Communities of practice in Alberta Health Services: advancing a learning organisation.

BACKGROUND: In 2009, Alberta Health Services (AHS) became Canada's first and largest fully integrated healthcare system, involving the amalgamation of nine regional health authorities and three provincial services. Within AHS, communities of practice (CoPs) meet regularly to learn from one another and to find ways to improve service quality. This qualitative study examined CoPs as an applied practice of a learning organisation along with their potential influence in a healthcare system by exploring the perspectives of CoP participants. METHODS: A collective case study method was used to enable the examination of a cross-section of cases in the study organisation. Semi-structured interviews were conducted with 31 participants representing 28 distinct CoPs. Using Senge's framework of a learning organisation, CoP influences associated with team learning and organisational change were explored. RESULTS: CoPs in AHS were described as diverse in practice domains, focus, membership boundaries, attendance and sphere of influence. Using small-scale resource investments, CoPs provided members with opportunities for meaningful interactions, the capacity to build information pathways, and enhanced abilities to address needs at the point of care and service delivery. Overall, CoPs delivered a sophisticated array of engagement and knowledge-sharing activities perceived as supportive of organisational change, systems thinking, and the team learning practice critical to a learning organisation. CONCLUSION: CoPs enable the diverse wealth of knowledge embedded in people, local conditions and special circumstances to flow from practice domain groups to programme and service areas, and into the larger system where it can effect organisational change. This research highlights the potential of CoPs to influence practice and broad-scale change more directly than previously understood or reported in the literature. As such, this study suggests that CoPs have the potential to influence and advance widespread systems change in Canadian healthcare.

The relevance of WHO injury surveillance guidelines for evaluation: learning from the aboriginal community-centered injury surveillance system (ACCISS) and two institution-based systems.

BACKGROUND: Over the past three decades, the capacity to develop and implement injury surveillance systems (ISS) has grown worldwide and is reflected by the diversity of data gathering environments in which ISS operate. The capacity to evaluate ISS, however, is less advanced and existing evaluation guidelines are ambiguous. Furthermore, the applied relevance of these guidelines to evaluate ISS operating in various settings is unclear. The aim of this paper was to examine how the World Health Organization (WHO) injury surveillance guidelines have been applied to evaluate systems operating in three different contexts. METHODS: The attributes of a good surveillance system as well as instructions for conducting evaluations, outlined in the WHO injury surveillance guidelines, were used to develop an analytical framework. Using this framework, a comparative analysis of the application of the guidelines was conducted using; the Aboriginal Community-Centered Injury Surveillance System (ACCISS) from Canada, the Shantou-Emergency Department Injury Surveillance Project (S-EDISP) from China, and the Yorkhill-Canadian Hospitals Injury Reporting and Prevention Program (Y-CHIRPP) imported from Canada and implemented in Scotland. RESULTS: The WHO guidelines provide only a basic platform for evaluation. The guidelines over emphasize epidemiologic attributes and methods and under emphasize public health and injury prevention perspectives requiring adaptation for context-based relevance. Evaluation elements related to the dissemination and use of knowledge, acceptability, and the sustainability of ISS are notably inadequate. From a public health perspective, alternative reference points are required for re-conceptualizing evaluation paradigms. This paper offers an ISS evaluation template that considers how the WHO guidelines could be adapted and applied. CONCLUSIONS: Findings suggest that attributes of a good surveillance system, when used as evaluation metrics, cannot be weighted equally across ISS. In addition, the attribute of acceptability likely holds more relevance than previously recognized and should be viewed as a critical underpinning attribute of ISS. Context-oriented evaluations sensitive to distinct operational environments are more likely to address knowledge gaps related to; understanding links between the production of injury data and its use, and the effectiveness, impact, and sustainability of ISS. Current frameworks are predisposed to disassociating epidemiologic approaches from subjective factors and social processes.