Neil [see note below] notified us a little while ago of this article: Evans, C, Yeung, E, Markoulakis, R and Guilcher, S (2014) An Online Community of Practice to Support Evidence-Based Physiotherapy Practice in Manual Therapy, Journal of Continuing Education in the Health Professions, Volume 34, Issue 4, pages 215?223.

I read it and thought I’d share some ideas. The premise of the example is quite simple: to describe the design features of an online CoP as a continuing education strategy and to explore how the community promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger’s constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework.

Mutual engagement, joint enterprise and shared repertoire are fundamental but also quite simple:

Mutual engagement refers to membership in a community in which participants, with their unique identities and diverse specializations, draw on each other and are engaged in doing things together.

Joint enterprise is the practices of the community, defined as the result of a collective process of negotiation.

Shared repertoire includes tools, routine, stories, jargon, shortcuts, or any resource that may be used over time in a shared pursuit to negotiate meaning.

They created a ten week course on using research evidence in practice and recruited Canadian physiotherapists all of whom had at least ten years experience. There were weekly activities and debates, and three assignments – carrying out an online search, critical appraisal, and writing a review for publication. The course appears to have been very successful; participants were active and gave good reports afterwards.

The authors argue that the course was in fact a community of practice, and provide evidence to show that it meets all the standard criteria as a learning CoP. It was also clear that this worked in an online format (using the Blackboard learning management system). The activity and the results of the course are convincingly analysed, using a very solid theoretical framework.

But I think the article is perhaps less value than it might sound. The authors conclude:

“Lessons for Practice

– Continuing education courses founded on community of practice principles can provide opportunities for collaborative, interactive learning.

– Participants in an online community of practice can share and create knowledge related to their practice through mutual engagement in shared endeavours.

– Design features such as guiding questions, instructor facilitation, and collaborative assignments help to create active, sustained participation in a fully online course.”

But they had ideal circumstances for the course to succeed: the best kind of participants, experienced professionals, used to consultative practices. And they note themselves that they have no idea if the connections created in this temporary CoP were continued after the course ended. (That goes under the heading of further research needed.)

I think we knew that such courses can succeed, but I am looking for a lot more than that. A CoP has to be ongoing. It might well start with a course that captures the imagination of a bunch of professionals or technicians, but there needs to be a platform for the connections made to continue afterwards. (The authors do not say whether the Blackboard platform remained available for the participants after the course finished. Knowing what universities are like these days, that seems unlikely.) The CoP structure and technology also need to be dynamic to encompass the dynamic requirements of the membership – it is a community, an organic thing – and it will ebb and flow in unpredictable ways. We need to be looking at experiments which deal with much less defined boundaries than a ten week course to find out how best to share knowledge on a continuous basis. [*see note below]

HIFA profile: Rob Parsons is a Healthcare Technology Management Consultant at Health Partners International, UK. Professional interests: Healthcare technology management, open source software, knowledge management, social media, open educational resources. robsub AT ariadne.org.uk

[*Note from HIFA moderator (Neil PW): HIFA itself is a Community of Practice on the Dgroups platform, which has more than 700 active CoPs supported by international development organisations. HIFA was evaluated in 2011 and the report identifies markers of success and recommendations for improvement (which we have only partially been able too implement, due to lack of resources). As Coordinator of HIFA and current Chair of the Dgroups Foundation, I would welcome expressions of interest from researchers who would like to undertake further research on HIFA and/or Dgroups.]

South African Family Practice

Vol 56 No 6: November/December 2014

Table of Contents

http://www.safpj.co.za/index.php/safpj/issue/view/344

Editorials

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Tribute: Douw GS Greeff – 6 November 1974-11 November 2014 (3)

Gboyega A Ogunbanjo

Review Articles

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Evidence-based treatment of acute otitis externa (6-8)

Kim Outhoff

Acute non-specific low back pain in primary care (10-14)

Kim Outhoff

Analgesic strategies (16-18)

C Quan

How sick is your appendectomy? (19-23)

N T Hlongwane

The Burning Truth(s) (24-26)

R Moore

Tuberculosis: the implications for anaesthesia (28-31)

T A Jackson, J M Thomas

Part 2: Medico-legal documentation – Practical completion of pages 1 and 4

of the J88 form (32-37)

J Marianne Kotze, Hanneke Brits, Mofalali S Monatisa, Johan Botes

Peripheralia

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The whirling dervishes (44)

Chris Ellis

________________________________________________________________________

South African Family Practice journal

http://www.safpj.co.za

I HAVE seen some of the applications that will launch for the Apple Watch when it makes its debut as early as March, albeit in simulation, and some are extraordinary. Along with the details Apple has already released about how the watch will work, it has convinced me Apple Watch will be a launching pad for the next wave of billion-dollar consumer-tech start-ups…..more

Below is the citation and abstract of a new paper in the International Journal for Quality in Health Care. The full text is restricted-access.

James Heiby. The use of modern quality improvement approaches to strengthen African health systems: a 5-year agenda.

DOI: http://dx.doi.org/10.1093/intqhc/mzt093 117-123 First published online: 30 January 2014

http://intqhc.oxfordjournals.org/content/26/2/117.long

ABSTRACT

There is a growing international consensus that African health systems need to improve, but no agreement on how to accomplish this. From the perspective of modern quality improvement (QI), a central issue for low performance in these health systems is the relative neglect of health-care processes. Both health system leaders and international donors have focused their efforts elsewhere, producing noteworthy health gains. But these gains are at risk if health systems do not develop the capacity to study and improve care processes. Substantial experience with QI in Africa shows impressive potential for broad-based process improvement. But this experience also highlights the need for modifying these growing programs to incorporate a more rigorous learning component to address challenges that have emerged recently. The addition of a region-wide knowledge management program could increase the efficiency of each country’s QI program by learning from the experiences of other programs. With a coordinated donor initiative, it is reasonable to project that within 5 years, evidence-based improvement will become a norm in health services, and African health systems will approach the model of a learning organization.

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Below are the citation and key messages of a new paper in journal Health Policy and Planning. The full text is freely available here: http://heapol.oxfordjournals.org/content/early/2014/12/11/heapol.czu126.full?papetoc

The study concludes: ‘Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.’

Curiously, the authors also note: ‘Studies mentioning the use of mobile phones in supervision (Arem et al. 2011; Cornman et al. 2011; Jack et al. 2012) did not report a clear influence on CHW performance’. However, the review was conducted in 2013 and excludes any studies later than July 2013.

CITATION: Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review

Maryse C Kok et al. Health Policy Plan. (2014) doi: 10.1093/heapol/czu126

First published online: December 11, 2014

KEY MESSAGES

– A systematic review of 140 quantitative and qualitative studies identified factors related to the nature of tasks and time spent on delivery, human resource management, quality assurance, links with the community, links with the health system and resources and logistics having an influence on CHW performance.

– Good performance was associated with intervention designs involving a mix of incentives, frequent supervision, continuous training, community involvement and strong co-ordination and communication between CHWs and health professionals, leading to increased credibility of CHWs.

– When designing CHW programmes, policymakers should take into account factors that increased CHW performance in comparable settings, to maximize programme outcomes.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org