara J Homoya,Edward J Miech,Ariel Cheatham,Nicholas A Rattray

doi:10.1007/s11606-020-06135-z

Abstract

BackgroundThe Community of Practice (CoP) model represents one approach to address knowledge management to support effective implementation of best practices.ObjectiveWe 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.DesignStepped wedge trial.ParticipantsMultidisciplinary staff at six Veterans Affairs medical facilities.InterventionsTo 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”).ApproachMixed-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 ResultsThe 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.ConclusionsThe 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.

Highlights

The Community of Practice (CoP) model represents one approach to address knowledge management to support effective implementation of best practices
A total of 42 unique stakeholders were interviewed at 6 months (n = 32) and 12 months (n = 30) after initiation of active implementation; an average of 5 staff were interviewed per site for each time period
Development of the PREVENT Communities of Practice (CoP) was a deliberative process built upon the focus and structure of the PREVENT quality improvement program

Summary

Introduction

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”). 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). CoPs function in several ways, including social interaction, knowledge creation, knowledge sharing, and identity building.[8] Multiple, large CoPs engage diverse providers across and within organizations to improve health

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