Paediatric Practice Guidelines Collaborative
Milestones and Achievements
September 2011: An Executive Steering Committee was established to develop a draft workplan and identify key stakeholders and partners. Agreement was reached that working with a virtual Community of Practice (CoP) would be a goal. Identification of priority areas for guideline development and individuals to work within a CoP were also identified goals.
"Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. " Wenger E
October 2011: Engagement with the Paediatric Community:
An inaugural meeting was held in Ottawa on October 17, 2011 in conjunction with CAPHC’s Annual Conference to present an overview of the initiative and national program vision, goals and objectives. This meeting was attended by approximately 50 individuals representing decision makers, practitioners, quality leaders, researchers and partner organizations. There was unanimous support for the initiative and the Steering Committee was expanded to include those individuals and organizations who expressed an interest in a leadership role.
October - December 2011:
Developed Terms of Reference and workplan for the next 12 months
Established 2 national working groups to work in collaboration with the national steering committee: A National Workshop Planning Committee , and A Systematic Review Committee.
December 2011 – March 2012:
Initiated and completed a literature review which provided current evidence to support the recommendation of specific methodologies and tools for guideline development and adaptation (i.e. AGREE II tool and ADAPTE Framework). Lack of consistent implementation and evaluation of guidelines and outcome were identified as a barrier to guideline adherence
National collaboration expanded to include Paediatric Outcome Measures Experts, bringing a formal evaluation arm to our National Paediatric Practice Guidelines Collaborative
March – November 2012 :
Systematic Review: Do collaborative models for improving healthcare practices (or CoPs) result in greater compliance to practice change and increased levels of success?
Further synthesis of the literature is being conducted to answer this research question and develop a sustainable framework for this collaborative model,
Results of this review will be presented at the October 2012 workshop (described below) to support the ongoing work and goals of the Collaborative.
October 31 – November 1, 2012 – National Workshop Goals & Objectives:
Provide groundwork to enable the development of a strategy for paediatric practice guidelines: development, implementation and evaluation supported by a Community of Practice;
Build awareness and understanding amongst workshop participants for the:
Rationale for a national clinical practice guideline collaborative specific to paediatrics using examples of other collaborative models;
Multiple development processes and tools being used by various organizations nationally and internationally to help inform the methodology to be incorporated into the national strategy;
Barriers to practice change that limit the ability of organizations to successfully implement and evaluate practice guidelines
Complexities of guideline development and change management processes; and
Importance and varying methods of evaluation and data collection that impact the usage and utility of practice guidelines.
Facilitate generation of the following outputs by participants:
A mechanism to match potential interventions with identified barriers to develop recommendations for interventions to be included in the national strategy;
Identify up to three areas of national interest for guideline development, all with potential for impact at a system-wide level; and
Identify roles and responsibilities of committed organizations for further the work of the collaborative through the continuous development and implementation of the national strategy and through the development of an evaluation framework.
Using the results of a national survey and an exercise at the CAPHC Conference Temperature Check, four areas of national priority for guideline development with potential for impact at a system-wide level were identified at the workshop.
Transition from paediatric to adult care
Management of medically complex children through the continuum of care
It was agreed at the Temperature Check and at the workshop that Family Centred Care should be an overarching philosophy in all of the guideline work and that it was necessary to include families in the entire process.
Clinical Practice Guidelines (CPG) are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (Reference - Institute of Medicine. (1990). Clinical Practice Guidelines: Directions for a New Program, M.J. Field and K.N. Lohr (eds.)).
Guidelines are designed to support the decision-making processes in patient care. The content of a guideline is based on a systematic review of clinical evidence - the main source for evidence-based care. The movement towards evidence-based healthcare has been gaining ground quickly over the past few years, motivated by clinicians, politicians and management concerned about quality, patient safety, efficiencies and costs. CPGs, based on standardized best practice have been shown to be capable of supporting improvements in quality, safety and consistency in healthcare. Successful implementation of practice guidelines will improve quality of care and safety by decreasing inappropriate variation and expediting the application of effective advances to everyday practice.
Communities of Practice
Communities of Practice can be defined as “a type of informal learning organization” according to Wenger’s concept of CoPs. (PMID 19250556) CoPs are established in order to address a certain issue and bring together people from different backgrounds and professions. These people share concerns, problems and a passion about a specific issue. This definition captures the three key elements of CoPs; domain (common concern), community (people who care about the domain), practice (mutual engagement of community members in the activity of the domain).
The concept of CoP is shaped by 3 dimensions. The first one is mutual engagement which describes the social interaction between individuals in order to create a shared meaning. The second dimension is called joint enterprise and refers to the process of people working together towards one goal. Shared repertoire is the third dimension of CoPs and is based on the use of common resources during the process of decision making. (Wenger et al)
Although CoPs are an evolving concept Li et al identified 4 key characteristics; social interaction, knowledge sharing, knowledge creation and identity building.
To summarize CoPs can be described as an innovative model to align interprofessional learning processes and knowledge translation. They are designed to develop a framework for decision making and to determine how these decisions can be implemented in the reality of practice.