This thesis explores the development of multiprofessional communities of practice within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester - a large-scale UK-based healthcare knowledge mobilisation partnership between the University of Manchester and local NHS organisations. In particular, it examines the role of pre-existing boundaries and identities in the process of community formation and develops our understanding of knowledge sharing across multiple interconnected communities of practice. The project deploys a qualitative single embedded case study as its research methodology, embracing 45 interviews and 69 hours of direct observation supplemented by documentary analysis, all of which were undertaken in 2010-2011. Three overlapping implementation contexts within the CLAHRC for Greater Manchester are explored, each of them reported in a different empirical paper: (1) a multi-professional community of practice emerging from a specialised project team driving an implementation project; (2) multiprofessional communities of practice operating within and across primary healthcare settings; and (3) the knowledge mobilisation initiative as a constellation of multiple communities of practice. The key theoretical contribution of this thesis is threefold. First, it demonstrates that a multiprofessional team can develop characteristics typical for a community of practice, identifies the mechanisms and consequences of this conversion and argues that teams and communities of practice do not need to be seen as mutually exclusive entities. Second, it introduces a notion of selective permeability of boundaries, whereby boundaries developing around a community of practice enable knowledge exchange between such a community and certain out-groups while impeding knowledge sharing with others. Finally, it enhances our understanding of large-scale knowledge mobilisation initiatives as emerging constellations of interconnected practices, describes a boundary between the fields of applied health research and research implementation and questions the role of implementation as a boundary practice bridging the real-time gap between the producers and users of research. The main practical contribution of this work is the formulation of a developmental approach to communities of practice, which lies midway between the analytical and instrumental perspectives previously described in the literature and can be beneficial in those cases where strong pre-existing boundaries make the emergence of a new community of practice problematic. This approach calls for the maximal utilisation of existing organic communities and for improving communication within and between them rather than attempting to foster a heterogeneous community centred on a time-limited project.

Made available in DSpace on 2015-05-14T13:24:19Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1142016 bytes, checksum: adbc38744f22e7f7675885e4aafef615 (MD5) Previous issue date: 2010-12-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The constant quest for realization of the right to health care is experienced by many professionals that guide their work practices through the blueprint of the SUS. The practice has demonstrated multi-configure itself as an important strategy to guarantee the principle of comprehensiveness. That is to enable the user of SUS means necessary so that they get full assistance it requires, at all levels of system complexity and scope of his life. The training of professionals committed to the NHS and prepared to actualize new knowledge and technologies in this system has become vital to maintaining that system. The present study examined the process of forming the Multidisciplinary Residency in Family and Community Health, linked to the Center for Public Health Research at the Federal University of Paraíba, trying to analyze how residents are experiencing a multidisciplinary practice in primary care and multidisciplinary practices which are being constructed in the process of formation. It was a field research, exploratory, with a theoretical foundation of the Marxist dialectic, conducted through literature search and questionnaire distributed to residents of the professional program available. We conclude that the RMSFC emerged as a privileged space for building new multi-practice interventions that are helping to change attitudes of professionals and consolidating multiprofessionality while a new strategic direction of the work process in health services, especially the health units of the family which residents are inserted. / A constante busca pela efetivação do direito ao cuidado em saúde é vivenciada por muitos profissionais que norteiam suas práticas profissionais por meio das diretrizes do SUS. A prática multiprofissional vem demonstrando se configurar como uma importante estratégia de garantia do princípio da integralidade. Que consiste em viabilizar ao usuário do SUS os meios necessários para que estes tenham a assistência integral que demandam, em todos os níveis de complexidade do sistema e na amplitude de sua vida. A formação de profissionais comprometidos com o SUS e preparados para efetivarem novos saberes e tecnologias nesse sistema tem se tornado vital para a manutenção desse sistema. O presente estudo analisou o processo de formação da Residência Multiprofissional em Saúde da Família e Comunidade, vinculada ao Núcleo de Estudos em Saúde Coletiva da Universidade Federal da Paraíba, buscando analisar como os residentes estão vivenciando a prática multiprofissional na Atenção Básica e quais práticas multiprofissionais estão sendo construídas nesse processo de formação. Tratou-se de uma pesquisa de campo, exploratória, com aporte teórico da dialética marxista, realizada por meio de pesquisa bibliográfica e questionário dirigido aos profissionais residentes do programa estudado. Conclui-se que a RMSFC surge enquanto um espaço privilegiado de construção de novas práticas de intervenção multiprofissional, que estão contribuindo para a mudança de posturas profissionais e consolidando a multiprofissionalidade enquanto uma nova estratégia de direcionamento do processo de trabalho nos serviços de saúde, em especial as nas unidades de saúde da família as quais os residentes estão inseridos.