EVALUATION OF COMMUNITIES OF PRACTICE
EVALUATION OF COMMUNITIES OF PRACTICE
Executive Summary
EXECUTIVE SUMMARY ABOUT THE EVALUATION The Office for Public Management (OPM) was commissioned by Yorkshire and the Humber Leadership Academy (Y&HLA) to conduct an independent and rapid evaluation of the Communities of Practice (CoP). The CoPs are part of the Co-Creation Network launched in 2014 by Y&HLA in partnership with the Yorkshire & Humber Improvement Academy (Y&HIA). They had two aims:
1. Understand the impact of a sample of Communities of Practice (CoP) 2. Understand the impact of Y&HLA’s support and facilitation of the CoPs. The Leader Evaluation Framework1 informed the evaluation design. Evaluation findings are based on telephone interviews with thirteen CoP members; the majority of who facilitated a CoP. Interviewees were selected by Y&HLA to be illustrative of a range of experiences. A total of ten CoPs2 were discussed to varying degrees by interviewees.
1. The Leader Evaluation Framework is a common framework for evaluation developed by the NHS Leadership Academy and the Leadership Development Partner Network. 2. The ten CoPs discussed in interviews were: Care Co-Ordination in Primary Care, AHSNs for Stroke Prevention in Atrial Fibrillation, Human Factors, Continuous Quality Improvement, Schwartz Rounds, Junior Doctors and Their Role in Quality Improvement, Community of Safer Medication Practice, Mindfulness, Innovation and Sepsis.
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Executive Summary
KEY EVALUATION FINDINGS
The interviewees involved with the three more active CoPs
FUNCTIONING AND IMPACT OF THE COPS
activity the CoP had created and sustained a functioning
When asked how well they thought the CoPs they were involved with had worked, the majority of interviewees focused on the level of activity the CoP had achieved, suggesting that activity levels are one of the main metrics through which interviewees measured CoP performance. This was because interviewees perceived CoP activity as a necessary pre-condition for creating impact. Three types of CoP activity status were identified: CoPs that had been formally closed (n=2)3, CoPs that had become dormant or that had never achieved expected levels of activity (n=5)4 and active CoPs where there is more regular activity and interaction between members/facilitators (n=3)5.
reported that they were generally working well because the community. The most significant factor explaining why these CoPs have been able to sustain member engagement is that the CoP topics are directly linked to the facilitators’ (and members’) core work. This means that not only do the members share an interest in the topic; they are more likely to receive organisational support for their involvement in the CoPs, be more accountable for CoP outcomes and experience immediate benefits as a result of their involvement in the CoP. The majority of interviewees (n=8) reported having organisational support for their involvement in CoPs or the wider Co-Creation Network. However most of these interviewees tended to describe their employer’s support as fairly ambivalent in that while they were given time to attend basecamp events they did not receive additional resources for their involvement in CoPs. The reasons for a lack of organisational support given by interviewees included: line managers not perceiving the CoP as of direct relevance to the facilitator or member’s core role (this was the most frequently mentioned reason); organisational scepticism as to the approach of CoPs, particularly with regards to the self-direction of members which meant outcomes could not be predicted; and a lack of awareness about the Co-Creation Network. Securing and sustaining organisational support was felt to be particularly difficult given the current NHS context and focus on efficiency, cost cutting and pressure to demonstrate tangible results.
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Executive Summary
States of CoP dormancy varied from those where the facilitator had not been able to devote time due to competing priorities at work, to those where the facilitator had tried repeatedly to encourage member involvement on the online platform but had received little, if any, response. No interviewees described dormancy resulting from completion of the CoPs’ objectives; in all five cases the state of dormancy was an unplanned lack of activity. The lack of activity that characterised dormant CoPs meant that interviewees discussing these CoPs generally reported that the CoPs had not worked as well as they had hoped for. This was primarily because lower than expected levels of member engagement meant that the specific aims facilitators had hoped to achieve via the CoP had not yet been realised. When asked what the key factors were that led to the CoPs working well (or not work well), interviewees identified five factors they had found to be important influencers of CoP activity levels, which in turn increases the likelihood that the CoP achieves impact at both individual and organisational levels. These five factors were:
1. Securing and sustaining engagement from a core group of members 2. Support from employer and stakeholder organisations 3. Effective facilitation 4. Face-to-face and real-time interaction 5. A diverse mix of members
3. Schwartz Rounds; Continuous Quality Improvement 4. Human Factors; National Frailty; Medicine Safety; Mindfulness; Innovation 5. Sepsis; AHSNs for Stroke Prevention in Atrial Fibrillation; Care Co-ordination in Primary Care
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Executive Summary
The most active CoPs appear to have reached a point
− The Yorkshire & Humber AHSN (Y&HAHSN) has
where they are able to identify some positive impacts
received money from the other regional AHSNs
at both individual and organisational levels. Many of the
to fund the facilitator’s co-ordination of the CoP,
dormant CoPs however have not yet reached a position
resulting in an additional income stream for the
where they are able to create organisational impact.
Y&HAHSN.
Nevertheless these dormant CoPs were still able to identify a number of impacts at the individual level. The primary impacts of CoPs at an individual level were: • Increased number of connections. • Sense of camaraderie and support during periods of change/turbulence.
• Sepsis CoP: − The CoP has helped create a more streamlined approach around sepsis process management across Leeds and Bradford Teaching Hospitals and Airedale General Hospital, including the creation and promotion of a more consistent visual identity for the Sepsis 6 (BUFALO) pathway
• Sharing learning and developing new knowledge.
which should reduce the time it takes for the
• Providing an alternative source of support to people
trainees as they rotate between the Trusts.
who lac k support in their organisations. • Learning how to work with and develop other people’s ideas more effectively. • Being inspired to think differently.
Sepsis 6 message to ‘sink into’ doctor and nurse
• Care Co-ordinators in Primary Care CoP: − The CoP has helped improve the quality of the measures to assess the impact of the care coordination pilot at Leeds West CCG. Involving the care co-ordinators CoP members in impact
Only the three most active CoPs were able to identify substantive impacts at an organisational or wider system level. Examples of the organisational impact reported by the interviewees involved in these three CoPs were: • AHSNs for Stroke Prevention in Atrial Fibrillation CoP: − The CoP model has created value for the
buy-in from them. In turn, their involvement has improved the quality of the measures by ensuring they are both practical and feasible. The Co-Creation Network’s online platform does not appear to be a resource that is widely used for the CoPs sampled and a significant volume of activity, particularly
Academic Health Science Network (AHSN) by
for the most active CoPs, occurs outside of the
providing an approach for the regional AHSN
Co-Creation Network’s online platform. These active
to be bought together for the first time to share
CoPs made regular use of other communication channels
learning from regional atrial fibrillation projects,
including emails, LinkedIn groups, teleconferences
and providing a safe space in which members
and face-to-face meetings.
felt able to share the failures their projects had experienced, as well as their successes. This has improved understanding of the effectiveness of organisational initiatives to improve clinical practices.
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monitoring has helped the pilot secure greater
Executive Summary
IMPACT OF Y&HLA’S SUPPORT AND FACILITATION OF THE COPS The CoPs have received a range of support during the different stages of a CoP’s journey, provided primarily by the Co-Creation Network support team and the CoP for Facilitators. At the beginning of the CoP journeys, the types of support received from Y&HLA have included: educating facilitators about the principles of CoPs and how they function; supporting facilitators recruit members and make connections across organisational boundaries both inside and outside of the Yorkshire and Humber region; suggesting ideas to facilitators for how to create value with the CoP and supporting facilitators implement those ideas; technical support; and attending meetings with the
The majority of interviewees were positive about the support and facilitation the Y&HLA had provided the Co-Creation Network and CoPs. Interviewees particularly valued the proactivity of the support team and their responsiveness and approachability. The basecamp events were on the whole thought to be useful and engaging for those who had attended, although interviewees had mixed reactions to the less structured approach of the basecamp events. The most frequently reported issue encountered was around the Co-Creation Network’s online platform. Almost of all of the interviews reported that they were not convinced of its value and very few interviewees had made extensive use of it.
CoP facilitators and their employer organisation to support facilitators gain organisational buy-in. Once the CoP had been established, a small number of interviewees reported that they had no longer required Y&HLA’s support as their CoP had ‘found its feet’. For many of the CoPs sampled however, the challenges encountered during the CoP journey meant that the facilitators had needed, and received, further support from Y&HLA.
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Introduction
INTRODUCTION This report outlines the findings of an independent evaluation of the Communities of Practice (CoP). The evaluation was undertaken by the Office for Public Management (OPM) and commissioned by Yorkshire 6
& Humber Leadership Academy (Y&HLA). The CoPs are part of the Co-Creation Network , a network launched 7
in 2014 by Y&HLA in partnership with the Yorkshire & Humber Improvement Academy (Y&HIA) to support people interested in health and social care improvement. The Co-Creation Network defines Communities of Practice as:
“Self-organising and self-governing groups of people who share a passion for the domain of what they do and strive to be better practitioners. They pursue a shared learning agenda and they create value for their members and stakeholders through developing and spreading new knowledge, practices and capabilities.” 8 Currently there are approximately 25 CoPs at differing stages of maturity, involving in the region of 150 people.
EVALUATION AIMS AND OBJECTIVES The primary aim of the evaluation was to understand the impact of a sample of CoPs, in terms of how well they are functioning and their impacts at both individual and organisation/wider system levels. A secondary aim of the evaluation was to understand the impact of Y&HLA’s support and facilitation of CoPs. The Leader Evaluation Framework, a common framework for evaluation developed by the NHS Leadership Academy and the Leadership Development Partner Network, has informed the evaluation design and focus. The analysis of impact has been informed by Nutley et al’s (2007)9 impact model, used by the Economic and Social Research Council (EHRC), which categorises three types of impacts:
1. Instrumental impacts: contributing to the understanding of policy, practice or service provision, shaping legislation, altering behaviour 2. Conceptual impacts: contributing to the understanding of policy issues, reframing debates 3. Capacity building impacts: through technical and personal skill development The report chapters are structured using the reporting template outlined in the Leader Evaluation Framework: • Methodology • Findings and Discussion • Recommendations • CoP case studies
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Methodology
METHODOLOGY The evaluation was based on qualitative data from 13 depth interviews conducted with CoP members (see Appendix A for a list of the interviewees). Interviews were conducted by telephone and lasted approximately 45 minutes. All interviews took place in April 2016. The timescale and resources available to the evaluation meant that it was not possible to gain feedback from all CoPs. Instead a selected shortlist of CoPs was provided to the evaluators by Y&HLA. The sampling framework informing this shortlist was designed to ensure that the evaluation drew on experiences from a range of CoPs at different stages of maturity and covered the perspectives of a range of members, including those who had recently joined the Co-Creation Network as well as those who have been involved for longer, in order to understand differences in member journeys.
6. OPM is an independent, employee owned public interest company specialising in evaluation and research 7. http://ia-cocreationnetwork.com/ 8. https://issuu.com/yhleadershipacademy/docs/co-creation_network_brochure_final 9. Nutley, S., Walter, I. and Davis, H.(2007), Using Evidence: How Research can Inform Public Services, Bristol: The Policy Press,
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Findings and Discussions Motivations for initiating or joining CoPs
FINDINGS AND DISCUSSIONS MOTIVATIONS FOR INITIATING OR JOINING COPS Interviewees were asked to describe their motivations for joining or initiating a CoP. Motivations tended to fall into two categories: goal orientated motivations where interviewees sought to achieve a specific task or project, and broader networking motivations where interviewees hoped to make new connections or identify new opportunities for themselves or their organisations.
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Findings and Discussions Motivations for initiating or joining CoPs
GOAL/TASK ORIENTATED MOTIVATIONS Interviewees described a range of specific goal or taskorientated motivations for initiating or joining a CoP. These motivations included enabling and demonstrating organisational leadership in a particular topic, providing a platform or a different way of working to support an internal organisational project, and fostering and supporting new initiatives within and across organisations: • Demonstrating leadership: several interviewees noted that their initial motivation resulted from being tasked by their organisation to take the lead in developing knowledge and practice around a particular topic or area. For example, the facilitator of the Human Factors CoP described being given an organisational remit around Human Factors as part of her recent 10
secondment to the Y&HIA, which had motivated her to initiate the Human Factors CoP. • Providing platforms for innovative internal projects: internal organisational projects had prompted a number of interviewees to join the Co-Creation Network. For example, a relatively new member described how his organisation is setting up a new project around service user engagement and that he went to one of the basecamp events to help find new connections that might benefit the project. Other
“One of the positive things about CoPs is that people aren’t on there with a job role; it’s supposed to be non-hierarchical. I see this as an opportunity to do service user involvement/ co-production differently.” • Fostering and supporting new initiatives: several interviewees described how they had initiated or joined a CoP because they wanted to establish a group of people from across different organisations working on similar initiatives and who could provide support and learning from each other. For example, the facilitator of the now disbanded Schwartz Rounds CoP initiated the CoP was she wanted to establish Schwartz Rounds11 at her Trust. As there was no one else internally at the Trust who had experience in running Schwartz Rounds, she hoped that the CoP would enable her make connections with people at other Trusts who already had experience.
“I had a conversation with Jane who was helping arrange and make links with other people in the region interested in Schwartz Rounds and she told me about CoPs, suggested it was a good vehicle for getting like-minded people together.”
interviewees initiated CoPs as a way of providing a platform to support a specific initiative, such as the Care Co-ordination in Primary Care CoP set up to support the care-co-ordinators taking part in a pilot at Leeds West Clinical Commissioning Group (CCG). In these cases, motivations for initiating a CoP were generally due to a desire to try doing something differently (for example, empowering members to deliver change rather than be recipients of top-down directives).
10. Human Factors examines the relationships between humans and the systems with which they interact by focusing on improving efficiency, creativity, productivity and job satisfaction, with the goal of minimising human errors. 11. Schwartz Rounds are an evidence-based forum for hospital staff from all backgrounds to come together to talk about the emotional and social challenges of caring for patients. The aim is to offer a safe environment in which to share their stories and support each other.
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Findings and Discussions Motivations for initiating or joining CoPs
OPPORTUNITY/NETWORK ORIENTATED MOTIVATIONS For other interviewees, their primary motivation for
“I found in the Co-Creation Networks others who want to make things better; this resonated with my core values.” (Member of the Co-Creation Network)
becoming involving with the Co-Creation Network or for joining or initiating a CoP was not to accomplish a specific
• Identifying future career paths: one interviewee who
goal but to help them more broadly network with people
used to work in quality improvement described how
who either shared their values or interests. This was either
he hoped to return to a career in quality improvement
because their job role involved networking responsibilities,
and that the Co-Creation Network, particularly the
or because they found it a helpful way to keep abreast of
basecamp events, provided opportunities of networking
developments in areas of interest to them. The broader
with the ‘right people’.
networking motivations identified by interviewees included: • Keeping up to date with new developments: one interviewee said it was important for him to keep abreast with new developments in the local area. He described the basecamp events in particular as helpful for meeting new people. This may also be a motivation for people registering with CoPs on the online platform, as several facilitators of CoPs mentioned that they felt members of their groups wanted to listen and learn from conversations online.
“I’ll be checking in again to see what’s going on, if you work in communications you need to have your head in everything and to listen in on lots of different conversations to find out what’s happening.” • Connecting with others who share the same values and interests: several interviewees mentioned that they joined the Co-Creation Network because they shared the same core values as the others involved. For example, one interviewee noted that for some years now he has been interested in creating caring cultures, and found this to be aligned with the Co-Creation Network ethos.
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“I’d potentially like to go back to working in service improvement in the NHS; the Co-Creation Network could introduce me to the right people – there are a lot of people who go to the events from different backgrounds. I want to keep my finger in that world.”
Findings and Discussions Motivations for initiating or joining CoPs
KEY FACTORS INFLUENCING COP SUCCESS Interviewees were asked what the key factors were that led to the CoPs they were involved with working well (or
“I volunteered to set up a teleconference, after the call people said that went well, why don’t we do it again. So we did. What started off as an informal community has now become a formally recognised group with 44 members.”
in the case of CoPs that were not working well, the key factors that they believed had led to the CoP not working as well as they would have liked). Analysis of the interviews suggests there are five key factors that increase the likelihood of CoP activity, which in turn better positions it to create impact at both individual and organisational level. This section of the report explores these five factors and draws out examples of how interviewees have sought to overcome the challenges they have experienced. 1. Securing and sustaining engagement from a core group of members. Not only did interviewees report this as important in helping achieve regular interaction between members early on in the CoPs journey (which in turn encouraged other members to participate), it also meant that core members could act as role models for less engaged members and those unsure as to what being a CoP member entails. Several interviewees also noted that having a core group of members made it more likely that the CoP could survive if the facilitator
For interviewees involved with CoPs that had not been able to secure engagement from a core group of members, this was felt to be due to a lack of understanding about the CoP topic or lack of immediate relevance to the members’ work. Even when members displayed initial enthusiasm this did not always translate into sustained engagement. For example, one facilitator described how disengagement with the CoP started early during a basecamp event that she had attended along with several others who she had previously talked to about initiating the CoP and expected to be core members – but who instead joined other CoPs at the basecamp event.
“I went to the basecamp with a sole purpose/ interest; the other four people were interested in other things as well. So I ended up being the only person sitting on the CoP table – it felt a bit disheartening and wasn’t a great start.”
moved onto in a different job role or went on leave for an extended period (e.g. maternity leave). Interviewees who described having a core group of members in the CoP felt that this was achieved as a result of the members already being involved and invested in the topic as part of their day jobs, and from shared positive experiences early on in the CoP journey.
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Findings and Discussions Motivations for initiating or joining CoPs
interviewees that securing organisational support was
OVERCOMING THE CHALLENGE OF NOT HAVING A CORE MEMBER GROUP
easier when there was a direct link between the CoP
Example 1. One facilitator suggests that a potential
often struggled to receive organisational support and
solution for CoPs struggling to recruit and sustain engagement from a core group of member would be to reframe the CoP around a shared problem that people can engage in, rather than starting off with an idea. Example 2: Some facilitators were finding it difficult to encourage members to become a self-governing group. The way they tried overcoming this challenge was to encourage the most enthusiastic members to act as role models, and to provide quality improvement training to help members see both the value of their potential role in improving health and social care outcomes for their target patient group and the value for a pilot of being able to measure impact.
they were involved in and their day job. As a result CoPs focused on non-clinical, ‘softer’ topics, or topics not considered as short-term priorities by senior management sustain member engagement, despite initial enthusiasm.
“Getting the support of organisations when there is no obvious direct link to my role is hard, it can be perceived as wasting time or faffing about.” In addition to topic relevance, interviewees also noted that the culture of the employer organisation and their associated values and ways of working influenced the likelihood of receiving support for CoP involvement. Interviewees reported a range of organisational cultures that their CoPs were exposed to. Some described benefiting from organisational cultures that were more embracing of risk taking and trialling new approaches, which had made it easier to ‘sell’ the CoP concept
Support from employer and stakeholder organisations (both for facilitators and members) was identified as a critical success factor as this made it more likely that resource, particularly employee time, would be released for the CoP. There was strong agreement from
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into the organisation – particularly once the CoP facilitator was able to demonstrate the positive impact of its approach.
Findings and Discussions Motivations for initiating or joining CoPs
“The ethos has helped, the vast majority of my organisation’s type propagate a ‘fail fast to achieve’ attitude. That organisational ethos gives us permission to fail in order to get a bigger success.” Other interviewees described organisational cultures focused on process management and demonstrating tangible outcomes, which they perceived caused the organisation to be less receptive to CoPs principles. In the majority of cases, interviewees identified reciprocity between the employer organisation and employee involved in the CoPs as an important factor in sustaining organisational support. There were many examples in the evaluation interviews of CoP facilitators and members sharing with their organisation the learning from their involvement with the CoPs. These interviewees noted that it was important to demonstrate that they were
OVERCOMING THE CHALLENGE OF LACK OF ORGANISATIONAL SUPPORT Example 1. Several CoPs have been able to increase the level of organisational support received for the CoPs by recruiting people from the stakeholder engagement to be members or co-facilitators of the CoP Example 2: One CoP has increased organisational support by using the CoP model as a template for how to establish communities and facilitate meetings differently to create the ‘safe space’ necessary for sharing learning around initiative failures, but has not explicitly branded the CoP as a ‘Community of Practice’. Instead the CoP methodology was presented as “just the way we do things”, which meant that the group more quickly focused on the topic.
‘giving back’ to their employer organisations for time
Example 3: Another CoP has also increased
spent on CoP activities.
organisational support by demonstrating the effective functioning of the community using metrics such as number of interactions/exchanges between members (from transcriptions of teleconferences), how many resources members have shared (they record documents in a database as well as on the Co-Creation Network online platform) and have been able to demonstrate how being part of a CoP has shaped delivery by pointing to members’ increasing comfort with sharing failures as well as assets.
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Findings and Discussions Motivations for initiating or joining CoPs
3. Effective facilitation was identified as an important factor for creating member engagement as it enabled the creation of ‘safe spaces’ in which members felt comfortable sharing their learning (both success and failures) and helped encourage members to drive the direction of the CoPs’ activities and agendas. Interviewees noted that encouraging self-governance among members and creating ‘safe spaces’ was challenging and often took time to establish. These interviewees identified the support they had received from the Co-Creation Network support team and the CoP for Facilitators as a valuable resource in helping develop facilitation styles effective for CoPs.
“They [CoP Facilitator events] helped me understand why I needed to go back to the members and encourage them to define their own roles, that it shouldn’t just be myself and [my co-facilitator] driving the direction of meetings and the wider community agenda.”
