title: A realist evaluation of the role of communities of practice in changing healthcare practice.
abstract: BACKGROUND
  Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare?
  
  
  METHODS
  The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP.
  
  
  CONCLUSIONS
  Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare.
authors: Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia. g.ranmuthugala@unsw.edu.au
authors: Geetha
authors: G
authors: Ranmuthugala
authors: Frances C
authors: FC
authors: Cunningham
authors: Jennifer J
authors: JJ
authors: Plumb
authors: Janet
authors: J
authors: Long
authors: Andrew
authors: A
authors: Georgiou
authors: Johanna I
authors: JI
authors: Westbrook
authors: Jeffrey
authors: J
authors: Braithwaite
references: J Clin Nurs. 2002 May;11(3):394-8
references: 12010537
references: Implement Sci. 2009 May 17;4:27
references: 19445723
references: Health Educ Behav. 2003 Dec;30(6):646-62
references: 14655861
references: Implement Sci. 2010 Jun 23;5:49
references: 20573254
references: Int J Med Inform. 2010 Jun;79(6):e116-25
references: 19008147
references: Milbank Q. 2009 Jun;87(2):391-416
references: 19523123
references: BMC Health Serv Res. 2009 Sep 15;9:162
references: 19754942
references: JAMA. 2008 Mar 12;299(10):1182-4
references: 18334694
references: Ann Surg. 2009 Apr;249(4):565-72
references: 19300234
references: BMC Med Res Methodol. 2009 Feb 28;9:13
references: 19250548
references: Jt Comm J Qual Patient Saf. 2006 May;32(5):253-60
references: 16761789