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Development of Communities of Practice to Facilitate Quality Improvement Initiatives in Surgical Oncology

Fung-Kee-Fung, Michael MBBS, FRCS; Goubanova, Elena MPA, MEd; Sequeira, Karen BSc, MBA; Abdulla, Arifa BCom; Cook, Rose MHSc; Crossley, Claire CHE, BA, MEd, (PhD); Langer, Bernard OC, MD, FRCSC, FACS; Smith, Andrew J. MD, MSc, FRCSC; Stern, Hartley MD, FRCSC, FACS

Quality Management in Health Care: April-June 2008 - Volume 17 - Issue 2 - p 174–185
doi: 10.1097/

Background The process of developing clinical guidelines and standards for cancer treatment and screening is well established in the Ontario health care system; however, the dissemination and implementation of such guidelines and standards are more recent undertakings. Traditional implementation strategies to improve surgical practice and the delivery of cancer care have not been consistently effective. There is a recognized need to develop integrated models that offer direct support for implementation strategies. Such a model should be feasible, adaptable, and open to evaluation across diverse surgical settings.

Discussion Research suggests that successful implementation should consider tools and expertise from other disciplines. This article considers a community of practice (COP) model to provide a supportive infrastructure for quality improvements in cancer surgery. The COP model was adapted for cancer surgeons. It is supported by 5 enablers referred to as tools: communication system, project development support, access to data, access to evidence review, and accreditation with continued medical education and continued professional development. These tools need to be part of an infrastructure that is both provided and supported by a team of administrators and health care professionals, who have active roles and responsibilities. Therefore, the primary objective of this article is to describe our COP model in cancer surgery including the key success factors necessary for providing the infrastructure and tools. The secondary objective is to offer the integrated COP model as a basis for future research and the evaluation of various collaborative improvement projects.

Summary Building on knowledge management concepts, we identified the 4 essential processes that should be targeted by implementation strategies. A common COP evaluation framework uses the outcomes of 4 knowledge conversion modes—organizational memory, social capital, innovation, and knowledge transfer—as proxies for actual provider and organizational behavior. Insights from different collaborative improvement projects described in a consistent way could inform future research and assist in the collation of systematic reviews on this topic.

Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada (Messrs Fung-Kee-Fung and Stern); and Cancer Care Ontario, Toronto, Ontario, Canada (Messrs Fung-Kee-Fung, Crossley, Langer, Smith, and Stern, and Mss Goubanova, Sequeira, Abdulla, and Cook).

Corresponding Author: Michael Fung-Kee-Fung, MBBS, FRCS, Department of Surgery, University of Ottawa, 501 Smyth Road, 8th Floor, Ottawa, Ontario, Canada K1H 8L6 (

All the authors contributed equally to this work. M.F.K.F. conceived of the study, designed the model, and drafted the manuscript; E.G. participated in sequence alignment and helped draft the manuscript; K.S. participated in study design and coordination; A.A. carried out the study and participated in acquisition, analysis, and interpretation of data; R.C. made substantial contributions to conception and design of the evaluation framework and was involved in revising the manuscript; C.C. made substantial revisions to the manuscript and continues to work with the COP concept on a daily basis; B.L. was involved in revising the manuscript critically for important intellectual content and contributed to the design of the study; and A.J.S. and H.S. made substantial contributions to conception and design of the study.

The authors thank Sue Huckson, Community of Practice Coordinator, National Institute for Clinical Studies, Australia, for sharing her experience in setting COPs in emergency care. (The National Institute of Clinical Studies was established by the Australian government in December 2000. It is a Commonwealth owned company, limited by guarantee. Under the Commonwealth Authorities and Companies Act (1997), the National Institute of Clinical Studies is responsible to the Australian Government through the minister for health and ageing.)

Funding: Cancer Care Ontario is a provincewide cancer agency mandated by the government of Ontario to provide strategic direction and leadership for all components of Ontario's cancer control system. It is funded by the Ministry of Health and Long-Term Care.

The authors declare that they have no competing interests.

©2008Lippincott Williams & Wilkins, Inc.