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OVERCOMING THE CHALLENGE OF FACILITATING A COP Example 1. A member of a now closed CoP noted that the co-facilitators did not always facilitate in ways aligned with CoP principles, but that the CoP members were reluctant to challenge them. The interviewee noted that a potential solution would have been to either recruit more senior members to CoP in order to challenge to the facilitators. Example 2: When the facilitator of a now closed CoP realised that the CoP was not functioning as intended, she felt as if she was personally responsible. The Co-Creation Network support team put her in touch with a facilitator of another CoP at a similar life stage. This helped her reflect and feel more positive about the challenges she had experienced.
Findings and Discussions Motivations for initiating or joining CoPs
4. Face-to-face interaction between CoP members was felt to increase the likelihood of securing member engagement; earlier in this chapter it was noted that the three most active CoPs had all had some form of face-to-face contact. While some of the active CoPs make more regular use of non face-to-face communication channels such as teleconferences due to geographical constraints, the real-time nature of these channels meant that conversations felt more interactive and dynamic than those conducted via forums on the online platform. This was reported as helping people get to know each other (and like each other), deemed necessary for creating a functioning community.
“Whilst I don’t think you need to know each other in real life to make a CoP work, it does make things a lot easier. Knowing someone face-to-face makes it easier to interact with them online.”
OVERCOMING THE LIMITATIONS OF COMMUNICATION CHANNELS Example 1. Face-to-face meetings can help create relationships with members who do not know each other, but does not provide the same automatic records of activity that online engagement provides. One facilitator of a CoP, which has monthly face-to-face meetings with members, takes meeting minutes. Other facilitators transcribe phone calls. Example 2: One facilitator of a CoP, which has experienced a lack of member engagement, is planning on asking members whether they would like to meet face-to-face to spark greater engagement. Other facilitators who facilitate geographically dispersed groups try to ‘piggyback’ on pre-organised events that members are likely to be going to anyway, and to use these face-to-face meetings to focus on activities that are better done in person (e.g. looking at data together)
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Findings and Discussions Motivations for initiating or joining CoPs
5. Having a diverse mix of members was the final common factor interviewees identified as creating engagement with the CoPs. Interviewees frequently noted the diversity of participants at the basecamp events and said they welcomed the opportunity to interact with and learn from people from different backgrounds to themselves. This was felt to be important as it helped them see problems from different perspectives and created enthusiasm for change.
“One of the things I’ve liked most about the events is the mix of people, and the networking opportunities – meeting people from different departments with different interests. It’s important for innovation – learning different ways of doing things from others.”
IMPACTS OF THE COPS Interviewees were asked what impacts, if any, their involvement in the CoPs had on them as individuals, and to identify any contributions the CoPs had made towards wider impacts at an organisational or system level. As discussed in the previous sections, the maturity of a CoP in terms of its activity levels among members and the organisational support it received strongly influenced its ability to create impact – particularly at an organisational level. The most active CoPs appear to have reached a point where they are able to identify some positive impacts at both individual and organisational levels. However many of the dormant CoPs have not yet reached a position where they are able to create organisational impact, as they are still primarily focused on creating member engagement. Creating and sustaining engagement from members
However, several interviewees – particularly those involved with active CoPs – described experiencing difficulties recruiting and engaging the types of people they viewed as necessary for their CoP to continue receiving organisational support. These interviewees noted that they had struggled in particular to recruit doctors and senior staff. One interviewee described how she had initially hoped the Co-Creation Network and basecamp events would be places where she could recruit new, clinical members. However this had not proved to be the case, which she surmised was due a lack of awareness among clinicians about the CoCreation Network as well as the ‘softer’ approach of the basecamp events ‘putting off’ the types of people she was trying to attract to her CoP.
and securing support from organisations have proven to be common barriers for CoPs achieving their intended impact. However, even among the dormant CoPs it appears that there are a number of small, but tangible impacts, for the individuals involved in them.
IMPACTS FOR INDIVIDUALS Interviewees were asked to consider a range of impact types. These are presented in the tables on the next two pages, along with a summary of responses received for each type of impact. The most frequently mentioned impact at an individual level was the value created from connections made during the basecamp events and involvement with CoPs, suggesting that this aspect of ‘capacity building’ impacts has been the most tangibly felt.
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Findings and Discussions Motivations for initiating or joining CoPs
Impact category
Measure
Impacts identified
Instrumental (Influencing the development of policy, practice or service provision, shaping legislation, altering behaviour)
Practice and behaviours
Interviewees reported some impact on their practice and behaviour; these tended to be models/techniques that they had been exposed to at the basecamp events e.g. flexible agendas that several interviewees noted they had replicated for both CoP activities as well as wider work meetings, and more conscious use of empathic modes of listening when conducting work meetings.
Conceptual (Contributing to the understanding of policy issues, reframing debates)
Awareness and attitudes towards issues
Majority of interviewees reported that they already knew about the topic prior to joining/initiating a CoP or that their involvement confirmed what they already knew. When impacts were identified, these tended to result from: learning about practice in other organisations that they would not normally have access to/share with; hearing about others’ experiences of failure; and being exposed to alternative perspectives as a result of interacting with people from different backgrounds. Due to the lack of interviews with members of CoPs (most interviews have been with facilitators) it is not possible to ascertain whether non-active members have become more aware of issues as a result of reading conversations/documents shared on the online platform. However facilitators noted instances where members’ awareness is likely to have improved as a result of CoP activities (e.g. distributing monthly newsletters to members, or provision of training).
Approach to work and interaction with others
Majority of interviewees noted that they had previous experience of working in networks, particularly within their organisations. Where impacts were identified these tended to result from: working with people across organisational boundaries with different organisational cultures; and working with other people’s ideas and developing these ideas together with no one single person in charge.
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Findings and Discussions Motivations for initiating or joining CoPs
Impact category
Measure
Impacts identified
Capacity building (Through technical and personal skill development)
Career progression
No interviewees identified benefiting from career progression or new role opportunities as a result of their involvement in CoPs; although several mentioned that this was something they hoped would happen in the future. However some interviewees described benefits of their involvement on their continuing professional development (CPD), as well as reinforcing future career goals e.g. the desire to go back to working in quality improvement.
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Leadership behaviours
Several interviewees felt they had developed their leadership behaviours as a result of their involvement with CoPs. Where mentioned these tended to result from becoming associated with a particular topic as a result of CoP facilitation and improving personal facilitation skills, particular for CoP facilitators who have had to negotiate tensions and competing objectives between CoP members and stakeholder organisations.
Connections
Nearly all interviewees were able to name at least one useful contact they had made as a result of their interaction with the CoPs or the wider Co-Creation Network. CoP involvement was reported as helping build connections and relationships due to giving members/facilitators more ‘courage’ to approach people in other organisations; enabling them to maintain relationships with ex-colleagues; creating alternative support networks for people who do not have a supportive team in their employer organisation; and providing opportunities for meeting people that they would be unlikely to meet otherwise.
Findings and Discussions Motivations for initiating or joining CoPs
EXAMPLES OF IMPACT AT AN INDIVIDUAL LEVEL Some of the examples of impact that the interviewees identified were described as quite minor, for example one interviewee noted that he had shared a game he had experienced at one the basecamp events to demonstrate knowledge management at a national team meeting held by his organisation. The most substantive impacts at an individual level were around the connections made via the CoPs and Co-Creation Network. Examples of the benefit these connections have had for individuals are: • Sense of camaraderie and support during periods of change/turbulence. The facilitator of the Care Co-ordination in Primary Care noted that the CoP had created greater camaraderie among the care co-ordinators taking part in the Leeds West CCG pilot by providing them with a network of support, enabling the care co-ordinators (who were all based at different GP practices) to come together and share tacit knowledge with others going through a similar experience. Similarly, the facilitator of the Sepsis CoP described how the CoP most often come together following the launch of new national guidance (e.g. the 2015/16 Commissioning for Quality and Innovation (CQUIN) for sepsis) with offers of support which makes it feel like they are ‘in it together’.
“We tend to get together when there have been national changes – sepsis is such an important topic nationally and it’s really something we have to do about. The CoP makes it feel like we’re in it together.”
• Sharing learning with new contacts in other regions. The facilitator of the Human Factors CoP recounted how someone working in human factors in London found her via the Co-Creation Network website and privately messaged her about a project she was working on about safer surgery (one of the work streams that the Human Factors CoP was hoping to engage members in). They exchanged a few direct messages and then spoke on the phone to share learning about their respective projects, which the facilitator was able to feed back into her secondment at the Y&HIA. • Widening professional networks. The facilitator of the now closed Schwartz Rounds CoP described how while she had not been able to secure engagement from the CoP members, her role as facilitator had encouraged her to make enquiries to find organisations already implementing Schwartz Rounds. As a result of talking to an organisation called Point of Care, she made contact with someone at South Tees Hospitals NHS Foundation Trust who runs Schwartz Rounds and was able to shadow them for a day. Although this was not a contact made via the Co-Creation Network, the process of being involved in the CoP encouraged her to think more widely. She also noted having helpful conversations with Jane Pightling who helped her think about what it was she was trying to achieve and how she could link the CoP more closely into her Trust.
“One impact of the CoP is that I’ve developed a wider network. I’ve built more connections and it gave me the courage and a reason to approach people I wouldn’t have otherwise approached…the process of being involved in the CoP got me thinking more widely and encouraged me to look outside of my organisation and to engage with other people, which is how I ended up talking to Point of Care.”
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Findings and Discussions Motivations for initiating or joining CoPs
• Providing an alternative source of support to people who lack support in their organisations. One interviewee noted that for him the most significant impact of the CoPs and the Co-Creation Network was that it offered a source of support for people who do not have support beyond their immediate teams. This could potentially increase the job satisfaction of those people who would otherwise feel unsupported.
“I’ve found that some people across both voluntary and statutory services don’t have the support in their teams to flourish and grow. The Co-Creation Network is allowing people to connect with like-minded others, and the CoPs can become centres of support for people, showing people a sign for how things can be different.” The other more significant impacts that CoP involvement had at an individual level were around encouraging new ways of looking at problems and collaborating with others to find solutions. Examples of this include: • Learning how to work with and develop other people’s ideas more effectively. The facilitator of the Sepsis CoP described that at a personal level the CoP had helped her work more effectively with other people’s ideas, which was important as their CoP aims to drive greater consistency in sepsis management between Trusts across the region (more detail is provided in the Sepsis CoP case study), and therefore involved using materials and initiatives developed in other Trusts.
“Where the CoP has impacted me on a personal level is that is helped me become better at using other people’s ideas which is a bit different to how I’ve previously worked. We’re building on these ideas together, there’s no one person in charge.”
• Being inspired to think differently. Several interviewees mentioned that they had found their involvement in the CoPs and wider Co-Creation Network inspiring. For example one interviewee who is not a member of any CoPs but who is planning on initiating a new CoP around co-production with services users for her organisation described the basecamps as inspirational. This was because she was able to see what other people had achieved through using approaches she described as ‘left field’ (she gave the specific example of hearing about the impact the Yorkshire & Humber Falls Prevention CoP had on reducing falls incidence through involving other people).
