# Presentation: 616069

## Strengths and Challenges of Action Research

**Carol VanDeusen Lukas, EdD**
**QUERI Implementation Seminar**
**June 26, 2008**

## Seminar objectives

- Outline the concepts and constructs of action research
- Explore the challenges of conducting action research

## Action research...

-  “engages the researcher in an explicit program to develop new solutions that alter existing practice and then test the feasibility and properties of the innovation.”
- Kaplan, RS.  *Innovation action research:  creating new management theory and practice. *Journal of Management Accounting Research.  1998. 10:89.

## Traditional research design

- RCT is gold standard
- Detailed replication is expected/assumed
- intention to treat design
- Context is controlled away
- Sites/subjects are recipients of treatment

## Contrast with action research

- RCT is gold standard
*Rigorously test theories in natural organizational setting*
- Detailed replication is assumed - intention to treat design
*Implement innovation while tailoring to meet local needs*
- Context is controlled away
*Reflect in-depth on system being changed*
- Sites/subjects are recipients of treatment
*Collaboration of researchers with managers*

## Key features of action research

- Rigorously test theories in natural organizational setting
- Implement innovation while tailoring to meet local needs
- Reflect in-depth on system being changed
- Collaboration of researchers with managers

## But action research is not easy

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

## Case example 

- “Strengthening organizations to implement evidence-based clinical practices”       (IMV 04-055)
- Collaboration of Network leaders in VISNs 1, 10, 23 and COLMR

## Project team

- Carol VanDeusen Lukas, EdD
- Ryann L. Engle, MPH
- Sally K. Holmes, MBA
- Marjorie Nealon-Seibert, MBA
- Vicky Parker, DBA
- Michael Shwartz, PhD
- Jennifer L. Sullivan, PhD
- Preet Ghuman
- Jason Silver

- Jeannette Chirico-Post, MD
- Michael Miller, MD, PhD
- Robert A. Petzel, MD
- Barry Graham, MD
- Sheila Gelman, MD, MPA

## Research objectives

- Test effectiveness of an organizational model (VISN 23) vs. data feedback model (VISNs 1 & 10) in improving compliance with evidence-based guidelines

- Identify factors that affect success of model implementation and effectiveness

## Organizational model for improving evidence-based clinical practices

## Study design: Intervention in VISN 23

- Innovation = the organizational model
- Clinical focus is hand hygiene
- Project aim is building organizational capabilities
- Hand hygiene data collection & reporting
- External facilitation to medical centers
- Shared learning group
- Leadership consortium

## Study design:  Intervention in VISNs 1 and 10

- Innovation = data feedback
- Clinical focus is hand hygiene
- Hand hygiene data collection & reporting
- Annual interviews

## Study design: Evaluation

- Is the organizational model implemented with high fidelity to the model design?
- Is the organizational model when implemented with fidelity more effective than comparisons in improving HH compliance?
- Why is the organizational model successful or not successful in terms of implementation & effectiveness?
- Are the activities used by the research team to introduce & support the organizational model successful?

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

- Rolling out the intervention
- Operationally defining the innovation
- Engaging leadership
- Engaging middle & front-line staff
- Conducting rigorous research
- Measuring implementation fidelity
- Measuring performance
- Documenting intervention, context and changes
- Balancing roles as researcher and change facilitator

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

- Communicating key elements
- Tailoring innovation to each site
- Reinforcing the innovation
- Case strategies
- Preliminary data as part of introduction
- Implementation plan
- Regular feedback in site visits

## Rolling out the intervention 2: Engaging leadership

- Reaching multiple levels of leadership
- Grappling with competing priorities
- Clarifying leadership roles
- Case strategies
- Model introduction at ELC
- Leadership consortium across network
- Quadrad champion
- Communication between visits

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

- Staff skills and buy in
- Site experience with systematic quality improvement and redesign teams
- Case strategies
- Redesign teams
- Improvement efforts linked with larger organization - quadrad champion
- Shared learning group
- NCOD consultation

## Conducting rigorous research 1: Measuring implementation fidelity

- Defining key elements of the innovation
- Developing tools
- Case strategies
- Research teams document and rate fidelity

## Conducting rigorous research 2: Measuring performance

- Developing local measures
- Systematic
- Consistent
- Sustainable
- Case strategy
- Work with individual sites
- Measurement subgroup of shared learning group
- VISN coordination of data collection

## Conducting rigorous research 3: Documenting intervention, context & changes

- Research team facilitation and support
- Changes in innovation
- Organizational context
- Case strategies
- Notes on all interviews, meetings, telephone conversations, e-mail
- Impressions journal

## Balancing roles as researcher & change facilitator

- Researchers are used to being objective observers
- How do you balance being actively involved in the project with stepping back and letting the project process happen naturally?