2013 National Health Leadership Conference...Benne, K.D., & Sheats, P. (1948). Functional roles of group members. Journal of Social Issues, 4, 41-49. The Minnesota Innovation Research

Mobilizing system change through communities of practice

James Conklin, Bruyère Research Institute & Concordia University Anita Kothari, Western University Shannon Sibbald, Western University Martha McKeen, Bruyère Research Institute

2013 National Health Leadership Conference

The “Knowledge-to-Action Processes in

SHRTN Collaborative Communities of

Practice” research program is supported by

the Canadian Institutes of Health Research.

www.cihr-irsc.gc.ca

2 Conklin, Kothari, Sibbald & McKeen

http://www.cihr-irsc.gc.ca/



We will briefly cover

• The investigation, its purpose and methods

• What happened, with emphasis on the CoP as a temporary context to promote transformation, and the leadership roles that we observed

• Some conclusions

Conklin, Kothari & Stolee 3

THE INVESTIGATION AND METHODS


Knowledge-to-Action Processes in SHRTN Collaborative Communities of Practice

• Three year, multiple case study design

• Aims to increase our understanding of KTA processes mobilized through communities of practice (CoPs) working to improve the health of Ontario seniors

• CoPs are situated within the SHRTN Collaborative

– SHRTN Knowledge Exchange

– Alzheimer Knowledge Exchange


Research Questions 1. Knowledge-to-action processes:

a. What KTA processes are initiated through the CoPs? b. How well do the three dimensions (evidence, context, and

facilitation) proposed in the Promoting Action on Research Implementation in Health Services (PARIHS) framework describe the emergent patterns of knowledge flow?

c. To what extent does KTA involve an interaction between explicit knowledge and tacit knowledge?

2. The role of human agents: a. What roles are evident among those who participate in

these processes? b. How does the active involvement of knowledge users in the

KTA process influence knowledge utilization? c. What factors support or hinder effective involvement in KTA

processes?


One of the First-Year Case Studies

The Mental Health, Addictions and Behavioural Issues Community of Practice

which in 2011 was undertaking an initiative to improve the treatment of seniors exhibiting responsive behaviours

The Behavioural Support Systems Learning Collaborative Case Study


The case involved

• Provincial leaders, regional leaders, local participants

• Planning meetings to design and mobilize the activities for the year

• “Local Conversations” at which all leaders and participants worked together through a facilitated dialogue

• Follow-up reporting and discussions


Methods

• Observations and interviews

• Directed and emergent coding

• Clustering themes

• Construction of a model of the system dynamics evident in the case


WHAT HAPPENED


Provincial Leaders

Regional Leaders

Regional Participants

SHRTN Knowledge Exchange

Alzheimer Knowledge Exchange

Mental Health, Addictions and Behavioural Issues Community of Practice

Transforming a Complex Social and Technical System

Ministry of Health

Fourteen Local Health Integration Networks

Other networks and initiatives operating provincially or regionally

Local practices

Institutions and organizations

Regional and local service delivery programs


To transform a complex social system, leaders must first transform existing mindsets and assumptions.


“It is about …pulling ourselves together to learn how to work together and ..., in the course of doing the work that we are doing, ...we are learning to work together which is ultimately going to strengthen the system that we create ... through our own experience. And the upshot of that will be that clients that we serve who have responsive behaviours will get a seamless experience and ... better quality of care.”

Community of Practice leader



Leadership was not about being in charge, making all decisions, telling people what to do, coming up with the vision, holding people accountable.

Leadership was about bringing people together, asking them what mattered, finding out what worked, creating pathways to relevant evidence, and designing sensemaking forums that allowed for innovation.

Developing teams and coalitions

• Provincial leaders reached out to regional leaders, who then recruited local leaders.

• When possible, links were created with the LHINs.

• QI Science experts from Health Quality Ontario provided advice and techniques.

• The initiative brought together policy makers, clinicians, researchers, educators.


Mobilizing knowledge

• Multiple sources and types of knowledge: research knowledge, clinical experience patient experience, QI science, implementation science.

• Mobilized through interaction and participation.

• Local conversations held across the province.