“[The Co-Creation Network] has made me interested to find out more because it shows there are other ways of doing things, it’s inspired me to think differently by seeing what other people have achieved – even if it’s on a topic that isn’t related to my area of work or what I want to do...even if it’s not exactly relevant to me I still find it inspiring.” In addition to impacts on them as individuals, interviewees were also asked to reflect on how their participation in the Co-Creation Network had made them feel. Interviewees reported both positive and negative feelings resulting from their involvement with the Co-Creation Network. Positive emotions included feeling like they were trying to do something/make change happen as a result of initiating a CoP, feeling energised, motivated and inspired as a result of participating in basecamp events, and feeling more supported and ‘in it together’ with colleagues from different organisations. Negative emotions included feeling disheartened and demotivated by lack of member engagement, feeling like they have personally done something wrong when a CoP has not worked as well as they had hoped, frustrated when they have been unable to get as many involved (or the secure involvement from clinicians) and overburdened when needing to balance responsibilities to CoP with responsibilities to employer organisation.
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Findings and Discussions Motivations for initiating or joining CoPs
IMPACTS FOR ORGANISATIONS Only the three most active CoPs were able to identify substantive impacts at the organisational or wider system level. Interviewees involved with dormant CoPs – or involved with the wider Co-Creation Network – were less able to identify organisational impacts. As discussed at the beginning of this chapter, this was primarily due to a lack of organisational support that in turn contributed to low levels of activity among CoP members.
EXPERIENCE OF INTERVIEWEES WHO LACK ORGANISATIONAL SUPPORT Just over a third (n=512) of interviewees reported their employer organisation was not supportive of their involvement in the CoPs or wider Co-Creation Network. The reasons for a lack of organisational support given by interviewees included: line managers not perceiving the CoP as of direct relevance to the facilitator or member’s core role (this was the most frequently mentioned reason); organisational scepticism as to the approach of CoPs, particularly with regards to the self-direction of members which meant outcomes could not be predicted; and a lack of awareness or understanding about the Co-Creation Network and CoPs. Securing and sustaining organisational support was felt to be particularly difficult given the current NHS context and focus on efficiency, cost cutting and pressure to demonstrate tangible results.
“My involvement with CoPs has impacted me at a personal level, but I don’t know if there has been added value for organisations, it would be very difficult to prove its financial value.”
12. Of these 5 interviewees, 3 were employed by Trusts, 1 was employed at a healthcare charity and 1 was employed at a government health authority.
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Findings and Discussions Motivations for initiating or joining CoPs
The lack of organisational support was often frustrating for
Interviewees described a range of forms that a lack of
interviewees, who noted that they could see the potential
organisational support could take. Examples of an explicit
benefits of CoPs for their organisation in terms of the
lack of support included the employer organisation
increased job satisfaction, improved dynamics between
reducing the time allocated to the employee for their
people, wider networks, access to external learning,
involved in CoPs/supporting the Co-Creation Network
and different approaches that CoP involvement had
and pressure on CoP facilitators to direct the CoP
the potential to create – which could in turn potentially
activities in ways not aligned with members’ priorities.
help organisations perform more effectively. However
More often than not however, interviewees noted that
the fact that currently CoPs were mostly perceived
their organisation did not display any overt resistance
by their employer organisations to be a luxury or a ‘nice
to their involvement with CoP but rather were simply
to have’ rather than as essential to improving employee
uninterested in it (the majority of interviewees reported that
or organisational performance meant that interviewees
their employer organisation was aware of their involvement
felt it was unlikely that organisational support could
with the Co-Creation Network).
be sustained.
“You want to do well for your organisation and your manager, and you want to bring in external perspectives but sometimes it feels like there is a tension between the two. In my day job the external stuff is a nice to have, it’s not part of my core role.” “The NHS can’t invest in the time for people to get to know each other – having team meetings are seen as a luxury. The NHS isn’t mature enough to recognise that talking to each other is adding value.”
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“My organisation knows about my involvement in the Co-Creation Network as I’ve told them about it, but no one ever asks me about it.”
Findings and Discussions Motivations for initiating or joining CoPs
EXPERIENCE OF INTERVIEWEES WHO HAVE ORGANISATIONAL SUPPORT The majority of interviewees (n=813) reported having organisational support for their involvement in CoPs or the wider Co-Creation Network. However most of these interviewees tended to describe their employer’s support as fairly ambivalent in that while they were given time to attend basecamp events they did not receive additional resources for their involvement in CoPs.
“My facilitation is part of my day job. It’s extra to what I need to do as part of my role, but other than the time off to go to a basecamp event I don’t get additional support to facilitate the CoP.”
Examples of the types of organisational support received from employer organisations included time to go to basecamp events or CoP meetings, colleagues’ attending basecamp events or being an active member of the CoP, research support from Trust librarians (Sepsis CoP – see case study for further detail) and funding from CoP members’ organisations to provide resources for the CoP facilitator role (AHSNs for Stroke Prevention in Atrial Fibrillation). There were some instances where despite receiving organisational support for their involvement in the Co-Creation Network, interviewees spent some of their own personal time on CoP activities. This was particularly the case for interviewees involved in CoPs not directly relevant to their core roles, or who were involved in the Co-Creation Network support team.
13. Of these 8 interviewees, 3 were employed by Trusts, 4 were employed by health improvement agencies, and 1 was employed by a social care charity.
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Findings and Discussions Motivations for initiating or joining CoPs
“I’m quite fortunate because my organisation is kind and supportive. My manager and my chief exec know about the CoPs – people from my organisation have come along to the basecamp events, they recognise it is important. So I’ve got that support but still a lot of my contributions come in my own time, e.g. writing blogs.” Interviewees noted that there were often few similar groups or networks that their CoP could be compared to (particularly at local or regional levels), which made it difficult for them to assess the impact of the CoP approach versus a more traditional approach. This also made it harder for their organisations to understand what CoPs were. For example, the AHSNs for Stroke Prevention in Atrial Fibrillation was the first internal group to bring regional employees/associates together (and is therefore seen as an exemplar in AHSN sharing), and there are no other sepsis networks operating at a regional level in Yorkshire & Humber other than the Sepsis CoP. According to the facilitator for the Sepsis CoP there is a national member network called NHS Quest, but this operates via an annual subscription and has more senior buy-in, so the Trusts supporting staff to be part of this network have higher expectations for what staff deliver as a result of their participation.
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The lack of organisational understanding was not always perceived to be a barrier. For example interviewees involved with the most active CoPs noted that while they received support from their organisation, their organisation was less concerned with the Communities of Practice model and approach being used and were more focused on the outcomes.
“The organisations aren’t interested in the model of the CoP, they’re just interested in what we’re doing – just seen as a tool to achieve goals.”
Findings and Discussions Motivations for initiating or joining CoPs
EXAMPLES OF ORGANISATIONAL IMPACT Interviewees associated with dormant CoPs most
The impacts at an organisational level identified by interviewees involved in the three most active CoPs were:
commonly identified the learning that the interviewee had
INSTRUMENTAL IMPACTS
gained as a result of their involvement in the CoPs and had
• Improved understanding of the effectiveness
shared with their organisation (i.e. conceptual impacts). However the majority of these interviewees noted that these conceptual impacts at an organisational level were relatively small scale, and that it was not always possible to identify whether this learning had resulted in any changes within their organisation (i.e. instrumental impacts).
“From my conversation with the lady in London that I met via the website I’ve been able to build in her learning into our work streams. I’ve shared a summary of our conversation with my team.” Interviewees involved in the three most active CoPs identified a number of impacts that they described as more substantive. As these impacts can all generally be classified as instrumental impacts, it suggests that interviewees may perceive a hierarchy of impacts whereby instrumental impacts are viewed as more important than conceptual or capacity building impacts at an organisational level. This is likely due to instrumental impacts being more visible (and measurable) than conceptual or capacity building impacts within organisations.
of organisational initiatives to improve clinical practices. The facilitator of AHSNs for Stroke Prevention in Atrial Fibrillation described how the CoP brings together AHSN employees or associates based in different regions to share what they have learnt from the atrial fibrillation initiatives/projects being conducted in their region. The CoP model has created value for the AHSN in two ways. Firstly it provided an approach through which the regional AHSNs could be bought together to share learning. Secondly, the CoP model helped the facilitator create a safe space in which members felt able to share the failures their projects had experienced, as well as their successes. Together, these two factors have helped the AHSN gain a more complete picture of what works.
“As a result of the community we’re able to assess far more effectively the progress of different approaches. Without it, we’d just have one small project testing a diagnostic tool, but with the CoP we can pool the learning from all the different projects the organisations are doing across the regions and it gives us a far better picture as a result.”
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Findings and Discussions Motivations for initiating or joining CoPs
• Funding from partner organisations. The facilitator
services could sometimes create delays in setting up
of AHSNs for Stroke Prevention in Atrial Fibrillation
support, helping to make the case for having a quick
also described that a positive impact of the CoP for
conversation with an available social worker to get
Yorkshire & Humber AHSN had been receiving money
information (e.g. about accessing ADL equipment).
from the other regional AHSNs to fund the facilitator’s co-ordination of the CoP, resulting in an additional income stream. • More consistent approaches between Trusts.
The facilitators of the Care Co-ordinators in Primary Care experienced considerable challenges in resolving issues around data collection to measure the impact of
The facilitator of the Sepsis CoP described how the
the pilot, partly due to the view amongst CoP members
CoP aimed to create a more streamlined approach
that data collection is traditionally managed centrally
between Trusts in the Yorkshire & Humber region
by the CCG and that measurement should not be the
around sepsis process management. This was felt
role of the people delivering the care (see case study
to be particularly important for the region because
for more detail). The facilitators provided the care
nurses and doctors transfer between Airedale General
co-ordinators with quality improvement training so that
Hospital, Bradford and Leeds Teaching Hospitals
they could understand why they need data to show
during their training. An example of how the CoP has
any changes they make are actual improvements They
been able to increase consistency is its work in creating
also supported the care co-ordinators to co-produce
and promoting a more consistent ‘brand’ for the Sepsis
the measures and the different types of data that
6 (BUFALO) pathway, BUFALO being a mnemonic
could be collected (qualitative and quantitative). While
to help nurses and doctors remember the six steps
it remains an ongoing challenge, the CoP principle of
for treating sepsis. Leeds Teaching Hospital had
involving the care co-ordinators in impact monitoring
previously introduced the mnemonic and once doctors
has helped secure greater buy-in from them and foster
started using the term at Bradford, the CoP facilitator
understanding among the wider primary care teams as
got in touch with CoP members at Leeds and asked
to why this is necessary. In turn, their involvement has
permission to use and develop it. They created a logo,
improved the quality of the measurement by ensuring
awareness raising posters and carry cards, which were
measures are both practical and feasible.
then shared with Leeds and Airedale who have also started using them. It is hoped that the use of these commonly branded materials across the three Trusts will reduce the time it takes for the Sepsis 6 message to ‘sink into’ trainees. • Identifying problems and coming up with
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• Improved quality of pilot impact measurement.
