1 Strengths and Challenges of Action Research Carol VanDeusen Lukas, EdD QUERI Implementation Seminar June 26, 2008.

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Strengths and Challenges Strengths and Challenges of Action Researchof Action Research

Carol VanDeusen Lukas, EdDCarol VanDeusen Lukas, EdD

QUERI Implementation SeminarQUERI Implementation SeminarJune 26, 2008June 26, 2008

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Seminar objectivesSeminar objectives

Outline the concepts and constructs Outline the concepts and constructs of action researchof action research

Explore the challenges of conducting Explore the challenges of conducting action researchaction research

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Action research…Action research…

““engages the researcher in an explicit engages the researcher in an explicit program to develop new solutions program to develop new solutions that alter existing practice and then that alter existing practice and then test the feasibility and properties of test the feasibility and properties of the innovation.”the innovation.”

Kaplan, RS. Kaplan, RS. Innovation action research: creating new management theory Innovation action research: creating new management theory and practice. and practice. Journal of Management Accounting Research. 1998. 10:89.Journal of Management Accounting Research. 1998. 10:89.

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Traditional research designTraditional research design

RCT is gold standardRCT is gold standard Detailed replication is Detailed replication is

expected/assumedexpected/assumed intention to treat designintention to treat design

Context is controlled awayContext is controlled away Sites/subjects are recipients of Sites/subjects are recipients of

treatmenttreatment

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Contrast with action researchContrast with action research

RCT is gold standardRCT is gold standard Rigorously test theories in natural Rigorously test theories in natural

organizational settingorganizational setting Detailed replication is assumed - intention to treat Detailed replication is assumed - intention to treat

designdesign Implement innovation while tailoring to Implement innovation while tailoring to

meet local needsmeet local needs Context is controlled awayContext is controlled away

Reflect in-depth on system being changedReflect in-depth on system being changed Sites/subjects are recipients of treatmentSites/subjects are recipients of treatment

Collaboration of researchers with Collaboration of researchers with managersmanagers

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Key features of action researchKey features of action research

Rigorously test theories in natural Rigorously test theories in natural organizational settingorganizational setting

Implement innovation while tailoring Implement innovation while tailoring to meet local needsto meet local needs

Reflect in-depth on system being Reflect in-depth on system being changedchanged

Collaboration of researchers with Collaboration of researchers with managersmanagers

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But action research is not easyBut action research is not easy

Challenges & strategies for Challenges & strategies for addressing examined in context addressing examined in context of a case exampleof a case example

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Case example Case example

““Strengthening organizations to Strengthening organizations to implement evidence-based clinical implement evidence-based clinical practices” (IMV 04-055) practices” (IMV 04-055)

Collaboration of Network leaders in Collaboration of Network leaders in VISNs 1, 10, 23 and COLMR VISNs 1, 10, 23 and COLMR

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Project teamProject team

Carol VanDeusen Lukas, EdDCarol VanDeusen Lukas, EdD Ryann L. Engle, MPHRyann L. Engle, MPH Sally K. Holmes, MBASally K. Holmes, MBA Marjorie Nealon-Seibert, Marjorie Nealon-Seibert,

MBAMBA Vicky Parker, DBAVicky Parker, DBA Michael Shwartz, PhDMichael Shwartz, PhD Jennifer L. Sullivan, PhDJennifer L. Sullivan, PhD Preet GhumanPreet Ghuman Jason SilverJason Silver

Jeannette Chirico-Post, Jeannette Chirico-Post, MDMD

Michael Miller, MD, Michael Miller, MD, PhDPhD

Robert A. Petzel, MDRobert A. Petzel, MD Barry Graham, MDBarry Graham, MD Sheila Gelman, MD, Sheila Gelman, MD,

MPAMPA

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Research objectivesResearch objectives Test effectiveness of an organizational Test effectiveness of an organizational

model (VISN 23) vs. data feedback model model (VISN 23) vs. data feedback model (VISNs 1 & 10) in improving compliance (VISNs 1 & 10) in improving compliance with evidence-based guidelineswith evidence-based guidelines

Identify factors that affect success of Identify factors that affect success of model implementation and model implementation and effectivenesseffectiveness

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Organizational model for Organizational model for improving evidence-based clinical improving evidence-based clinical

practicespractices

Improved evidence-based clinical

practices

Active top leadership commitment

Links to senior management structures

& processes

Multi-disciplinary evidence-based clinical process

redesign

Organizational infrastructure

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Study design: Study design: Intervention in VISN 23Intervention in VISN 23

