Submitted by: Erika Steibelt (Team Lead for Knowledge Development & Exchange, PTCC), Laura McCammon-Tripp (Research Associate, PTCC) and Christine Stich (Junior Scientist, PTCC)
I Introduction
II Documentation of Practice – sharing practitioners’ experiential knowledge
III Example of a documented practice: the cessation Communities of Practice of the Central West Tobacco Control Area Network
IV Conclusions
I Introduction
With all of the demands on public health practitioners, it can be challenging to assess the relevance of published scientific evidence, and to incorporate and apply this evidence into one’s daily work. Often this evidence lacks important contextual information which is essential to understanding the enablers and barriers to implementing an intervention in a real-world setting. Increasingly a number of agencies engaged in knowledge exchange are seeing the value of harnessing and disseminating practice-based or tacit knowledge, that is, the practical knowledge that is gained through being involved in the planning, implementation, and evaluation of health promotion interventions. This article describes the deliberate efforts that are being made through the Program Training and Consultation Centre’s (PTCC) Learning through Evidence, Action and Reflection Networks (LEARN) project to formally document and share the practical knowledge and expertise of Ontario public health practitioners.
II Documentation of Practice – sharing practitioners’ experiential knowledge
The knowledge development and exchange strategy of the Program Training and Consultation Centre’s Learning through Evidence, Action and Reflection Networks (LEARN) project, is focused on assisting Ontario public health practitioners to share and use research knowledge as well as practice-based knowledge. The LEARN project uses documentation of practice to produce rich descriptions of innovative local public health practices. A multi-method case study approach (Yin, 2003) is used to collect data from several sources, including interviews, direct observations, and archival records. Key informant interviews are conducted with public health practitioners involved with a practice, and documents related to the planning, implementation and evaluation of a practice are collected. Through analysis, key success factors and lessons learned can be identified. Key success factors are defined as aspects of a practice identified as being critical to its success. Lessons learned describe aspects that were less successful and could be improved or issues that could be avoided in future iterations of a practice. These case studies can help other practitioners save time and avoid unnecessary duplication of resources as they provide a guide through the process and help practitioners avoid or overcome barriers that others have encountered. The following provides an example of a documentation that addresses the development of a knowledge exchange structure – a system of tobacco cessation communities of practice – in Central West Ontario.
III Example of a documented practice: the cessation Communities of Practice of the Central West Tobacco Control Area Network
In Ontario, a growing number of communities of practice (CoPs) have brought together public health practitioners, health care professionals and others working in and interested in tobacco cessation. These CoPs are seen as a way to increase community capacity to provide cessation services in order to reduce the burden of tobacco-use.
CoPs are defined as “groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis” (Wenger, McDermott & Snyder, al., 2002, p. 4). Individual members can exchange information and insights, get access to a network that keeps abreast of developments in a field, receive help with challenges, and feel part of a movement. Organizations whose members belong to CoPs benefit by getting more perspectives on solving problems, being able to foresee developments in a field and learning what other organizations are doing which helps to set benchmarks (Wenger et al., 2002).
PTCC learned that tobacco control practitioners were interested in learning how cessation CoPs were being developed, implemented and sustained so they could learn from these experiences when developing their own CoPs. As a result, cessation CoPs within Central West Ontario were selected as a topic for documentation of practice.
A group of six related CoPs in the Central West Tobacco Control Area Network (TCAN) was identified as a case for documentation (The Central West TCAN is one of seven TCANs across the province established by the Ministry of Health Promotion and Sport to implement the Smoke-Free Ontario Strategy.) The group responsible for supporting the development and implementation of the six CoPs is the Central West TCAN’s Cessation Sub-Committee, a working group consisting of tobacco-cessation Public Health Nurses (PHNs), Health Promoters (HPs) and others from the Central West region.The Sub-committee is responsible for planning and implementing cessation related programming and trainings in the region. The purpose of the documentation conducted by PTCC’s LEARN project team was to highlight how these six CoPs were planned, implemented and evaluated, and how they were supported by the Central West TCAN. The documentation also aimed to facilitate the sharing of key success factors from this process to facilitate the process of implementing similar knowledge exchange structures in other regions.
In-person semi-structured key informant interviews were conducted with seven individuals who facilitated or co-facilitated the CoPs, with the Central West TCAN Coordinator, and with a Senior Coordinator, Regional Cessation who works for Smokers’ Helpline and is a member of each of the six CoPs as well as a member of the Central West Cessation Sub-Committee. Documents relevant to the planning, implementation and facilitation of the CoPs were also collected; these documents as well as interview transcripts were analyzed using qualitative analysis software.
Results
Practitioners from Hamilton Public Health Services, Region of Waterloo Public Health and Wellington-Dufferin-Guelph Health Unit had begun work in 2008 to establish CoPs to facilitate knowledge exchange among local practitioners with an interest in cessation. When the Central West TCAN Cessation Sub-Committee began discussing how to engage a variety of stakeholders with an interest in cessation, these practitioners spoke of their experiences with and ideas about cessation CoPs. Recognizing the potential of these cessation CoPs, the Cessation Sub-Committee decided to support the development of four additional CoPs within the region.
