Developing clinical governance in a service for people with intellectual disabilities: An action research approach

Action research in the healthcare field: a scoping review

OBJECTIVE

This scoping review aimed to explore international literature related to the application of action research in studies in the healthcare context.

INTRODUCTION

Action research is an approach that involves collaboration to develop a process through knowledge building and social change. Several viewpoints of action research have been introduced as the different traditions of developed action research. To develop a coherent process, researchers have to posit their worldviews and theoretical framework and align these with the research aims and procedures, and local transformation needs. This diversity leads to a variety of action research practices in healthcare. Particularly, in this review, we raised the need for examining participants' experiences and changes related to the action research process.

INCLUSION CRITERIA

This scoping review considered studies that included any professional healthcare provider, patient or recipient of healthcare products or services involved in action research. Studies that used the action research methodology in the healthcare context were included. All quantitative and qualitative studies were considered. The quantitative component considered experimental and epidemiological studies, whereas the qualitative component considered studies that focused on qualitative data.

METHODS

A three-step search strategy was used in this review. MEDLINE, CINAHL, Web of Science, Social Sciences, ERIC, PsycINFO, Health Source, ScienceDirect, Wiley and SciELO databases were searched with no publication date limitation. Studies published in English, Portuguese and Spanish were included. The data were extracted using a charting table, which was developed to record key information from sources relevant to the review question. The findings were descriptively presented, with tables and figures to support the data when appropriate.

RESULTS

We included 124 studies with different aims and procedures. The levels of participation ranged from no real input into or influence on the research process to democratic knowledge sharing and collective understanding. The action research processes occurred in diverse settings in the healthcare context, and participants with different objectives and demands took part in the research.From study objectives, knowledge building, and social change data, we developed three domains and categorized the studies. In general, Europe and Australia published more studies in the organizational domain and mainly had healthcare stakeholders as participants. North America published more studies in the individual domain, and Latin America, the continent with a higher percentage of publications, published studies that were more frequently related to the collective domain. Asia and Africa did not have a consistent number of publications. There was a major repercussion on the health promotion perspective in North America and Latin America.

CONCLUSIONS

There are several ways of conducting action research in healthcare that consider the researcher's aims and theoretical assumptions. Further qualitative systematic review questions may arise from the results and conclusions of this scoping review.

Supporting and activating clinical governance development in Ireland: sharing our learning

Purpose

– The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

Design/methodology/approach

– A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Findings

– Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

Research limitations/implications

– The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

Practical implications

– The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Originality/value

– Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

Clinical governance in the Irish health system – a review of progress

Purpose

– The purpose of this paper is to explain the path that the Irish health system has taken towards achieving good clinical governance, exploring the historical influences on its’ development, some of the major initiatives that have been implemented and the obstacles that have been encountered.

Design/methodology/approach

– The paper draws on the author's experience researching and teaching in health systems and healthcare management.

Findings

– The paper offers some explanations for why earlier attempts failed to change the system as well as why recent attempts have met with more success. Greater efforts need to be made to progress clinical governance in the primary care services. In addition it is argued that there is a need to institute systems that enable learning form errors, to involve the public and patient groups and to invest in research that enables answers to the how and why questions that are so often neglected in the reform process.

Originality/value

– The paper discusses clinical governance in the Irish Health system and identifies some of the challenges yet to be addressed, many of which are common to clinical governance efforts in other jurisdictions.