Innovation = the organizational modelInnovation = the organizational model Clinical focus is hand hygieneClinical focus is hand hygiene Project aim is building organizational Project aim is building organizational

capabilitiescapabilities Hand hygiene data collection & Hand hygiene data collection &

reportingreporting External facilitation to medical centersExternal facilitation to medical centers Shared learning groupShared learning group Leadership consortiumLeadership consortium

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Study design: Study design: Intervention in VISNs 1 and 10Intervention in VISNs 1 and 10

Innovation = data feedbackInnovation = data feedback Clinical focus is hand hygieneClinical focus is hand hygiene

Hand hygiene data collection & Hand hygiene data collection & reportingreporting

Annual interviewsAnnual interviews

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Study design: EvaluationStudy design: Evaluation Is the organizational model implemented Is the organizational model implemented

with high fidelity to the model design?with high fidelity to the model design? Is the organizational model when Is the organizational model when

implemented with fidelity more effective implemented with fidelity more effective than comparisons in improving HH than comparisons in improving HH compliance?compliance?

Why is the organizational model successful Why is the organizational model successful or not successful in terms of implementation or not successful in terms of implementation & effectiveness?& effectiveness?

Are the activities used by the research team Are the activities used by the research team to introduce & support the organizational to introduce & support the organizational model successful?model successful?

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Challenges of action research: Challenges of action research: Lessons from the case exampleLessons from the case example

Rolling out the interventionRolling out the intervention Operationally defining the innovationOperationally defining the innovation Engaging leadershipEngaging leadership Engaging middle & front-line staffEngaging middle & front-line staff

Conducting rigorous researchConducting rigorous research Measuring implementation fidelityMeasuring implementation fidelity Measuring performanceMeasuring performance Documenting intervention, context and changesDocumenting intervention, context and changes

Balancing roles as researcher and Balancing roles as researcher and change facilitatorchange facilitator

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Rolling out the intervention 1:Rolling out the intervention 1: Operationally defining the Operationally defining the

innovationinnovation Communicating key elements Communicating key elements Tailoring innovation to each siteTailoring innovation to each site Reinforcing the innovationReinforcing the innovation

Case strategiesCase strategies Preliminary data as part of introductionPreliminary data as part of introduction Implementation planImplementation plan Regular feedback in site visitsRegular feedback in site visits

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Rolling out the intervention 2:Rolling out the intervention 2: Engaging leadershipEngaging leadership

Reaching multiple levels of leadershipReaching multiple levels of leadership Grappling with competing prioritiesGrappling with competing priorities Clarifying leadership rolesClarifying leadership roles

Case strategiesCase strategies Model introduction at ELCModel introduction at ELC Leadership consortium across networkLeadership consortium across network Quadrad championQuadrad champion Communication between visitsCommunication between visits

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Rolling out the intervention 3:Rolling out the intervention 3: Engaging middle & front-line Engaging middle & front-line

staffstaff Staff skills and buy inStaff skills and buy in Site experience with systematic quality improvement and Site experience with systematic quality improvement and

redesign teamsredesign teams

Case strategiesCase strategies Redesign teamsRedesign teams Improvement efforts linked with larger organization - quadrad Improvement efforts linked with larger organization - quadrad

championchampion Shared learning groupShared learning group NCOD consultationNCOD consultation

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Conducting rigorous research 1:Conducting rigorous research 1: Measuring implementation Measuring implementation

fidelityfidelity

Defining key elements of the Defining key elements of the innovationinnovation

Developing toolsDeveloping tools

Case strategiesCase strategies Research teams document and rate Research teams document and rate

fidelityfidelity

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Conducting rigorous research 2:Conducting rigorous research 2: Measuring performanceMeasuring performance

Developing local measuresDeveloping local measures SystematicSystematic Consistent Consistent SustainableSustainable

Case strategyCase strategy Work with individual sitesWork with individual sites Measurement subgroup of shared learning groupMeasurement subgroup of shared learning group VISN coordination of data collectionVISN coordination of data collection

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Conducting rigorous research 3:Conducting rigorous research 3: Documenting intervention, Documenting intervention,

context & changescontext & changes Research team facilitation and supportResearch team facilitation and support Changes in innovationChanges in innovation Organizational contextOrganizational context

Case strategiesCase strategies Notes on all interviews, meetings, telephone Notes on all interviews, meetings, telephone

conversations, e-mailconversations, e-mail Impressions journalImpressions journal

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Balancing roles as researcher Balancing roles as researcher & change facilitator& change facilitator

Researchers are used to being Researchers are used to being objective observersobjective observers

How do you balance being actively How do you balance being actively involved in the project with involved in the project with stepping back and letting the stepping back and letting the project process happen naturally?project process happen naturally?