Many of the CoPs in the Central West TCAN were informed by Wenger and colleagues’ model of CoP development. Wenger and his colleagues (2002) observed that although CoPs evolve on a continuous basis, there are five typical stages of development: Potential, Coalescing, Maturing, Stewardship, and Transformation, which are described later in the document. The first stage of development, Potential, includes the activities related to planning and developing the CoP. In the Central West TCAN, it was determined that the PHNs and HPs who were members of the Cessation Sub-Committee would take on the role of coordinating the CoPs in their regions. The CoPs were integrated into the Central West TCAN’s annual plan and cessation logic model, and annually each CoP received funding from the TCAN to support some meeting costs and honoraria for guest speakers. In addition, the TCAN provided support for regional trainings and materials, and the Cessation Sub-Committee meetings provided opportunities to those coordinating the CoPs to share learnings and challenges they were facing.
During the second stage of CoP development, Coalescing, the first CoP meetings were planned and held, partnerships and trust began to develop between members, and tools to facilitate communication between members were determined. The first meetings focused on determining the interests of the members so the CoPs could be positioned to provide immediate value. During these meetings, discussions were held on what CoPs were, who should be a member of the CoP, and how frequently the group would meet. A key benefit of participating in CoPs is the ability to share resources and information, therefore having effective ways to communicate between meetings is critical (Wenger et al., 2002). Most Cessation PHNs/HPs found that e-mail was the most effective way to keep members engaged between meetings, though they were careful to ensure that members were not overwhelmed by too many e-mails.
The third and fourth stages of development, Maturing and Stewardship, involved activities related to ensuring the CoPs maintained an evolving, relevant focus, expanding membership, measuring the CoPs’ value, and maintaining the momentum of the CoP. For these CoPs, that meant that in some cases the focus of the CoP shifted to another area of cessation, or broadened to include information on tobacco-use more generally. During this time the Cessation Sub-Committee launched a region-wide campaign called You Can Make It Happen which encourages all health care providers to provide advice to their clients about tobacco use using the 5As approach (Ask, Advise, Assess, Assist, Arrange). The campaign website (youcanmakeithappen.ca) includes contact information for the CoPs, which can support health care providers to implement the 5As. A Central West regional pamphlet about the CoPs was also created to expand membership and can be found on the campaign’s website. The Cessation Sub-Committee also developed and implemented a common evaluation framework, focused primarily on process evaluation. The CoPs have not yet reached the fifth and final transformation stage of CoP development, which signals the end of a CoP or its conversion into a new type of structure
The documentation highlights key success factors from the experiences of planning, implementing and sustaining the six CoPs. Key success factors include: ensuring financial support for the CoPs; sharing the work and experience of planning and facilitating the CoPs (through the Cessation Sub-Committee); allowing for flexibility in the ways and speed in which each CoP grew; and, allowing members of the CoPs to set each CoP’s priorities. Providing local and regional educational events relevant to the learning needs expressed by the CoPs is also important and helps to maximize resources.
Overall, the CoPs were perceived by the Cessation Sub-Committee as being successful and instrumental to building cessation service momentum in Central West Ontario. For more information on the Central West TCAN CoPs, please see the detailed description of the practice as well as other accompanying documents on the PTCC website at: http://www.ptcc-cfc.on.ca/cms/one.aspx?pageId=103889
IV Conclusions
Knowledge exchange methods can help disseminate knowledge gained from public health implementation experience and support capacity building across a system of public health practice. This article illustrates documentation of practice as one approach to knowledge exchange that helps to articulate and share practice-based knowledge so that others can learn from it. The documentation of the processes related to the planning and implementation of the Central West TCAN’s CoPs as well as factors key to their success aims to further exchange valuable practice-based knowledge, and can inform public health practitioners who are interested in developing CoPs in their own regions and on other topics.
The LEARN project also supports province-wide communities of practice (CoPs) to facilitate the exchange of practice-based knowledge and experiences. To learn more, visit us at: http://www.ptcc-cfc.on.ca/learn
The authors would like to thank all the individuals that have taken the time to share their knowledge, experiences and documents for this project:
Andrea Kita, BHSc, Central West TCAN Coordinator
Karen Haughey, RN, Public Health Nurse, Brant County Health Unit
Elisha Krupa, BHSc, RN, BScN, Public Health Nurse, Brant County Health Unit
Tanya Kulnies, Health Promoter, Halton Region Health Department
Lina Hassen BA, MPH (Candidate), Health Promoter, Haldimand-Norfolk Health Unit
Janice Johnston, RN, BScN, Public Health Nurse, Hamilton Public Health Services,
Jennifer Mitton, RN, PhD, Public Health Nurse, Hamilton Public Health Services
Stephanie Hicks, BA, Health Promoter, Niagara Region Public Health
Laurie Nagge, RN, BScN, MHS, Public Health Nurse, Region of Waterloo Public Health
Monica Bennett, Senior Coordinator, Canadian Cancer Society Smokers’ Helpline
Lynn Johnston, RN, BN, Resource Staff, Program Training and Consultation Centre
Key related resources
https://www.ohpe.ca/node/12799
References
Wenger, E., McDermott, R., Snyder, W.M. (2002). A guide to managing knowledge: cultivating communities of practice. Harvard Business School Press: Boston, MA.
Yin, R. K. (2003). Case study research: design and methods. 3rd Edition. Applied Social Research Methods Series, Volume 5. Thousand Oaks: Sage.