Article Text

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic
  1. Vikram Datta1,
  2. Sushil Srivastava2,
  3. Komal Lalwani3,
  4. Rahul Garde3,
  5. Suprabha K Patnaik4,
  6. Praveen Venkatagiri5,
  7. Jeena Pradeep6,7,
  8. Vidhyadhar Bangal8,9,
  9. Harish Pemde10,
  10. Achala Kumar6,
  11. Ankur Sooden11,
  12. Shreeja Vijayan12,
  13. Kedar Sawleshwarkar13,
  14. Rajesh Mehta14,
  15. Neena Raina15,
  16. Rajesh Khanna15,
  17. Vivek Singh16,
  18. Priyanka Singh16,
  19. Khushboo Saha17,
  20. Chhavi Sharma7,
  21. Sonam Jain3
  1. 1Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
  2. 2Pediatrics, University College of Medical Sciences, New Delhi, Delhi, India
  3. 3Quality Improvement, NQOCN, New Delhi, Delhi, India
  4. 4Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
  5. 5Neonatology, Chinmaya Mission Hospital, Bangalore, Karnataka, India
  6. 6Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
  7. 7Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
  8. 8Obstetrics and Gynaecology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
  9. 9Centre for Social Medicine, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
  10. 10Paediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
  11. 11Private Sector Engagement, JSI India, New Delhi, Delhi, India
  12. 12Child Health Nursing, Choithram College of Nursing and Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
  13. 13NICU, Deogiri Childrens Hospital, Aurangabad, Maharashtra, India
  14. 14WHO Consultant, New Delhi, Delhi, India
  15. 15World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
  16. 16Health Section, UNICEF India, New Delhi, Delhi, India
  17. 17The University of Texas Southwestern Medical Center at Dallas Library, Dallas, Texas, USA
  1. Correspondence to Professor Vikram Datta; drvikramdatta{at}gmail.com

Abstract

Introduction Ensuring quality of care in Low and Middle Income countries (LMICs) is challenging. Despite the implementation of various quality improvement (QI) initiatives in public and private sectors, the sustenance of improvements continues to be a major challenge. A team of healthcare professionals in India developed a digital community of practice (dCoP) focusing on QI which now has global footprints.

Methodology The dCoP was conceptualised as a multitiered structure and is operational online at www.nqocncop.org from August 2020 onwards. The platform hosts various activities related to the quality of care, including the development of new products, and involves different cadres of healthcare professionals from primary to tertiary care settings. The platform uses tracking indicators, including the cost of sustaining the dCoP to monitor the performance of the dCoP.

Result Since its launch in 2020, dCoP has conducted over 130 activities using 13 tools with 25 940 registration and 13 681 participants. From April 2021, it has expanded to countries across the South-East Asia region and currently has participants from 53 countries across five continents. It has developed 20 products in four thematic areas for a targeted audience. dCoP is supporting mentoring of healthcare professionals from five countries in the South-East Asia region in their improvement journey. Acquiring new knowledge and improvement in their daily clinical practice has been reported by 93% and 80% of participants, respectively. The dCoP and its partners have facilitated the publication of nearly 40 articles in international journals.

Conclusion This dCoP platform has become a repository of knowledge for healthcare professionals in the South-East Asia region. The current paper summarises the journey of this innovative dCoP in an LMIC setting for a wider global audience.

  • Implementation science
  • Quality improvement
  • Practice-based research network
  • Collaborative, breakthrough groups
  • Health professions education

Data availability statement

Data are available upon reasonable request. All relevant data are available upon reasonable request from the corresponding author and also available as online supplementary material.

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WHAT IS ALREADY KNOWN ABOUT THIS TOPIC

  • Community of practice (CoP) is a well-known mechanism to bring together like-minded professionals to share their experience of improving patient care using local innovations.

  • Sustaining the interest and motivation of participants over longer periods of time in CoP activities is challenging.

  • The exact operational process and costs for sustaining a CoP vary according to the health system in which it operates.

