System change through situated learning

Pre-evaluation of the Health Innovation Network's Communities of Practice

by Bryn Garrod, Tom Ling

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Research Questions

  1. How do the CoPs operate and how can their work be explored in more depth?
  2. How, when and why can the knowledge generated within CoPs lead to improved work?

Communities of Practice (CoPs) are self-organising and self-governing groups of people who share a passion for their working practices and strive to be better practitioners by developing and spreading new knowledge, practices, capabilities and organisational capacity. CoPs are increasingly seen as valuable means to improve knowledge sharing and collective learning, overcoming disciplinary and organisational boundaries in health and social care. However, measuring their effect is difficult. Wider evidence is incomplete about both how CoPs work and the value and impacts they create. Yet if CoPs are to be a part of current ambitions to transform health and social care in the UK and beyond, we urgently need a deeper understanding of their operation and consequences.

This project was a scoping study, looking at the CoPs set up in 2015 in association with the Health Innovation Network, the Academic Health Science Network for South London. The CoPs referred to in this report cover: medicines safety; maternity; duty of candour; medicines optimisation; sepsis; acute deterioration; and delirium. CoPs members include NHS non-medical and medical staff from a range of professional groups, and academics.

The aim of this study was to collect data to assess the feasibility of, and best approach to, a full-scale evaluation of CoPs, as well as to provide immediate evidence to help the CoPs improve their effectiveness.

Key Findings

HIN CoPs created enthusiastic engagement and provided their members with an attractive route to greater patient safety and healthcare improvement.

If the knowledge needed to address the problem is contained within, or can be explored through, the CoP, there is an opportunity to deliver change. However, if the knowledge is not accessible to the community, and if the levers for delivering change are beyond its reach, there needs to be some modification of the model to engage senior leadership, change national mandates or work with commissioners.

Based on our research, we proposed a five-level maturity model for the HIN CoPs. Sustaining the rhythm of learning at a high level of maturity may be more easily done where the CoP is linked to, or embedded within, other approaches to improvement.

This report identified a number of future evaluation questions along with associated subsidiary questions. The key overarching questions are:

  • (How) is the momentum towards transformation sustained and what are the wider dependencies that are needed for this to happen?
  • (How) is progress and value-added measured?
  • (How) is the rhythm of learning sustained?
  • (How) are cultures and principles nurtured and sustained?

Table of Contents

  • Chapter One


  • Chapter Two


  • Chapter Three

    Summary of findings

  • Chapter Four

    Initial conclusions based on the evidence collected to date

  • Chapter Five

    ToC and evaluation questions

  • Chapter Six

    Recommendations for future research

Research conducted by

The research described in this report was prepared for the Health Innovation Network (HIN) and conducted by RAND Europe.

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