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. 2014 Jan 8:9:6.
doi: 10.1186/1748-5908-9-6.

Engaging pediatric intensive care unit (PICU) clinical staff to lead practice improvement: the PICU participatory action research project (PICU-PAR)

Jean-Paul Collet, Peter W Skippen, Mir Kaber Mosavianpour, Alexander Pitfield, Bubli Chakraborty, Garth Hunte, Ronald Lindstrom, Niranjan Kissoon, William H McKellin  1
Affiliations

Engaging pediatric intensive care unit (PICU) clinical staff to lead practice improvement: the PICU participatory action research project (PICU-PAR)

Jean-Paul Collet et al. Implement Sci. .

Abstract

Background: Despite considerable efforts, engaging staff to lead quality improvement activities in practice settings is a persistent challenge. At British Columbia Children's Hospital (BCCH), the pediatric intensive care unit (PICU) undertook a new phase of quality improvement actions based on the Community of Practice (CoP) model with Participatory Action Research (PAR). This approach aims to mobilize the PICU 'community' as a whole with a focus on practice; namely, to create a 'community of practice' to support reflection, learning, and innovation in everyday work.

Methodology: An iterative two-stage PAR process using mixed methods has been developed among the PICU CoP to describe the environment (stage 1) and implement specific interventions (stage 2). Stage 1 is ethnographic description of the unit's care practice. Surveys, interviews, focus groups, and direct observations describe the clinical staff's experiences and perspectives around bedside care and quality endeavors in the PICU. Contrasts and comparisons across participants, time and activities help understanding the PICU culture and experience. Stage 2 is a succession of PAR spirals, using results from phase 1 to set up specific interventions aimed at building the staff's capability to conduct QI projects while acquiring appropriate technical skills and leadership capacity (primary outcome). Team communication, information, and interaction will be enhanced through a knowledge exchange (KE) and a wireless network of iPADs.

Relevance: Lack of leadership at the staff level in order to improve daily practice is a recognized challenge that faces many hospitals. We believe that the PAR approach within a highly motivated CoP is a sound method to create the social dynamic and cultural context within which clinical teams can grow, reflect, innovate and feel proud to better serve patients.

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Figures

Figure 1
Figure 1
PICU-PAR project description – PAR spiral and specific interventions.
Figure 2
Figure 2
PAR description with teamwork process and reflection for improved adapted intervention.
Figure 3
Figure 3
Logic Model for PICU-PAR project evaluation framework.
Figure 4
Figure 4
PICU-PAR Research Plan with stages and timeline.
See this image and copyright information in PMC

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