To summarise it appears that interviewees are benefiting at an individual level from a range of instrumental, conceptual and capacity building impacts as a result of their participation in the CoPs and wider Co-Creation Network. Interviewees were more cautious around identifying impacts at an organisational level, with those
workable solutions. The facilitators of the Care Co-
involved with dormant CoPs largely unable to identify
ordinators in Primary Care recounted how one of the
any impacts at this level, or only conceptual impacts
biggest impacts of the CoP for the CCG pilot has been
through knowledge sharing that they generally described
the care co-ordinators identifying common barriers to
as small scale. However the active CoPs do appear to
the successful implementation of co-ordinated care,
be generating impacts at an organisational level, with the
and developing solutions during their monthly CoP
interviewees in involved in these CoPs able to identify
meetings. For example the care co-ordinators identified
a number of instrumental impacts that they felt their
that having a single point of access at social care
CoP had directly contributed to.
Findings and Discussions Motivations for initiating or joining CoPs
IMPACT OF Y&HLA SUPPORT AND FACILITATION
• Administrative and technical support e.g. setting
TYPES OF SUPPORT RECEIVED
• Receiving ‘tours’ of the online platform to help
Interviewees were asked what types of support and facilitation they were aware that the Y&HLA had provided for their CoP. They reported receiving a range of support during the different stages of a CoP’s journey, provided primarily by the Co-Creation Network support team and the CoP for Facilitators. At the beginning of the CoP journey, the types of support and facilitation interviewees had received from Y&HLA included: • Educating CoP facilitators around the principles of CoPs and how they function; advising them how to get a CoP up and running and how to create dynamism; and helping facilitators think through the aims and objectives for the CoP and how to frame the questions/ problems that the CoP would be bringing people together to solve • Supporting facilitators recruit members and make connections across organisational boundaries both inside and outside of the Yorkshire and Humber region, e.g. helping man CoP tables and sign up members at
up the CoP group on the Co-Creation Network’s online platform and troubleshooting technical problems
navigate the website and understand how to use the different features • Attending meetings with the CoP facilitators and their employer organisation to support facilitators gain organisational buy-in e.g. giving presentations about the Co-Creation Network and answering questions Once the CoP had been established, a small number of interviewees reported that they had no longer required Y&HLA’s support as their CoP had ‘found its feet’, which one interviewee noted was a sign of the CoPs’ success.
“Y&HLA played a role early on supporting me to understand how to get a community up and running and how to keep it dynamic. And the peer support for other facilitators at basecamp events has been useful. But I’ve drifted away, I’ve got what I’ve needed from them – they gave me a model and support/advice but now it is a self-sustaining group, it’s achieved what I set out to do.”
the basecamp events, arranging introductions between CoP facilitators and people known to have shared interests in other organisations • Suggesting ideas to facilitators for how to create value with the CoP and supporting facilitators implement those ideas e.g. suggesting that the CoP forms a partnership with the hospital library to create topic bulletins as a resource for keeping CoP members up-to-date with developments in their domain
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Findings and Discussions Motivations for initiating or joining CoPs
For many of the CoPs sampled however, the challenges encountered during the CoP journey meant that the facilitators had needed, and received, further support from Y&HLA. Examples of ongoing support received during the CoP journey included: • Discussing with other CoP facilitators during WebEx calls the struggles facilitators experienced around creating a core group of members and maintaining CoP dynamism, and receiving advice from others as to overcoming potential barriers • Support from other facilitators and the support team to help resolve ongoing challenges and reminders as to the CoP methodology e.g. one facilitator described how the peer support she had received helped her find ways of encourage the CoP members to self-direct and take on more active roles. Only one interviewee had experience of closing down a CoP at the end of its journey. This interviewee noted that Y&HLA had supported her to come to a decision about what to do with the inactive CoP by describing how the CoPs have different life stages, which had given her the permission she felt she needed to actively close the CoP down. In addition, the interviewee describe how Y&HLA had put her in touch with another CoP facilitator who was in a similar position, and being able to share experiences had helped her feel more positive.
30
Findings and Discussions Motivations for initiating or joining CoPs
The basecamp events were on the whole thought to be useful and engaging for those who had attended. Interviewees valued being able to meet and network face-to-face with people working in different roles at other organisations, as well as the opportunities for sharing experiences/challenges and providing peer support. The interviewees had mixed reactions to the
PERCEPTIONS OF Y&HLA SUPPORT
format of the basecamp events; some interviews enjoyed
The majority of interviewees were positive about the
from the usual format of meetings, while others found
support and facilitation the Y&HLA had provided the Co-Creation Network and CoPs, and did not report finding any types of support unhelpful. Interviewees particularly valued the proactivity of the support team and their responsiveness and approachability. Several interviewees also noted that Y&HLA had played an important role in demonstrating the CoP ethos through their values
the flexible agenda and found it a welcome change it challenging. For example several interviewees noted that they had been quite sceptical about the agenda (particularly around the mindfulness exercises at the beginning of the events) and had struggled with the lack of structure. They noted that this approach suited certain personalities/mind-sets more than others, and could be off-putting to some people, particularly those with a clinical
and behaviours.
background used to a different way of working.
“I’ve found them to be accessible and responsive if you’ve got any questions, Lucy will email me proactively, it feels well facilitated.”
“I’m a bit of a planner and I like structure, I found it difficult at first because there wasn’t much structure, it felt like I was having to find my own way. A bit more structure and guidance at the beginning would have been helpful.”
“They’re quite personable and easy to approach. Lucy recognised me and remembered me from the last basecamp event. That’s probably the reason why I’m still going.” “They walk the walk; they embody the values of the Co-Creation Network and consistently demonstrate its values. They see their job not to provide wisdom but to listen. The Network has been very fortunate to have Lucy, Jane and Angela – they’ve made it what it is. Without them it would be very different.”
“I was initially sceptical about the CoCreation Network. I come from a technical, pharmaceutical background and I’m a rule follower. I found some of the things they did different such as the meditating and the reflecting. I think it can put people off.” One of the interviewees who had described feeling sceptical at the start of his involvement with the CoCreation Network noted that to his surprise he had found its approach at the basecamp events to create space for thinking and reflection refreshing.
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Findings and Discussions Motivations for initiating or joining CoPs
“I struggled with the mindfulness because I wasn’t convinced that it would help with networking, pharmacists are not an esoteric bunch. I was also sceptical about measuring the success of CoPs; I come from a hard-nosed ‘what are your outcomes’ background. Taking the time out to have a think seemed like a luxury, but actually it turned out to be refreshing.” However another interviewee who also reported initial scepticism reported that she had found the basecamp events less useful than expected. This was because as a CoP facilitator she had hoped to be able to recruit new members to her CoP, particularly doctors, but found fewer members with clinical backgrounds than she expected.
“I’m not sure that the way the basecamp events are run makes them attractive to the people we’re trying to attract into our CoP, although it’s probably less of an issue for the other CoPs.”
• Lack of integration with existing communication channels – interviewees tended to report that their CoP had tried to use the online platform early on but found it less convenient than other channels, particularly email. As a result the majority of CoP discussion in the most active CoPs does not take place on the online platform. The simple, but seemingly significant, fact that members have to open up a separate website was perceived to the biggest barrier to the CoPs usage of the online platform. Instead, interviewees whose CoP did use online communication made more frequent usage of channels members would be interacting with on a daily basis (e.g. email, LinkedIn groups and schedules conferenced calls) • Privacy and confidentiality issues – one interviewee noted that the CoP she facilitated did not use the online platform forum or document storage functionalities as the sensitivity of the information the CoP members shared meant that they preferred using their NHS emails to communicate and share documents, at that the ability to make CoPs private could not substitute
The most frequently reported issue encountered was around the Co-Creation Network’s online platform. Almost of all of the interviews reported that they were not convinced of its value and very few interviewees had made extensive use of it. The barriers to using the online platform described by interviewees included: • Poor user experience and technical difficulties – while several interviewees said they had received help from the support team in understanding how to use and navigate the site, many interviewees still experienced issues such as problems with passwords, poor mobile access and a lack of understanding about the different features.
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the security of protected organisational email systems. However interviewees involved with CoPs on less sensitive topics noted that actually the document storage functionality of the online platform was one of few features they had found valuable.
Findings and Discussions Motivations for initiating or joining CoPs
OTHER TYPES OF SUPPORT NEEDED
This suggests that for some members of the Co-Creation
Interviewees were asked what other support or facilitation
can compare their performance with others and assess
they would like to see. Most responded saying they could not think of any additional support they needed, as they felt they would be able to ask questions to the support team or CoP for Facilitators if they needed to. Several interviewees did however make suggestions. One interviewee said that she would have found written guidance and background information useful when she first joined the Co-Creation Network.
“I turned up at the basecamp event feeling quite nervous as I didn’t know what we were doing. There were facilitators but I felt like I had missed out on previous conversations about CoPs because I hadn’t been to the first event. It always felt like I was on the back foot; written guidance would have been useful.”
Network, there is a need to provide ways in which CoPs themselves against more tangible measures. Some interviewees noted that they had found ways of doing this already. For example, the facilitator of the AHSNs for Stroke Prevention in Atrial Fibrillation noted that Y&HLA had helped him assess the performance of his CoP as a community by suggesting the use of the following metrics:
1. Number of interactions/exchanges between members 2. How many resources members have shared 3. How being part of a CoP has shaped delivery The final suggestion made by an interviewee was not for additional support for his CoP but rather an observation that it may be useful for the Co-Creation Network to refocus its efforts away from starting up new CoPs towards identifying and supporting ‘organic’ communities
Two interviewees mentioned that they would like more help identifying contacts they could approach. For example, one of the interviewees is hoping to set up a CoP on the topic
with shared interests that already exist in and across organisations, who are unlikely to be aware that they are operating as a community of practice.
of innovation and said it would be really useful to be given a list of people working in healthcare innovation. Another interviewee described how she found it frustrating that there was no way of assessing how well her CoP was performing. This interviewee was aware of the CoP principle that is was up to the individuals to decide what success looked like, but found this approach unhelpful.
“I’m quite competitive and not knowing how well our CoP is doing compared to the others is frustrating, there is nothing to say this is what a successful CoP looks like.”
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Findings and Discussions Motivations for initiating or joining CoPs
“There is something about supporting existing CoPs ‘out in the wild’ not just creating new ones. Don’t have to create CoPs from scratch – they already exist e.g. in GP practices. With these already existing CoPs (who might not recognise themselves as a CoP or know what that is) Y&HLA should be putting the information out there on how to improve them. And thinking how do we use these existing CoPs to improve quality of healthcare.” To summarise, it appears that interviewees have a positive perception of Y&HLA’s support and facilitation of the Co-Creation Network and value the support they have received at the different stages of their CoPs journeys. Support is particularly valued by CoP facilitators during the early stages when initiating their CoP and recruiting new members, and when they experience difficulties sustaining member engagement. When a CoP is perceived to have become self-sustaining, facilitators are less likely to feel that they need continued support from Y&HLA; however the challenges that the majority of CoPs face suggest that Y&HLA’s support continues to be important, particularly around supporting facilitators to sustain member engagement and achieving impact at an organisational level.
