What’s important when building a strong learning community to drive improvement?

Reflections from some active learning communities 

Since 2021, the Health Foundation’s Common Ambition programme has been supporting four projects to build sustainable change in health care through collaboration between those who use services and those who deliver them. 

Keen to explore how teams have gone about convening and maintaining their own learning communities, we spoke to two of the projects to gather their insights.

• Elena Sheldon (pictured, top) is Project Manager for AWARE-IBD, a Common Ambition project based in Sheffield that’s using extensive patient involvement to lead service redesign and deliver improved outcomes for people with inflammatory bowel disease (IBD).
• Aisha Namurach (pictured, bottom) is Project Co-ordinator at Common Ambition Bristol, a project working with people of African and Caribbean heritage to increase levels of HIV awareness and testing within marginalised communities in Bristol, and to reduce stigma and late diagnosis within those communities.

Elena: I think there's always a little bit of friction as all parties have different priorities. We’re working with the IBD team, the clinical team, the secretaries, the administrative staff, and their challenges and frustrations are often quite different. But this project is all about patient-led service changes so it was really about listening to what the patients want. Issues around access, communication and patient-centred care came through loud and clear, so there was consensus about wanting to respond to that.  

What’s helped to maintain a productive learning community? 

Aisha: Being open and honest about our work has been vital. And that means acknowledging that this work sits within some much bigger issues of inequalities which affect our communities. We needed to acknowledge that things haven’t been great, especially for marginalised communities during the pandemic, and that this was one way we were trying to change things. That seemed to really resonate with people and helped to build trust. 

Paying community members properly to sit on our project delivery group was also essential. Because what's happened before with projects like this is that black communities are brought in on a voluntary basis, do a lot of the work, and don't get paid or recognised for their time. We wanted it to be clear this project was different. 

Elena: We learned that rather than getting people to come to you, you go to them. Seems basic but we got some useful feedback early on that made us think about why this is important. We ran one of our first engagement sessions in a university building in the city centre and a community leader who attended said to me ‘I don’t feel comfortable in this kind of setting, this environment is so foreign to me’. That really changed our approach.  

The other big thing we learned is the importance of taking the time to build and maintain a rapport and sense of trust with people. Community groups told us they’d often have people visit, get the information they needed and then they’d never hear from them again. If you want people to open up, you need to invest in that relationship and make it mutually beneficial. Even if that’s just a follow up visit to tell them what you've done with the information they gave you and how it’s made a difference 

What challenges or difficulties have you faced and how have you overcome these?  

Elena: Getting a truly diverse and representative community group involved in the work was challenging. This is where we really valued the skills of the partner agencies involved in our project. The outreach and engagement sessions our charity partner VoiceAbility helped to run with community groups really made space for lesser heard voices and helped us understand any specific challenges they faced in their care.  

Aisha: Emotions got a bit charged within our project delivery group when we realised we were looking at the last leg of the project. Community members felt upset at the idea the project could just end and importantly noted that the community don’t get to walk away at the end of the 3-year funding – they’ll still be here dealing with health and racial inequalities. It was challenging at the time but we realise now it was a bit of a breakthrough and led to people really feeling heard. It also prompted some very important conversations about the legacy of the project, how we wanted to focus our remaining time and what could be next. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.