WHAT THIS STUDY ADDS

  • The study adds to the existing literature on CoP with a new perspective on the process of conceptualising and sustaining a CoP and its operational mechanisms especially amidst an ongoing pandemic in a Low and Middle Income country (LMIC) setting.

  • The study adds a preliminary analysis of financing of a CoP and how this supports the spectrum of activities required to sustain a CoP.

  • The study uniquely focuses on a simplified methodology of quality improvement implementation (Point of Care Quality Improvement) as a main driver for the creation and sustenance of the CoP.

  • This study also adds an element of impact assessment of the CoP using innovative measurement tools, which are being used for the first time in CoP in the South-East Asia setting.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • This study can help policymakers, programme managers and healthcare professionals alike to help develop a CoP as a cost-effective, formal or informal network for sharing and enriching local innovative practices to ensure safe and quality care for the community.

Introduction

India’s health sector has undergone transformative changes in the healthcare delivery system in recent years, focusing on improving quality to fulfil Sustainable Development Goals (SDG) goals. Assuring quality in a vast country like India is challenging as there is a considerable variation in terms of population, literacy, socioeconomic status and other health determinants. Quality improvement (QI) initiatives across the South-East Asian region are in the early stages of evolution, and there is a lack of focus on system-wide implementation.1 It is documented that poor quality of care is a major contributor to mortality compared with lack of access to care.2 This fact clearly outlines the need for incorporating a quality-centric approach in our health systems on an ongoing basis. India has embarked on a mission to achieve the global SDG/ENAP (Every Newborn Action Plan) targets by 2030 by specifically addressing the five intervention pillars of ENAP and including an additional pillar of care beyond survival. A major focus has been on interventions focusing on the quality of care to achieve the aforementioned goals.3

With the onset of the COVID-19 pandemic and ensuing travel restrictions, ongoing onsite clinical mentoring and capacity building undertaken by NQOCN were severely disrupted. This led to the loss of connection between the mentors and the peripheral teams. There was a risk of losing the gains achieved after years of hard work. With no immediate end to the pandemic in sight, NQOCN started to explore innovative means to establish reconnect between the facility teams and the national mentors. Within 3 months of the pandemic-led disruptions in travel, NQOCN conceptualised and launched an online point of care quality improvement (POCQI) community of practice (CoP).1

This narrative aims to recount the journey of the digital community of practice (dCoP), informing readers about the steps taken to initiate and maintain the CoP. Additionally, with nearly 3 years of continuous operation, this paper includes a section discussing the impact of the community using novel measurement metrics.

Methodology

We describe the results from our dCoP, which is focused on POCQI across the South-East Asia Region of the WHO. The CoP was launched in August 2020 and is currently operational in digital mode at the web address www.nqocncop.org. It has its digital footprints in 53 countries across five continents.

Process of establishing the dCoP

The dCoP was designed to unite people with various backgrounds, expertise and resources in QI. A team of 14 members from across India was selected to create a guiding document. This group thoroughly reviewed current guidelines, models and literature on CoP formation through multiple meetings. They then prepared a draft charter, which was reviewed by supporting partners and experts in the field. The finalised CoP charter outlined the mission, objectives, roles, responsibilities, membership criteria, partnerships, organisational structure and risk management strategies. This charter can be found online at www.nqocncop.org.

The dCoP was created with the goal of forming an inclusive platform that encourages interactive learning among individuals, facilities, stakeholders and government agencies to enhance healthcare quality. To accomplish this, the dCoP set the following objectives:

  • Collaborate to improve healthcare that is safe, effective, patient-centred, efficient, timely and fair.

  • Bring together local, national and international QI experts on one platform.

  • Establish a collection of research documents, guidelines and innovations related to POCQI and QI.

  • Foster a culture of QI and support health system strengthening in a country.

  • Offer a safe and positive environment for brainstorming, developing and implementing innovative QI initiatives that result in meaningful change.

  • Discover and nurture talented and promising QI practitioners.