RECOMMENDATIONS FOR THE FUTURE AND LESSONS LEARNED 1. The most active CoPs are those that are more directly linked to clinical and/or strategic priorities but there is a lack of membership from people with these backgrounds, which can be detrimental to some of the active CoPs. Consider establishing a strategy for promoting the Co-Creation Network to clinicians and recruiting members with clinical backgrounds. 2. While the majority of interviewees reported receiving organisational support for their involvement in the Co-Creation Network, the support was in many cases ambivalent and at risk of diminishing due to a lack of direct relevance to members’ core organisational roles and the current pressured NHS environment. Encourage CoPs without organisational support, or at risk of losing support, to reframe their problem/ question in a way that is more directly linked to strategic and/or clinical priorities or understood as contributing to one or more of such priorities. 3. The Co-Creation Network’s online platform appears to be underutilised and the majority of communication among the active CoPs occurs via other channels. Undertake a cost/benefit study of the online platform to inform future decision-making; members may receive more value from resources spent supporting face-to-face interaction, and there is potential to utilise less costly forms of digital engagement (e.g. LinkedIn groups or email) that are already frequently used by members.
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Findings and Discussions Motivations for initiating or joining CoPs
4. The Y&HLA has managed to provide considerable
8. The connections made via the Co-Creation Network
support to the CoPs in spite of the resource/time
and CoPs appear to be one of the biggest impacts
constraints faced by the support team, and the CoPs
it has had for the people involved, and Y&HLA have
are largely very positive about the support they have
helped members make useful contacts. Explore ways
received when they have requested it. However the
in which to support CoP facilitators identify new
number of dormant CoPs suggests that these efforts
contacts without relying on the existing networks
have not always resulted in increased member activity.
of the support team e.g. whether it is possible for
Consider reprioritising Y&HLA focus towards identifying
hospital librarians to help provide this resource.
and supporting communities of practice that already exist in/across organisations. 5. The Co-Creation Network basecamp events appear
9. It appears to be difficult for the facilitators of the more active CoPs to understand and assess how well their CoP is performing, and this can be frustrating
to be more compatible with certain personality/mind-
for them. Enable the CoPs to measure and assess
set types than others, which can cause hesitation
their performance as a community through use of
among new members. Ensure that new members
metrics if they wish to do so (e.g. through provision
of the Co-Creation Network feel informed as to what
of online platform data such as click-rates, number of
to expect – consider introducing a ‘buddy’ system for
downloads etc.). Consider using leaderboards on the
new members.
online platform – or giving access to members who
6. There appears to be relatively low awareness of the
would like to know how they compare with other CoPs.
Co-Creation Network and CoPs among stakeholder organisations, which can make it difficult for CoP facilitators to gain organisational support. Continue supporting CoP facilitators seeking to secure organisational support by attending and presenting at meetings with stakeholders. 7. There appears to be some scepticism as to the value added by the Co-Creation Network among stakeholder organisations, in part due to competing organisational cultures. Create a briefing document that CoP facilitators can share with their organisations (particularly for facilitators seeking to secure support from organisations that may be sceptical about the approach/’softer’ language used on the Co-Creation Network website).
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Case Studies
CASE STUDIES CASE STUDY 1: CARE CO-ORDINATION IN PRIMARY CARE COP
to providing support though the community of practice model. Initially, Leeds West CCG planned to support the care co-ordinators via a traditional organisational network, led and managed by the CCG. However, on developing
INTRODUCTION
relationships with the care co-ordinators and understanding
The Care Co-ordination in Primary Care Community of
care co-ordination, all agreed to reframe the network as a
Practice (CoP) is one of the longest running CoPs in the
community of practice as this was more likely to empower
Co-Creation Network. Its members are composed primarily
the care co-ordinators to actively lead the change.
of clinical care co-ordinators, a new role currently being
The Care Co-ordination in Primary Care CoP was launched
piloted by Leeds West Clinical Commissioning Group
early in 2015.
(CCG) that aims to bridge the gap between health and social care. The CoP is jointly facilitated by Sarah De Biase, an Improvement Programme Manager at Yorkshire & Humber AHSN Improvement Academy and Karen Newboult, a Locality Manager at Leeds West CCG. This case study is based on an interview with Sarah De Biase. The care co-ordinators meet monthly as a CoP to explore together the challenges and unknowns they encounter in their new role. The aim of the CoP is to provide members with a platform for knowledge sharing, peer learning and support, allowing the care co-ordinators to explore as a community how their role impacts on the way older people are cared for in primary care. Sarah’s role as facilitator is primarily to support the care co-ordinators to use the ‘Model for Improvement’ framework to answer the unknowns they face and come up with and test potential solutions; as well as helping with the mobilisation of knowledge. Karen’s role is to ensure the CoP direction aligns with the CCG’s vision of care for older people. The role of the CoP members or care co-ordinators is to act as ‘critical friends’, both to each other as well as to the CCG, who are seeking to learn from the pilot and evaluate the impact of the care co-ordinator role. The journey of the CoP over the past year and a half has undoubtedly been challenging. Not only is the CoP involved in supporting its members undertake a new role in primary care, it is also experimenting with a new approach
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the complexity of the evidence base around what works for
This case study documents some of the challenges and successes that the CoP has experienced on its journey, building on learning which Sarah has shared at the internationally renowned Jonkoping Microsystem Festival in March 2016.
CONTEXT Nationally over the past decade there has been growing interest in care co-ordination as a way of bridging the gap between health and social care. In the Leeds West CCG pilot, the care co-ordinators are part of the primary care teams in GP practices. The care co-ordination role in the pilot is to identify older patients aged over 75 with complex needs at most risk of deteriorating health and proactively case manage these patients by putting support in place to help them stay as independent as possible and avoid admission to hospital. Each care co-ordinator is hosted by one of the 37 GP practices taking part in the pilot. Throughout the journey, the CoP facilitators have received support from Yorkshire & Humber Leadership Academy (Y&HLA) and the Community of Practice for Facilitators, a CoP that aims to provide peer support for all facilitators who have initiated a community of practice. At the start of the Sarah’s journey with the Care Co-ordination in Primary Care CoP this support helped her understand what communities of practice are.
Case Studies
“Initially I felt like a novice, I had never heard about the ethos or the language of CoPs before – I only encountered networks or steering groups or task and finish groups as a clinician. Therefore, I needed to understand more but when it resonated – specifically the bringing together of people with a common purpose to improve care, you can see it is a perfect fit for health and care professionals and a vehicle to drive up quality in a safe way, which in its simplest form can just be about the sharing of the tacit knowledge we each have that we don’t get a chance to talk about with others as we are so busy.” Further along in the journey, Y&HLA’s support has been particularly helpful in helping the CoP facilitators understand how to balance their responsibility to their employer (for example, in terms of performance management and demonstrating impact and cost effectiveness) with their responsibility to empower their CoP members to take ownership of their community and lead positive change.
“They [CoP Facilitator events] helped me understand why I needed to go back to the members [CCCs] and encourage them to define their own roles as CCCs within the community, that it shouldn’t just be myself and Karen driving the direction of meetings and the wider community agenda.”
FUNCTIONING The Care Coordination in Primary Care CoP operates primarily face-to-face, via monthly meetings. The members decided early on that they did not want to use the virtual platform as this would require them to log onto a separate website. The functioning of the CoP via face-to-face meetings has had both positive and negative impacts. On the positive side, the meetings have enabled the care co-ordinators to more easily connect with and build relationships with each other. The downsides have been that communication across the entire community between meetings has often been limited and it can be difficult getting the members to come together, either via email dialogue or in person when such activities would not usually be part of their core day job. Therefore, there are fewer ‘records’ of the activity that has taken place. If members were communicating via the virtual platform, these conversations would automatically be ‘recorded’ and could be used as evidence to demonstrate knowledge sharing. Instead, the facilitators must take minutes of the meetings to provide that same evidence and capture that tasks that members had committed to completing. However, smaller groups of care co-ordinators have and do meet outside of the CoP meetings – these meetings are often in response to specific issues or challenges faced by a group of care co-ordinators who work within a specific locality or if they work with a particular system or process. Having someone from the CCG as a joint facilitator of the CoP has helped incentivise members to attend meetings as it demonstrated the CCGs support of the process and offers credible and visible local leadership.
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Case Studies
A more fundamental challenge to the functioning of the
This need to demonstrate impact has sometimes created
CoP has been a reluctance of members to self-determine.
a tension for the CoP, as the members felt that discussions
From the outset there was some resistance among
related to the improvement measures and data collection
members to take the lead in creating the change and
were monopolising their face-to-face meetings, which they
improvement that the CoP aimed to enable. The care
felt would be more usefully spent sharing best practice.
co-ordinators were used to being recipients of information,
This tension is confounded by the view amongst CoP
and initially found it hard to adapt to the role of actively
members that data collection is traditionally managed
identifying problems that they could then go onto solve
centrally by the CCG and that measurement should not be
themselves. They have however started identifying
the role of the people delivering the care.
problems and co-creating solutions (discussed in the ‘impacts’ section.) The facilitators helped overcome this problem by identifying and encouraging individual members to act as role models to the others and demonstrate what the new way of working looks like in practice.
The facilitators have invested a lot of time and effort into resolving this tension by providing the care co-ordinators with quality improvement training so that they could understand why they need data to show any changes they make are actual improvements. They supported the
The involvement of the CoP in a regional pilot has
care co-ordinators to co-produce the measures and the
presented a number of additional challenges, highlighting
different types of data that could be collected (qualitative
how the wider context in which a CoP is situated can
and quantitative) and sought data quality support to design
impact on its functioning. On the one hand, the CCG was
data collection processes that caused least burden to the
supportive of the CoP taking a non-traditional, bottom up
primary care teams. While it remains an ongoing challenge,
approach to empower the care co-ordinators and to adopt
the CoP principle of involving the care co-ordinators in
a measurement for improvement approach. However
impact monitoring has helped secure greater buy-in from
on the other hand, as a pilot project the CCG required
them and foster understanding among the wider primary
standardised, quantifiable data to demonstrate impact.
care teams as to this is necessary. In turn, their involvement
“The external/wider system can impose pressures on communities of practice and create challenges for them.”
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has improved the quality of the measurement by ensuring they are both practical and feasible.
“There has been support at the CCG to work differently [via a CoP]. However working differently has led to complexity.”
Case Studies
IMPACTS
The CoP helped the care co-ordinators to identify these
At an individual level the CoP has provided individual care
problem themselves and to be action-orientated. However
co-ordinators with a network of support, camaraderie and a place where best practice can be shared. The newness of the care co-ordinator role and the unknown nature of what works has played to the strengths of the CoP model. By bringing the care co-ordinators together in a safe place, they have been able to form relationships with others in the same role from different GP practices and share their tacit knowledge that would not necessarily be shared otherwise.
