title: Use of communities of practice in business and health care sectors: a systematic review.
abstract: BACKGROUND
  Since being identified as a concept for understanding knowledge sharing, management, and creation, communities of practice (CoPs) have become increasingly popular within the health sector. The CoP concept has been used in the business sector for over 20 years, but the use of CoPs in the health sector has been limited in comparison.
  
  
  OBJECTIVE
  First, we examined how CoPs were defined and used in these two sectors. Second, we evaluated the evidence of effectiveness on the health sector CoPs for improving the uptake of best practices and mentoring new practitioners.
  
  
  METHODS
  We conducted a search of electronic databases in the business, health, and education sectors, and a hand search of key journals for primary studies on CoP groups. Our research synthesis for the first objective focused on three areas: the authors' interpretations of the CoP concept, the key characteristics of CoP groups, and the common elements of CoP groups. To examine the evidence on the effectiveness of CoPs in the health sector, we identified articles that evaluated CoPs for improving health professional performance, health care organizational performance, professional mentoring, and/or patient outcome; and used experimental, quasi-experimental, or observational designs.
  
  
  RESULTS
  The structure of CoP groups varied greatly, ranging from voluntary informal networks to work-supported formal education sessions, and from apprentice training to multidisciplinary, multi-site project teams. Four characteristics were identified from CoP groups: social interaction among members, knowledge sharing, knowledge creation, and identity building; however, these were not consistently present in all CoPs. There was also a lack of clarity in the responsibilities of CoP facilitators and how power dynamics should be handled within a CoP group. We did not find any paper in the health sector that met the eligibility criteria for the quantitative analysis, and so the effectiveness of CoP in this sector remained unclear.
  
  
  CONCLUSIONS
  There is no dominant trend in how the CoP concept is operationalized in the business and health sectors; hence, it is challenging to define the parameters of CoP groups. This may be one of the reasons for the lack of studies on the effectiveness of CoPs in the health sector. In order to improve the usefulness of the CoP concept in the development of groups and teams, further research will be needed to clarify the extent to which the four characteristics of CoPs are present in the mature and emergent groups, the expectations of facilitators and other participants, and the power relationship within CoPs.
authors.affiliation: Department of Physical Therapy, University of British Columbia; Arthritis Research Centre of Canada, Vancouver, Canada. lli@arthritisresearch.ca
authors.forename: Linda C
authors.initials: LC
authors.lastname: Li
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: Camilla
authors.initials: C
authors.lastname: Nielsen
authors.forename: Maria
authors.initials: M
authors.lastname: Judd
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham