Abstract
BackgroundDespite 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.MethodologyAn 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.RelevanceLack 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.
Highlights
Despite considerable efforts, engaging staff to lead quality improvement activities in practice settings is a persistent challenge
We believe that the Participatory Action Research (PAR) approach within a highly motivated Community of Practice (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
During the semi-structured interviews, participants will be asked to diagram their own networks of individuals whom they recognize as leaders in different areas of quality improvement
Summary
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. Despite considerable efforts nationwide, Over the past decade, the Pediatric Intensive Care Unit (PICU) at British Columbia Children’s Hospital (BCCH), as member of the Canadian Pediatric Critical Care Collaborative, experienced a track record of successes following the quality improvement approach with repeated Plan-Do-Study-Act (PDSA) cycles. The reason was attributed in part to the way RPIW projects were implemented with unit and organizational leadership selecting isolated component deficiencies without seeking input and engagement of the broad team of care providers and staff
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