“I think the CoP has allowed the journey to happen at a pace directed by the care co-ordinators rather than be mandated by the CCG, it’s been more natural as a result – although sometimes unnerving for the care co-ordinators as it is a different way of working.” The CoP has also played an important role in establishing relationships across the wider health and social care system. By inviting stakeholders such as GPs, dementia support workers and CCG employees to their monthly meetings, the CoP has created greater knowledge in primary care and in the wider community around what the care co-ordinators have to offer. The focus on relationships and solutions has helped the CoP achieve impact at a pan-organisation level. One of the biggest impacts has been the care co-ordinators identifying common barriers to the successful implementation of co-ordinated care and developing solutions during their monthly meetings. For example they identified that there was a gap in helping service users with Dementia remember their appointments at Memory Clinics. In addition, the care co-ordinators identified that having a single point of access at social care services could sometimes create delays in setting up support, helping to make the case for having a quick conversation with an available social worker to get information (e.g. about accessing ADL equipment).
solutions by encouraging the members to frame the despite these successes, demonstrating the impact of the care co-ordinators remains a problem for the CoP due to the lack of a formal evaluation framework agreed at the beginning of the process and the collection of baseline data. As a result the CoP has had to spend a lot of time problem solving around processes to support evaluation, time which its members would have preferred to be spent sharing good practice. A key learning for other CoPs involved in pilot programmes and/or working with CCGs is to agree expectations for impact measurement at the start of the process, and to help members understand its value.
SARAH’S ‘TOP TIPS’ FOR FACILITATING A COMMUNITY OF PRACTICE • Try and gain enthusiasm and buy-in from a core group of members which includes someone with credibility or a key leadership or clinical role • Start co-producing from day one so it becomes habitual, including the vision and aims of the CoP and constantly revisiting them • Be willing to be open minded about the format and structure of your CoP while trying to preserve the organic nature of what comes out of it • Keep persevering – not all communities will flourish quickly or even at all, you need to set yourself some milestones and ask if they are being accomplished. If not, then reframe or stop. If it is working then take reassurance from this and share achievements to keep the momentum going.
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Case Studies
CASE STUDY 2: SEPSIS COP
CONTEXT
INTRODUCTION
There are no regional sepsis improvement networks in
Erin Payne, a quality and patient safety manager at Bradford Teaching Hospitals NHS Foundation Trust initiated the Sepsis CoP over a year ago. As part of her role, Erin manages a number of improvement projects, including a project to improve the Trust’s management and treatment of sepsis. Sepsis is a potentially life threatening condition, triggered by an infection or injury. Erin facilitates the CoP and it has fifteen registered members on the Co-Creation Network’s online platform, most of who are involved in
Yorkshire and Humber, and there has not typically been a co-ordinated approach to sepsis management across the Trusts. Erin hoped the CoP would play a role in making the approaches more consistent and streamlined, particularly between Bradford and Leeds Teaching Hospitals and Airedale General Hospital as doctor and nurse trainees transfer between these three hospitals during their training. The different approaches to sepsis management between the hospitals meant that it could be confusing for trainees.
sepsis projects at different NHS organisations across the
At a national level sepsis is an important topic and there
Yorkshire and Humber region. One of the members is
have been a number of recent government directives such
a librarian called Federica Bianchini, based at Bradford
as Commissioning for Quality and Innovation (CQUIN)
Teaching Hospital’s library. The Sepsis CoP is one of
guidance and new NICE guidelines. As a result there is
the first CoPs in Yorkshire and Humber to have involved
pressure on Trusts to make improvements, providing an
a librarian to help create knowledge resources that are
additional motivation for members of the Sepsis CoP.
shared with members. This case study is based on interviews with Erin and Federica. Erin learnt about communities of practice through her former manager, who was involved in the Co-Creation Network. Her manager encouraged her to attend one of the basecamp events and supported Erin’s development of the Sepsis CoP. Erin was initially quite sceptical about the Network, as coming from a pharmacy background she found some of the basecamp activities (such as the meditation exercises at the beginning of the event) different from what she was used to. However she could see the value of the CoP model as a framework in which to bring together people interested in sepsis management improvement across the region.
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“The Sepsis CoP is working well, we have a common goal. Sepsis is something that requires action, and nationally it is an important area. The new national guidance is the main reason why everyone is involved in the CoP; it’s something we all have an interest in but the national agenda is also forcing us to do something about it.” (Erin Payne, facilitator of the Sepsis CoP)
Case Studies
FUNCTIONING The CoP tends to get together when there has been a national development that members wish to discuss with each other. The support members give each other during these times of change has proved to be one of the biggest benefits of the CoP, as it has helped create the feeling that they are all ‘in it together’. For example the new CQUIN guidance around sepsis means that Trusts have to improve their sepsis management processes or face financial penalties. Improving sepsis management is however difficult in reality for a number of reasons, and the CoP offers members a way to support each other in their work to make improvements. The CoP members include doctors, nurses and project managers as well as the services librarian. There is a core group of around 6 to 7 members who are more active. These members act as representatives for their local hospitals, and so the CoP functions as a ‘network of networks’. In addition, one of the members is based at Yorkshire and Humber Improvement Academy (Y&HIA); having a representative from the Y&HIA involved in the CoP has helped it secure organisational support, as has the fact that sepsis is on Y&HIA’s agenda as a priority topic. The Sepsis CoP operates primarily through the members emailing each other and occasional face-to-face meetings. Few of the conversations between members occur on the Co-Creation Network’s online platform. This is because email tends to be more convenient and also because they can be more open with each other via the NHS email system when discussing what can be quite sensitive topics (e.g. the barriers and challenges the different Trusts are facing). While Erin has encouraged members to self-direct, in reality she has found that her role as facilitator means she is expected by members to provide direction.
“In my experience it does need someone leading it; it can’t just be left to the members. The people who have gotten involved are willing but if I don’t do anything then it doesn’t move on.” (Erin Payne, facilitator of the Sepsis CoP) The biggest challenge Erin has faced is recruiting new members to the CoP. Initially she had hoped to use the Co-Creation Network basecamp events to make contacts and recruit new members. However the events have not yet proved to be useful for recruitment as there have been relatively low numbers of doctors and nurses attending the events - these are the types of people Erin needs to attract to her CoP in order for her CoP to achieve impact. The idea to involve a hospital librarian in the CoP came from one of the Co-Creation Network support team, who arranged a meeting between Erin and Bradford Teaching Hospital’s library manager to discuss the possibility of the library supporting the CoP. As information specialists, librarians are well placed to identify new evidence being published on sepsis such as systematic reviews, books, journal articles and conference papers, which could then inform the approaches taken by the CoP members. When the CoP approached the library at Bradford Teaching Hospital, the library was in the process of launching a new service producing bulletins on multidisciplinary topics that clinical and non-clinical staff can subscribe to. They agreed to produce a monthly bulletin on sepsis for the CoP, with the provision that it be made available to other staff who wished to subscribe to it. Bradford Teaching Hospital’s library now produces bulletins on 31 topics. The sepsis bulletin takes Federica 1 to 2 hours a month to produce, and she uploads it onto the Co-Creation Network online platform for the CoP members to download. In addition to helping Erin make connections, Y&HLA have also supported the CoP secure buy-in from stakeholders by attending meetings to explain what CoPs are.
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Case Studies
IMPACT
An example of this sharing among members is what they
The Sepsis CoP has had an impact at both an individual
Teaching Hospital had introduced the BUFALO mnemonic
and organisational level. For Erin there have been two primary impacts at an individual level. Firstly Erin feels she has become better at working with other people’s ideas and building on them, which has helped her develop a new way of working. Secondly, the support of the other CoP members has helped her feel a sense of camaraderie with others in similar roles at different Trusts; this has been particularly important given the pressure exerted on Trusts at a national level to improve sepsis management. For Federica, the impact for her as the services librarian supporting the CoP has been a feeling that she is contributing indirectly to improving patient outcomes and that CoP members value her contributions. At an organisational level, the CoP has played a role in creating greater consistency across Trusts around
have done around the Sepsis 6 (BUFALO) pathway. Leeds to help clinical staff remember the six steps to sepsis management. When doctors started using the mnemonic at Bradford Teaching Hospital, Erin contacted the CoP member based at Leeds and asked whether they could use and develop it further. They created a visual identity for BUFALO that was used on awareness posters and carry cards. These materials were then shared with CoP members who began using them at their Trusts.
“This has been hugely beneficial as it has reduced the time it takes for the Sepsis 6 pathway to sink into the trainees and it means they see the same materials when they rotate between Leeds, Bradford and Airedale hospitals.” (Erin Payne, facilitator of the Sepsis CoP)
the materials used to raise awareness about sepsis management among clinical trainees, and because members can use the resources that have been shared within the CoP at their own Trusts, it is helping minimise the duplication of work leading to greater resource efficiency.
“We have shared our ideas with each other and the materials we’ve created e.g. sepsis awareness posters. This has been beneficial because it means someone else has already done the work and they know what has worked or not worked as they have already implemented it. Using each other’s work in our own Trusts means that we don’t have to reinvent the wheel and it’s creating greater consistency across the Trusts.” (Erin Payne, facilitator of the Sepsis CoP)
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For Bradford Teaching Hospital library, their involvement with the CoP has enabled them to demonstrate that they are meeting the criterion of the National Framework for NHS libraries that requires them to actively collaborate with clinical and non-clinical staff in the creation and capture of knowledge. Their involvement with the CoP has also contributed to the increased visibility of their services.
Case Studies
ERIN’S ‘TOP TIPS’ FOR FACILITATING A COMMUNITY OF PRACTICE • Create a shared vision between the CoP members that members can relate to • Gain as much support for your CoP as possible, particularly from those who are influential in any changes that you wish to make • Accept that not all interested parties will be hands-on in the CoP but can still have valued input in other ways
FEDERICA’S ‘TOP TIPS’ FOR INVOLVING LIBRARIES IN COP ACTIVITIES • Engage with library staff to understand what services are already in place that can be adapted to CoPs (e.g. bulletins, literature reviews, using databases) • Ensure that outputs produced by the library for the CoP are able to be used more widely within Trusts, to help libraries justify the expenditure of their resources • Identify topics that are multidisciplinary and are of relevance to both clinical and non-clinical staff • Frame the CoP as a benefit of the library e.g. in helping them demonstrate that they are meeting the criterion of the National Framework for NHS Libraries • Help library staff understand how their outputs are being used by CoP members so they can ensure that the outputs are designed to create maximum value • Invite library staff to CoP meetings and keep them informed so that they feel involved as members, but build flexibility into library staff participation so they do not feel their attendance is mandatory as they have competing work commitments
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Case Studies
CASE STUDY 3: SUPPORT TEAM COP
Y&HLA commissioned a consultancy called Future
INTRODUCTION
development of the Co-Creation Network. Future
The Support Team CoP was set up to provide coaching and process support to all the CoPs in the Co-Creation Network in order to help the CoP facilitators develop and nurture their communities. It sees itself at the heart of the potential for growing the movement of communities of practice. This case study is based on an interview with Angela Green, a member of the Support Team CoP who has been involved with the Co-Creation Network since its launch two years ago. Angela is a Neighbourhood Team Operational Lead at Leeds Community Healthcare NHS Trust.
