title: Communities of practice for supporting health systems change: a missed opportunity.
abstract: BACKGROUND
  Communities of practice (CoPs) have been used in the health sector to support professional practice change. However, little is known about how CoPs might be used to influence a system that requires change at and across various levels (i.e. front line care, organizational, governmental). In this paper we examine the experience of a CoP in the Canadian province of Ontario as it engages in improving the care of seniors. Our aim is to shed light on using CoPs to facilitate systems change.
  
  
  METHODS
  This paper draws on year one findings of a larger multiple case study that is aiming to increase understanding of knowledge translation processes mobilized through CoPs. In this paper we strategically report on one case to illustrate a critical example of a CoP trying to effect systems change. Primary data included semi-structured interviews with CoP members (n = 8), field notes from five planning meetings, and relevant background documents. Data analysis included deductive coding (i.e. pre-determined codes aligned with the larger project) and inductive coding which allowed codes and themes to emerge. A thorough description of the case was prepared using all the coded data.
  
  
  RESULTS
  The CoP recognized a need to support health professionals (nurses, dentists) and related paraprofessionals with knowledge, experience, and resources to appropriately address their clients' oral health care needs. Accordingly, the CoP led a knowledge-to-action initiative that involved a seven-part webinar series meant to transfer step-by-step, skill-based knowledge through live and archived webinars. Although the core planning team functioned effectively to develop the webinars, the CoP was challenged by organizational and long-term care sector cultures, as well as governmental structures within the broader health context.
  
  
  CONCLUSIONS
  The provincial CoP functioned as an incubator that brought together best practices, research, experiences, a reflective learning cycle, and passionate champions. Nevertheless, the CoP's efforts to stimulate practice changes were met with broader resistance. Research about how to use CoPs to influence health systems change is needed given that CoPs are being tasked with this goal.
authors.affiliation: Western University, School of Health Studies and Schulich Interfaculty Program in Public Health, 1151 Richmond St, London, N6A 3K7, Canada. akothari@uwo.ca.
authors.forename: Anita
authors.initials: A
authors.lastname: Kothari
authors.affiliation: Western University, School of Health Studies and Faculty of Information and Media Studies, London, Canada. jboyko@uwo.ca.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Boyko
authors.affiliation: Department of Applied Human Sciences and Élisabeth Bruyère Research Institute, Concordia University, Portland, USA. james.conklin@concordia.ca.
authors.forename: James
authors.initials: J
authors.lastname: Conklin
authors.affiliation: University of Waterloo, School of Public Health and Health Systems, Waterloo, Canada. stolee@uwaterloo.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
authors.affiliation: Western University, School of Health Studies, Schulich Interfaculty Program in Public Health and Department of Family Medicine, London, Canada. ssibbald@uwo.ca.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Sibbald
mesh_terms: D003153:Community Health Services; D003299:Cooperative Behavior; D003695:Delivery of Health Care; D006282:Health Personnel; D006302:Health Services Research; D006299:Health Services for the Aged; D006801:Humans; D033181:Information Dissemination; D019359:Knowledge; D007858:Learning; D008134:Long-Term Care; D009864:Ontario; D015279:Organizational Culture; D011364:Professional Practice; D012111:Residence Characteristics; D057170:Translational Research, Biomedical