The dCoP was developed as a multitiered structure (figure 1). It has an internal tier consisting of internal stakeholders (layer 1), a middle tier consisting of the participating community (layer 2) and an outermost tier consisting of supporting partners and external stakeholders (layer 3). The internal stakeholders were referred to as the core group and were responsible for the orderly conduction of the technical and operational activities of the dCoP. The external stakeholders included experts, dCoP members, media, advocacy groups, funding partners and governmental and international agencies.

Figure 1

Structure and operational mechanism of the NQOCN digital community of practice. CoP, community of practice; dCoP, digital community of practice; POCQI, point of care quality improvement.

The dCoP web platform, found at www.nqocncop.org, was created by a young college student. This online platform acts as a central hub for members to participate in dCoP events, access informational resources and network with others. Much of the content on the website is openly accessible, which encourages wider involvement and allows for sharing among various teams

The functional structure of the dCoP comprises five interconnected components (figure 1). At the heart of the system lies the dynamic, three-tiered dCoP, which is bolstered by a network of engaged stakeholders and partners. Periodically scheduled activities are organised for local and regional participants, ensuring consistent involvement. Internal stakeholders perform adaptive measures to tailor the functional mechanisms and content to the community’s requirements, utilising active feedback and monitoring processes.

Activities

The dCoP conducts activities for all cadres of healthcare workers and the community. The dCoP activities include webinars, workshops, in-person meetings, podcasts, blogs and recorded sessions (details shown in table 1). It also actively supports two young professional networks of medical and nursing undergraduate students through capacity building, handholding, experience sharing and publications4

Table 1

List of tools used by dCoP to conduct its activities and engage with the participants

Data handling process

The dCoP manages various types of data, including information on its size and reach, participant backgrounds, engagement, activities, feedback from participants and mentors, online course data, CoP and QI project-related data and financial data. Specifics about the different indicators used by the dCoP can be found in the online supplemental appendix A.

Supplemental material

Impact assessment of dCoP

(A) The dCoP performance and impact are assessed using a set of indicators pertaining to various aspects of the dCoP (table 2).

Table 2

Indicators tracked to assess the impact of dCoP

(B) Products developed: from the beginning of the dCoP, the team has focused on creating 20 products across four key areas: online collaboration platforms, development of online QI workshops, creation of online courses, development of QI resources and documentation and dissemination of learnings from the South-East Asia region. Further details can be found in online supplemental appendix B. NQOCN has published numerous original articles and QI reports that have the potential to be replicated and some of these were developed with technical assistance from BMJ Open Quality and financial support from UNICEF India . These are described in detail in table 3.

Table 3

List of published QI initiatives with translational potential by network facilities of the dCoP

(C) Expenses for conceptualising, launching and maintaining the dCoP: the dCoP documents the costs associated with its sustainability since its inception in 2020. A breakdown of financial utilisation is presented in table 4.

Table 4

Financial utilisation breakup

Patient involvement

No patients were involved in this work as the study focused on developing and sustaining the regional CoP for QI. Similarly, no patients were involved in developing the research questions, surveys, measurement indicators and study conduct.

Results

Following the establishment of the dCoP in 2020, it has sought to unite state, national and international QI experts on a shared platform. The dCoP has a presence across five continents, with significant representation in the South-East Asia region. Operating consistently since August 2020, the dCoP has been active for the past 32 months. It conducts different types of activities to keep its participants engaged and since its inception has conducted more than 130 activities, as shown in table 2. Through these activities, over the last 128 weeks, the dCoP has generated over 500 hours of content. To evaluate its performance and assess the real-time impact of its sessions, the dCoP employs various indicators, which include automated metrics built into the platform and additional data gathered through individual feedback mechanisms.

General trackers

Participant demographics

The majority (54.7%) of the participants belong to the age group of 46–65 years, followed by the 26–45 years age group (43.4%). The dCoP includes all healthcare professional cadres, ranging from frontline healthcare workers such as ANMs and ASHAs, medical professionals, management professionals, medical doctors, nurses and medical and nursing students.

