title: Contextualizing learning to improve care using collaborative communities of practices.
abstract: The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.
  
  
  
  The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.
  
  
  
  Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.
  
  
  
  Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.
authors: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. jeffsl@smh.ca.|Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. jeffsl@smh.ca.|University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada. jeffsl@smh.ca.
authors: Lianne
authors: L
authors: Jeffs
authors: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
authors: Julie
authors: J
authors: McShane
authors: University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
authors: Virginia
authors: V
authors: Flintoft
authors: Canadian Health Outcomes for Better Information and Care (C-HOBIC), Ottawa, Canada.
authors: Peggy
authors: P
authors: White
authors: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
authors: Alyssa
authors: A
authors: Indar
authors: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
authors: Maria
authors: M
authors: Maione
authors: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada.
authors: A J
authors: AJ
authors: Lopez
authors: St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
authors: Sue
authors: S
authors: Bookey-Bassett
authors: The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors: Lauren
authors: L
authors: Scavuzzo
mesh_terms: D003299:Cooperative Behavior; D017144:Focus Groups; D006801:Humans; D007373:Interinstitutional Relations; D058436:Knowledge Management; D008611:Mentors; D009936:Organizational Innovation; D019095:Point-of-Care Systems / Q000458:organization & administration / Q000592:standards; D011364:Professional Practice; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*
keywords: Collaboration; Communities of practice; Interorganizational learning; Mentorship; Point-of-care; Quality improvement