• Knowledge flow was not in a single, linear direction from experts to frontline practitioners, but rather was multidirectional, flowing to and from policy makers, health workers, research scientists, and people directly affected by dementia (patients and their families).


Transforming the way people think and act

• Action Science: organizational learning and change depend on the ways in which people think and act.

• To change a human system, change the way people think (beliefs, intentions, values) and act.

• Knowledge in BSS was used to change how policy makers, health care workers, and people living with dementia and their families think and act in relation to this condition.


Argyris, C., Putnam, R., & Smith, D.M. (1985). Action science. San Francisco: Jossey-Bass.

Community of Practice as Temporary Context

• A planning process that linked provincial, regional, and local leaders.

• An intervention—the local conversations—that offered structure and support, as well as autonomy and empowerment.

• The CoP as a context where leaders reframed complex issues, developed innovative approaches, and broadened their coalition.


Prominent Leadership Roles • Championing the initiative: early adopters of and

“missionaries” for new approaches; people of integrity; thought leaders in dementia care; willing to help sell BSS in their regions; proactive; keen; knew how to overcome adversity well-connected in the worlds of policy and practice.

• Empowering others: encouraged participants to take ownership of the work; showed understanding of local constraints and challenges; empowered participants with perspectives and techniques needed to implement change; often stated that regional participants are free to tailor the initiative to meet local needs.


Prominent Leadership Roles (cont.)

• Facilitator: Leaders talked about playing a facilitation role in the overall initiative; specific facilitation activities (e.g. clustering and naming activity during the VOC exercise); framing a conversation, providing terminology to aid in sensemaking; helping participants to understand and use techniques; capacity building and network building.

• System integrator: Leaders encouraged participants to share experiences and perspectives, so people became aware of differences; revealed silos, duplication and overlap; integrated initiative activities (e.g. Framework for Care document).


Prominent Leadership Roles (cont.)

• Emergent opportunist: Leaders did not try to predict and control; co-discovery and co-design; BSS initiative was a broad framework, and participants were open to emerging possibilities and alternatives.

• Benne & Sheats (1948) observational framework of eleven task-related roles, five group maintenance roles, and three individual (non-functional) roles. During meetings and discussions numerous interpersonal roles were evident: elaborator, initiator-contributor, collaborator, empowerer, information seeker, opinion seeker, information-giver, coordinator, energizer, encourager, including others, gatekeeper/expeditor, opinion-giver, compromiser.

Conklin, Kothari & Stolee 21 Benne, K.D., & Sheats, P. (1948). Functional roles of group members. Journal of Social Issues, 4, 41-49.

The Minnesota Innovation Research Program found that the implementation of

innovation succeeds when:

• “(1) the adopting organization modifies and adapts the innovation to its local situation

• (2) top management is extensively involved and commits resources to innovation adoption, and

• (3) process facilitators help people understand and apply the new innovation" (p. 56).


Van de Ven, A.H., Polley, D.E., Garud, R., & Venkataraman, S. (1999). The innovation journey. Oxford: Oxford University Press.

CONCLUSIONS


System transformation depends on creating social

forums that are suited to cultivating new ways of

thinking about intractable issues. CoPs, with their

ability to foster dialogical processes and social

learning, can be well-suited to this purpose.


“From rhetoric to action” (the conference slogan) may imply that we want to move from mere talk and shift into action.

This case suggests that certain forms of talk (the local conversations) can create the shared intentionality needed to bring about system-wide change.


Today

• The transformation continues

• Behavioural Supports Ontario (BSO)

– http://www.akeresourcecentre.org/BSO

– “by working together we can reinvent the system of care for seniors across Ontario, their families and caregivers who live and cope with responsive behaviours associated with dementia, mental illness, addictions and other neurological conditions”

– “a cultural transformation that has enabled new ways of thinking, acting and behaving”


http://www.akeresourcecentre.org/BSO

James Conklin

[email protected]


Documents

2013 National Health Leadership Conference...Benne, K.D., & Sheats, P. (1948). Functional roles of group members. Journal of Social Issues, 4, 41-49. The Minnesota Innovation Research