Geographical reach

Due to the overwhelming response from the community, the dCoP expanded in April 2021 to become a Regional POCQI CoP for healthcare workers throughout the South Asia region. With this expansion, the platform has hosted numerous inter-country sessions focusing on neonatal and maternal health topics, particularly during the pandemic. QI experts from the Maldives, Bangladesh, Bhutan, Canada, the USA, Dubai, Qatar and the UK have participated. The dCoP has supported capacity-building for country teams from the Maldives and facilitated experience-sharing sessions with teams from Bangladesh and Bhutan. Moreover, coaching and basic POCQI workshops were conducted for teams from Indonesia, Sri Lanka and Nepal. Currently, the dCoP maintains a virtual presence in 53 countries across five continents. Further details can be found in online supplemental appendix C.

Digital platform trackers

The platform attracts more than 12 000 visitors (average) from around the world each year, with 42% accessing the dCoP website directly, 51% being redirected from Google and 4% coming from Twitter. The majority of participants (54%) use mobile phones to view the content available on the platform.

Since its inception, dCoP has held approximately one activity per week. These events have received around 25 000 registrations from across the globe. Out of these registrants, about 50% or over 13 000 participants have attended the dCoP activities, resulting in a 2:1 ratio of attendees to registrants—meaning that for every two registrations, one participant joined the sessions. In the 32 months since the dCoP’s launch, the network has developed a group of over 240 national QI mentors who have conducted online QI training and consistent mentoring sessions with field teams throughout the region. Additionally, about 300 subject matter experts have shared their knowledge with online participants during this time.

Participant feedback metrics

Participant feedback is collected in real-time and automatically incorporated into the ‘CoP Dashboard’, which can be accessed through the CoP website (www.nqocncop.org).

Based on the feedback received, 93% of participants reported gaining new knowledge from the online webinars and over 80% applied the insights and learnings from the sessions to their daily clinical work. They also connected with other healthcare workers, policy leaders and programme managers. The sessions were found to be helpful in various areas, such as enhancing team communication (66.3%), improving clinical outcomes (54.9%), fostering better patient communication (47.8%), facilitating more effective communication with senior administration (36.4%) and implementing broader and more complex QI projects (29.9%).

Social media indicators

Since April 2021, dCoP has been actively engaging with a broader global audience through social media platforms such as Twitter, Facebook, Instagram, LinkedIn and YouTube to connect with more potential members. The dCoP consistently posts updates on these channels to promote events, interact with followers and offer an enriched experience for quality teams and individuals seeking fundamental and advanced knowledge related to QI.

Dashboard

A dashboard has been implemented on the dCoP platform, allowing for the real-time updating of event data, registered participants and attendees. This feature promotes transparency by showcasing the platform’s progress. Participant feedback has also been integrated into the dashboard to assess the impact of the sessions and make improvements based on participants’ suggestions.

QI initiatives with translational potential

Over the past 32 months, the dCoP has published articles on various QI initiatives from throughout the region. Some of the findings from these articles can be easily adapted by clinical teams in their local settings. A selection of these initiatives, along with their translational potential, is provided in table 3.

Cost of developing and sustaining the dCoP

The dCoP activities have received support from WHO-SEARO, UNICEF India and other development partners, with a total of $290 954 in funding since its inception in August 2020.

To estimate the cost of establishing the CoP, the costs incurred during each of the two phases were calculated, as detailed in table 4. Based on the overall costs incurred, our preliminary analysis indicates that the initial phase of dCoP development necessitated substantial resource allocation and financial support. During this phase, the average monthly costs for operating the dCoP amounted to $14 600. In the subsequent sustenance and maintenance phase of the CoP, the average monthly cost was reduced to $8000.