CONTEXT Angela first became involved with the Co-Creation Network in her previous role at the Yorkshire and Humber Improvement Academy (Y&HIA) where she worked as a programme manager. She recounted how Y&HLA approached Y&HIA about doing a joint project to set up the Co-Creation Network to support the development of communities of practice in Yorkshire and the Humber. The purpose of the Co-Creation Network would be to provide a way of supporting and connecting the Y&HIA’s growing network of Improvement Fellows, as well as more broadly responding to the feeling of disconnection some people working in the health and social care sectors reported in the region.
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Considerations to support the initial set up and Considerations facilitated workshops with Y&HIA’s Improvement Fellows to find out what people would want from a Network and whether there was interest in CoPs. Following positive feedback, Y&HIA agreed to support the establishment of the Co-Creation Network and to commission its website. It was at this point that Angela got involved.
“I soon realised that this was going to be a different way of working; it felt very different to the Improvement Academy’s usual approach which is very focused on project management, reporting and accountability. The Co-Creation Network instead would be grown from people’s interests and passions. It was exciting.”
Case Studies
FUNCTIONING Membership in the Support Team CoP is open; the only requirement is an interest in the professional development of communities of practice. The CoP members communicate via the forum on the online platform and occasional virtual meetings. The CoP currently has nine members, of which around five are active. At the start, three of the support team members were resourced by their organisations to provide support (Angela, Lucy Scarisbrick and Jane Pightling). However due to Angela and Jane moving roles, they now contribute to the Co-Creation Network on a voluntary basis. Initially Angela was resourced to spend 2 to 3 days a week supporting the Co-Creation Network, which involved a range of activities including developing the online platform, and supporting CoP facilitators get their communities off the ground. However Y&HIA eventually reduced the time she could spend supporting the Network down to half a day a week. As a result, the support Angela could offer the CoPs was reduced further and she spent some of her own personal time providing support. The Co-Creation Network’s online platform has put further pressure on the Support Team CoP as it experienced many technical issues in the early days. This meant that much of Angela’s time was spent trouble shooting technical issues, which resulted in her being able to spend less time supporting the CoPs.
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Case Studies
IMPACT
However, Angela does not yet think that the CoPs have
Angela feels like she has learnt a great deal about
level as it has taken time for many of them to build a
communities of practice due to her involvement in the Support Team CoP. In particular, she has learnt that helping people explore what the right question their CoP should ask is the thing that matters most. She has observed that CoPs can be effective in harnessing what people are really interested in and answering ‘sticky questions’, but they must be supported in order to achieve impact.
“People in CoPs need support from their employers. People have passions and interests but feel that they need permission from their organisation…There’s a lot of passion out there but it feels like there’s a strong resistance from normal management approaches.” At an individual level, not only has Angela developed her knowledge and understanding of how communities of practice work and what makes them successful, her involvement in the Support Team CoP has also enabled the
been able to achieve much impact at an organisational functioning community; although she noted that her reduced involvement in the Co-Creation Network since taking on a new role means she is less up-to-date with CoP developments. In her opinion the lack of organisational support experienced by some CoPs, and the culture of some organisations, have been the biggest challenges to developing the CoPs. However, Angela believes that Trusts may be more amenable to the approach taken by CoPs and she sees signs that attitudes may be changing, particularly in regards to the perceived value of improved social dynamics within organisations.
“I think on the front line people are realising that change needs to come from the people. Organisations that provide support themselves such as the Trusts are more likely to see the benefits of the CoPs... Emerging leaders get this way of working, they get that social learning is important.”
development of her leadership skills as a result of dealing with the challenges the Co-Creation Network has faced.
“I’ve personally learnt a lot, I feel like a better leader, supporting others who are looking to support others.”
Despite the challenges the Support Team CoP have faced, Angela is generally positive about the future of the CoCreation Network and she has been approached by NHS England who want to set up three CoPs around integrated care, which she believes demonstrates the interest that the CoPs are generating.
“I have no doubt that going forward that CoPs can demonstrate impact, NHS England wouldn’t be having these conversations of they didn’t think they are of value.”
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Case Studies
ANGELA’S ‘TOP TIPS’ FOR FACILITATING A COMMUNITY OF PRACTICE • Actively seek out people who share the same passions and interests and have conversations with them • Find a question that keeps you up at night and gets you out of bed. Choose a question that needs more than one person to solve it and be clear on the purpose of the CoP; make it quite specific • Sharing and learning do not come from the places that people think it will come from. Involve people who are not the ‘usual suspects’.
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Appendix
APPENDIX A: LIST OF INTERVIEWEES 1. Alison Martindale, Transformation Team Programme Manager at Bradford Teaching Hospitals NHS Foundation Trust (ex-member of Continuous Quality Improvement CoP) 2. Angela Green, Neighbourhood Team Operational Lead at Leeds Community Healthcare NHS Foundation Trust (member of Co-Creation Network support team and facilitator of the Mindfulness CoP) 3. Carol Read, Horizons Team at NHS Improvement (facilitator of Innovation CoP) 4. Debbie Clark, Academic Safety Improvement Fellow at Yorkshire & Humber Improvement Academy (facilitator of the Human Factors CoP) 5. Dex Hannon, Communication Manager at Healthwatch Leeds (new member of the Co-Creation Network) 6. Erin Payne, Quality & Patient Safety Manager at Bradford Teaching Hospitals NHS Foundation Trust (facilitator of the Sepsis CoP)
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7. Federica Bianchini, Services Librarian at Bradford Teaching Hospitals NHS Foundation Trust (member of the Sepsis CoP) 8. Fran Coard, Operational Manager at Community Links (planning on initiating a CoP) 9. Gareth Curt, Benefits Realisation Manager at HSCIC (ex-member of Continuous Quality Improvement CoP) 10. John Walsh, Practice Manager at York Street Practice (member of Co-Creation Network support team) 11. Sarah De Biase, Improvement Programme Manager at Yorkshire & Humber Improvement Academy (joint facilitator of the Care Co-ordination in Primary Care CoP) 12. Tony Jamieson, Clinical Lead for Medicines at Yorkshire & Humber AHSN (facilitator of AHSNs for Stroke Prevention in Atrial Fibrillation CoP and facilitator of Medicine Safety CoP) 13. Zoe Nicholl, ODIL Facilitator at York Teaching Hospitals NHS Foundation Trust (ex-facilitator of the Schwartz Rounds CoP)
Appendix
APPENDIX B: OVERVIEW OF COPS DISCUSSED IN INTERVIEWS Status
CoP
Reasons underpinning CoP status
Closed
Schwartz Rounds
Set up in order to create a community for people interested in introducing Schwartz Rounds into their Trusts, the CoP was hampered by a lack of engagement from members on the online platform, lack of organisational support from Trusts for implementing Schwartz Rounds due to resourcing barriers (financial and time), and not framing the CoP in a way that would encourage member engagement. Although the CoP has closed due to the lack of member engagement, the facilitator plans on being an active member of a new CoP that is currently in the process of being launched, suggesting continued enthusiasm for participating.
Continuous Quality Improvement
Initially two CoPs based around themes of quality improvement in health and social care but merged as a result of overlap, the CoP lost momentum and eventually closed due to co-facilitators taking on new roles and going on maternity leave and not being replaced, tensions between the co-facilitators in terms of differing agendas and motivations, (it should be noted that interviewees discussing this CoP had been members not facilitators of the CoP).
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Appendix
Status
CoP
Reasons underpinning CoP status
Dormant
Human Factors
Set to create a community for those interested in human factors, there was initial interest from members as demonstrated by relative ease of recruiting people to the CoP but lack of response to facilitators’ attempts to initiate conversations online. The facilitator hypothesised that this was likely due to a lack of knowledge about human factors among members, which either inhibited their confidence in taking part in online discussions or created a desire to ‘lurk’ and absorb information rather than actively participate. The facilitator is planning on asking CoP members whether they would like to meet face-to-face to see if this will spark greater interaction.
National Frailty
Set up to bring health and social care professionals with interest in frailty working nationally together, but described by its facilitator as ‘never quite getting off the ground’ due to a lack of member engagement. The CoP continues to be used by the facilitator as a file and document repository to share learning.
Safer Medicine Safety
Set up to bring together people with an interest in medicine safety, this CoP went dormant due time pressures and lack of a critical mass of members necessary for reaching regular activity. The facilitator went on to initiate a second CoP (AHSNS for Stroke Prevention in Atrial Fibrillation) that has been more successful, and described his experience with the Safer Medicine Practice as a useful exercise in testing and learning how CoPs work, which informed the second CoP.
Mindfulness
Despite being one of the largest CoPs at 31 members, the CoP struggled to become a functioning community. This is in part due to a lack of online engagement from members but also due to the facilitator lacking time to commit to its ongoing development (the facilitator is part of the support team, and had organisational support via time allocations reduced significantly). In addition, the facilitator noted that her employer organisation at the time was not supportive of the topic of mindfulness as it was not directly relevant to the organisation’s core focus, and was told by her line manager that the facilitation of the Mindfulness CoP would need to be done during her personal time.
Innovation
Set up to provide a ‘home’ for people interested in innovation in healthcare, the facilitator has not yet done anything with the CoP but plans to become more active in the near future once she has time (she is currently finishing a Masters course and is temporarily performing two job roles).
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Appendix
Status
CoP
Reasons underpinning CoP status
Active
Sepsis
Set up to co-ordinate and share learning around sepsis management across Trusts based in Yorkshire & Humber to encourage consistency, minimise duplication of work and support each other as they respond to national agendas and guidelines. The CoP has 15 members on the online platform, of which 5 to 6 are active; these members act as spokespeople for teams working on sepsis within their Trusts, so the CoP functions as a ‘network of networks’. Due to the sensitive nature of discussions, most of the CoP communication occurs via email rather than on the online platform forums.
AHSNS for Stroke Prevention in Atrial Fibrillation
Set up to co-ordinate and share learning between the regional Academic Health Science Networks (AHSNs) on initiatives being undertaken to prevent stroke in patients with atrial fibrillation. The CoP does have a home on the online platform but this is rarely used; instead the CoP primarily functions via regular teleconferences between members and occasional face-to-face meetings that ‘piggyback’ onto existing AHSN national events. While the CoP does not make use of the online platform, the facilitator uses the CoP model and principles as a template for facilitating the group (e.g. providing semi-structured agendas with flexibility built in and creating a safe space for members to share failures as well as successes).
Care Co-ordination in Primary Care
Set up to support the Care Co-ordinators taking part in a Leeds West CCG pilot, the CoP functions primarily through monthly face-to-face meetings. While the facilitator would like to encourage greater use of the online platform among the care co-ordinator members, she reported the members are not keen on online engagement, as it requires logging onto a separate site. The success and challenges experienced by this CoP are outlined in depth in the case study.
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EVALUATION OF COMMUNITIES OF PRACTICE
Evaluation undertaken and written by Chloe Cook, with thanks to Chih Hoong Sin at OPM Thank you and deep appreciation to the Co-Creation Network members for sharing their journeys with us for this report.
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