Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

Alicia C. Bunger, Nathan Doogan, Rochelle F. Hanson, Sarah A. Birken

Successful implementation depends on the transfer of knowledge and expertise among clinicians, which can occur when professionals seek advice from one another. This study examines advice-seeking patterns among mental health clinicians participating in learning collaboratives (a multi-component implementation and quality improvement strategy) to implement trauma-focused cognitive behavioral therapy (TF-CBT). We apply transactive memory system theory, which explains how professionals access and retrieve knowledge, to examine factors associated with the evolution of advice-seeking relationships during implementation. Our aim is to unpack learning collaboratives' mechanisms by investigating how and why advice-seeking networks change, which may help us understand how implementation strategies can best target networks. Using social network analysis and a pretest-post-test design, we examined patterns in general and treatment-specific advice-seeking among 146 participants (including five clinical experts) from 27 agencies participating in a regional scale-up of TF-CBT. Surveys were administered in-person at the first and last of three in-person learning sessions (10 months apart) that comprise a core component of learning collaboratives. Participants nominated up to five individuals from whom they seek general and treatment-specific advice. Exponential random graph models (ERGMs) tested the likelihood of maintaining or forming advice-seeking relationships based on indicators of expertise quality, accessibility, need, and prior advice-seeking relationships. Participants formed or maintained advice-seeking relationships with those who possess perceived expertise (e.g., learning collaborative faculty experts, supervisors, and those with greater field experience than themselves). Participants also tended to seek advice from those within the same organization and with similar disciplinary training, highlighting the importance of expertise accessibility. Prior relationships and network structural features were associated with advice-seeking, indicating that participants built on existing social ties. Advice-seeking did not vary based on participants' role or experience. Given the importance of accessible clinical expertise and ongoing supervision for delivering treatment with fidelity, learning collaboratives may support implementation by promoting clinicians' awareness of and access to others' expertise, especially those with substantial expertise to share (e.g., faculty experts and supervisors). Future controlled studies are needed to verify the effectiveness of learning collaboratives for building networks that connect clinicians and experts and for improving implementation.