Health care providers are increasingly seeking new technologies to improve quality and cost effectiveness. In nursing homes, quality involves clinical excellence and creating a culture of care that provides an enriched living experience desired by older people and their families. The concepts of evidence-informed practice and partnerships in caring are thus central to the achievement of the nursing home improvement agenda, in addition to the satisfaction of regulatory requirements. Improvement per se is an imprecise science and the challenge of prioritizing nursing home development strategies is compounded by regulatory imperatives, material and manpower resource issues including workforce stability and commercial competition. Practice development and more recently quality improvement and its rapid derivatives have generated an arr.ay of approaches, none of which stand out as superior in terms of their demonstrable impact on practice or patient outcomes. As Berlowitz et al acknowledge, there are few robust studies investigating the impact of quality improvement in nursing homes. With growing international interest in communities of practice (CoPs), it is timely that we explore the potential for CoPs to advance cultural change in nursing homes in order to drive sustainable improvements. This article examines the merits of an empirically derived CoP model for use in care homes and in the strategic expansion of knowledge management and knowledge translation in Scotland.
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