Discussion

A CoP in healthcare is a group of individuals who share a common interest or passion for a particular healthcare area and come together to collaborate, learn and share knowledge and the best practices. Members of a CoP typically have a shared goal or purpose, and they engage in ongoing conversations and activities related to their area of interest.5

In healthcare, CoPs can exist among a variety of groups, such as clinicians, researchers, administrators, or patients and their families. CoPs can be informal or formal, and they can take many different forms, including online forums, regular meetings or ongoing projects.6

In this paper, we share our experience of creating and maintaining a dCoP for POCQI across South-East Asia. In the context of a resource-constrained setting, we faced unique challenges in establishing and sustaining the community, particularly during the COVID-19 pandemic for over 32 months.

Building on the original concept of CoP by Lave and Wenger,7 we aimed to create a digital platform for POCQI professionals to share experiences, exchange ideas and collaborate on QI initiatives. Our experience sheds light on the potential of dCoPs to overcome geographical and resource barriers, especially in the context of a pandemic. By sharing our challenges and successes in establishing and maintaining the community, we hope to inform other healthcare professionals seeking to create similar communities in their own settings. Our dCoP has a global footprint in 53 countries across five continents. It has over 13 000 participants to date and has generated nearly 40 international peer-reviewed publications using the POCQI method. The results of this work helped 93% of the dCoP participants acquire new knowledge and were reported to be useful for 80% in their day-to-day clinical work.

The operational process of our dCoP is similar to other contemporary CoPs like the Institute for Healthcare Improvement (IHI) Open School.8 The Open School provides online courses and resources focused on QI, patient safety and leadership. The community includes students, healthcare professionals and educators worldwide. The Open School offers a variety of resources, such as case studies, webinars and discussion forums, to help members develop their skills and knowledge in these areas.

The Quality-of-Care Network9 is an initiative jointly supported by WHO, UNICEF and UNFPA that aims to build and strengthen national institutions and mechanisms to improve the quality of care centred around mothers and newborns. Currently, it is present in 11 countries worldwide including Bangladesh and India from Asia, and another 11 countries would be joining it soon including Bhutan, Maldives, Sri Lanka, Indonesia, Myanmar and Timor Leste from the South-East Asia region. It has extensively cited the work of NQOCN and its CoP on its platform10

In addition to these examples, there are many speciality-specific dCoPs in healthcare. For example, the Society of Hospital Medicine operates a dCoP called the Hospital Medicine Exchange (HMX).11 HMX allows hospitalists to discuss their experiences and share best practices related to hospital medicine. The community includes over 20 000 members and offers a variety of resources, such as discussion forums, webinars and podcasts.

The other prominent global CoPs, like IHI, are interdisciplinary platforms focusing on improving healthcare quality and patient safety outcomes using initiatives like ‘Triple Aim strategy’12 and incorporating IT in healthcare delivery. Along with this, notable government initiatives like the Agency for Healthcare Research and Quality13 provide various tools and resources like the ‘Hospital Survey on Patient Safety Culture’ and the ‘Patient Safety Indicators’ to help healthcare organisations improve the quality of care. Our dCoP was created with a similar objective as a national interdisciplinary platform for facilitating interactive learning between various individuals, facilities, stakeholders and government agencies to improve healthcare quality and promote evidence-based practices. Being a digital platform, it leveraged technology to connect its members and foster collaboration, thus allowing for greater access to resources and knowledge sharing, as evidenced by its evolving presence in the South Asian Region.

USAID report on Health Communication Capacity Collaborative14 on maintaining a CoP mentions that at least one face-to-face and four virtual events a year are required to sustain a CoP. Based on these recommendations, our dCoP has conducted >1 activity per week and organised multiple workshops and an in-person conference in a year to maintain and sustain the dCoP for the past 2 years. Based on our experience of developing and operating the dCoP, it offers a promising way to drive system-level changes in a healthcare system. It does so by focusing on empowering healthcare professionals (HCPs), especially the frontline workers, and expanding the space for exchanging ideas on improving care in various settings within a health system.

