title: Engaging pediatric intensive care unit (PICU) clinical staff to lead practice improvement: the PICU participatory action research project (PICU-PAR).
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Collet
authors.forename: Peter W
authors.initials: PW
authors.lastname: Skippen
authors.forename: Mir Kaber
authors.initials: MK
authors.lastname: Mosavianpour
authors.forename: Alexander
authors.initials: A
authors.lastname: Pitfield
authors.forename: Bubli
authors.initials: B
authors.lastname: Chakraborty
authors.forename: Garth
authors.initials: G
authors.lastname: Hunte
authors.forename: Ronald
authors.initials: R
authors.lastname: Lindstrom
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.affiliation: Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, Canada. mcke@mail.ubc.ca.
authors.forename: William H
authors.initials: WH
authors.lastname: McKellin
mesh_terms: D003142:Communication; D004777:Environment; D006302:Health Services Research; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007857:Leadership; D015279:Organizational Culture; D010564:Personnel, Hospital; D058996:Quality Improvement / Q000458:organization & administration*