Thies Kathleen, Angers Meaghan, Schiessl Amanda, Khalid Nashwa, Harding Kasey, Ward Deborah
Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA.
BMJ Open Qual. 2025 Aug 11;14(3):e002972. doi: 10.1136/bmjoq-2024-002972.
Evaluation of learning collaboratives (LC) needs to account for not just outcomes and context, but also the mechanisms participating teams use to implement and normalise new practices. Normalisation process theory (NPT) mechanisms-, , and -were used to do a constant comparison coding of transcripts of weekly calls between team coaches and mentors during a 9-month LC to implement team-based primary care in 13 health centres. Both the positive and negative (eg, lack of ) use of normalising mechanisms, as well as when they occurred over time, were noted. Findings suggest that normalising mechanisms are not linear, but work concurrently in real time, in a recursive fashion and in negative and positive ways. Clarity of purpose () became clearer as teams met regularly, and optimised team relational work and commitment to using a shared quality improvement process (). Similarly, the concurrence of and likely refined each other. It took 3-4 months for most teams to establish sufficient and , and to access actionable data. Nine months was not enough time for some teams to both implement and change using data. A separate analysis indicated that prominent topics of discussion were interactions within the team, its relationship with the larger organisation, and difficulties accessing data and determining its reliability. Teams which experience sufficient positive aspects of normalising mechanisms are able to tolerate the unevenness and negative aspects of normalising change to succeed.
对学习协作组织（LC）的评估不仅需要考虑结果和背景，还需要考虑参与团队用于实施新实践并使其常态化的机制。在一个为期9个月的学习协作组织中，为在13个健康中心实施基于团队的初级保健，运用常态化过程理论（NPT）的机制——协调一致、行动互依、知识共享和意义建构——对团队教练和导师之间每周通话的文字记录进行持续比较编码。记录了常态化机制的积极和消极（如缺乏……）运用情况，以及它们随时间的出现情况。研究结果表明，常态化机制并非线性的，而是实时并行运作，以递归方式，以积极和消极的方式发挥作用。随着团队定期会面，目标清晰度（协调一致）变得更加清晰，优化了团队关系工作以及对使用共享质量改进过程（行动互依）的承诺。同样，知识共享和意义建构的同时出现可能相互完善。大多数团队花了3到4个月的时间来建立足够程度的协调一致和行动互依，并获取可采取行动的数据。九个月的时间对一些团队来说，既不足以实施也不足以利用数据进行变革。另一项分析表明，讨论的突出主题是团队内部的互动、团队与更大组织的关系，以及获取数据和确定其可靠性方面的困难。经历了常态化机制足够多积极方面的团队能够容忍常态化变革的不均衡和消极方面从而取得成功。