Our analysis of the platform’s impact on various QI initiatives revealed several notable successes. These include reduced late-onset neonatal sepsis rates,15 improved adherence to infection control practices16 and enhanced team communication and collaboration across various health facilities. Other outcomes which have been reported and published in contemporary literature by members of the CoP are increasing adherence to the use of e-partograph,17 improving donor human milk collection,18 development of an antibiotic stewardship programme,19 use of sucrose analgesia in NICU20 and pre-identification of high-risk pregnancies.21 These outcomes not only demonstrate the potential of the dCoP platform to drive meaningful change in clinical practice but also highlight the importance of nurturing a culture of continuous learning and improvement among healthcare professionals.

Despite the platform’s positive impact, several challenges and limitations emerged during the implementation process. Common challenges included technical difficulties with online software, limited access to reliable internet connections and the ongoing need for user training and support in conducting mentoring sessions. To address these issues, the dCoP platform adopted a user-centred design approach, integrating feedback from its members to make iterative improvements and enhance user satisfaction. A real-time CoP dashboard is available for users worldwide, showcasing the scale and scope of activities and benefits for healthcare workers. The dashboard can be accessed through the following link: https://tinyurl.com/nqocn-dashboard.

The central challenges faced by various communities of practice include accommodating diverse levels of expertise, encouraging participation from less experienced members and addressing concerns about revealing knowledge gaps.22 To overcome these challenges, the dCoP features and rotates speakers from various healthcare professional cadres. This approach facilitates knowledge sharing, accommodates a range of experiences and emphasises the importance of effective collaborations in delivering high-quality healthcare services.

A significant barrier in the functioning and sustenance of CoPs, as identified by Terry and Nguyen, is addressing feelings of alienation, marginalisation, frustration and work pressure,23 particularly among novice nurses and students. These feelings can further impact their full participation, hindering successful CoP sustenance. To address this issue, NQOCN collaborated with a group of medical and nursing undergraduate students, supporting the creation of the ‘Be the Change’ group. This initiative aimed to facilitate active participation and representation of the future generation of healthcare workers in QI projects, capacity building and knowledge sharing. The framework of collaboration with an autonomous, student-led group proved effective in overcoming the aforementioned barrier.

Other studies have highlighted that sufficient funding and proper allocation of funds are crucial factors in sustaining a CoP.24 Since its inception, our dCoP has received financial support from UN agencies such as WHO and UNICEF. To promote transparency and ensure the effective use of funds for various platform activities, the organisation’s governing board makes decisions based on mutual agreement. The adoption of digital tools and an online platform has led to cost reductions, contributing to the dCoP’s enhanced sustainability. A detailed comparison of our dCoP with other contemporary CoPs can be found in online supplemental appendix E.

As we progress, the dCoP for QI aims to make a significant impact by extending its reach to all South-East Asian countries and enhancing the QI expertise within the existing health workforce. It is crucial to emphasise that QI is a multifaceted and intricate process involving healthcare systems, patients, families, communities and broader society. In light of this, the dCoP will concentrate on the ecological aspects of quality and the multidimensional model of QI.25 The ultimate objective is to establish and promote a network of QI-proficient healthcare professionals within health systems, supporting them with a comprehensive repository of research documents and knowledge products to maintain a culture of QI in their local environments. The dCoP remains committed to providing a psychologically safe and positive environment for brainstorming, developing and implementing innovative QI initiatives that lead to meaningful change.

In conclusion, the dCoP for QI has made significant strides in bringing together healthcare professionals, experts and stakeholders from diverse backgrounds to create a platform for collaborative learning and improvement in healthcare quality. By leveraging digital technologies, the dCoP has overcome geographical barriers, enabling the exchange of knowledge and resources across a vast network of participants.

Despite the challenges faced in its implementation, the dCoP has successfully adapted and evolved to meet the needs of its members, fostering a safe and positive environment for innovation and the development of QI initiatives. The platform’s transparency, funding support and continuous user-driven improvements have contributed to its sustainability and impact.

