Multiprofessional communities of practice in a large-scale healthcareknowledge mobilisation initiative: A qualitative case study of boundary, identity andknowledge sharing

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Abstract

This thesis explores the development of multiprofessional communities of practicewithin the Collaboration for Leadership in Applied Health Research and Care(CLAHRC) for Greater Manchester—a large-scale UK-based healthcare knowledgemobilisation partnership between the University of Manchester and local NHSorganisations. In particular, it examines the role of pre-existing boundaries andidentities in the process of community formation and develops our understanding ofknowledge sharing across multiple interconnected communities of practice.The project deploys a qualitative single embedded case study as its researchmethodology, embracing 45 interviews and 69 hours of direct observationsupplemented by documentary analysis, all of which were undertaken in 2010-2011.Three overlapping implementation contexts within the CLAHRC for GreatManchester are explored, each of them reported in a different empirical paper: (1) amulti-professional community of practice emerging from a specialised project teamdriving an implementation project; (2) multiprofessional communities of practiceoperating within and across primary healthcare settings; and (3) the knowledgemobilisation initiative as a constellation of multiple communities of practice.The key theoretical contribution of this thesis is threefold. First, it demonstrates thata multiprofessional team can develop characteristics typical for a community ofpractice, identifies the mechanisms and consequences of this conversion and arguesthat teams and communities of practice do not need to be seen as mutually exclusiveentities. Second, it introduces a notion of selective permeability of boundaries,whereby boundaries developing around a community of practice enable knowledgeexchange between such a community and certain out-groups while impedingknowledge sharing with others. Finally, it enhances our understanding of large-scaleknowledge mobilisation initiatives as emerging constellations of interconnectedpractices, describes a boundary between the fields of applied health research andresearch implementation and questions the role of implementation as a boundarypractice bridging the real-time gap between the producers and users of research.The main practical contribution of this work is the formulation of a developmentalapproach to communities of practice, which lies midway between the analytical andinstrumental perspectives previously described in the literature and can be beneficialin those cases where strong pre-existing boundaries make the emergence of a newcommunity of practice problematic. This approach calls for the maximal utilisationof existing organic communities and for improving communication within andbetween them rather than attempting to foster a heterogeneous community centredon a time-limited project.

Keyword(s)

CLAHRC; boundary; communities of practice; identity; knowledge mobilisation; multiprofessionality

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