As the dCoP moves forward, its focus on expanding its reach within the South-East Asian region and further promoting a culture of QI will be crucial in achieving its goal of creating a robust network of QI-proficient healthcare professionals. This network, supported by a wealth of research and knowledge products, will ultimately lead to meaningful and lasting changes in healthcare systems, benefiting patients and communities at large.

Data availability statement

Data are available upon reasonable request. All relevant data are available upon reasonable request from the corresponding author and also available as online supplementary material.

Ethics statements

Patient consent for publication

Ethics approval

Not applicable.

Acknowledgments

We would like to thank the following organisation and persons for their invaluable support in making this Community of Practice a reality and helping us in preparing this manuscript. We thank WHO South-East Asia Regional Office and UNICEF India for financially supporting our digital Community of Practice and its activities since its inception. ISQua, URC, Oxford University Hospitals (UK), 3M, MGIMS and Aastrika Foundation for providing technical support to the digital Community of Practice. Ministry of Health and Family Welfare, Govt. of India and various State National Health Missions for facilitating our work in different states of India. Quality of Care Network (QoC) and Global Learning Lab WHO for appreciating our work and publishing it for global reach. ‘Be The Change’ group—a medical and nursing students’ network for their hard work in improving the quality of students’ lives using quality improvement. Mr Varun Datta for his outstanding work in designing the dCoP platform. MOH Maldives and its QARD division for collaborating with our platform towards the cause of quality and capacity-build for the healthcare professionals of their country. Our special thanks to Ms Thasleema Usman, Commissioner QARD, for facilitating this collaboration. Dr Bani Singh for supporting the charter drafting and finalisation with the drafting committee. Dr Aashna Dhingra for coordinating the online course development on QI with the Aastrika Foundation. Ms Rashi Arora and Mr Harshit Sharma from the NQOCN Office for coordinating various activities during the inception and initial intensive phase of the digital Community of Practice. NQOCN members and the participants of the dCoP. Their contributions to the dCoP are deeply appreciated.

References

Supplementary materials

  • Supplementary Data

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Footnotes

  • Twitter @SushilUCMS, @drpraveen_v, @jeena_pradeep6, @harishpemde, @AnkurSooden, @kedarpriya1

  • Contributors VD, SS, SKP, PV, JP, RM, RG, HP and NR were involved in the conceptualisation of the dCoP and its operational requirements. Along with these authors, RK, VS and PS guided in the development of dCoP activities. VD, SS, SKP, PV, JP, RG, KL, SJ, VB, AK, AS, SV, KS, CS, KhS and RM were responsible for conducting online and onsite CoP activities. VD, SS, KL, RG and SJ were responsible for developing the draft manuscript and analysing the data from the dCoP platform. KhS and SJ contributed to the initial draft of the manuscript and data collection. All listed authors reviewed and approved the final draft of the manuscript. VD is the guarantor for this manuscript.

  • Funding For developing and sustaining the dCoP, WHO’s South East Asia Regional Office funded this initiative from its conceptualisation to its implementation and spread into a regional CoP. These activities were supported through the following APW grants (PO) 202522047 (2020–2021), 202712497 (2021), 202788173 (2021), 202664704 (2021–2022), 202988101 (2022), 202809227 and 202800494 (2022–2023). For some of the knowledge products and mentoring sessions, funding was provided by UNICEF India as SSFA grants under its output 101 (2020–2022) and IND/SSFA2020757 (2020). The funding agencies had no bearing on this study's methodology, data collection and analysis and results. The opinions expressed herein are those of the authors and do not represent the official views of their respective organisations.

  • Competing interests NR and RK are employed with the WHO-SEAR Office. They were responsible for the release of funds for developing and sustaining the dCoP described in the paper. VS is employed by UNICEF India. They were responsible for the release of funds for some of the knowledge products described in the paper. The remaining authors declare no competing interests. The views expressed here are those of the respective authors and they do not necessarily represent the decisions, policies or views of their respective organisations.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.