Participatory Action Research

#IHI09 Roger Resar (speaking) and John Whittington (with some audience participants), of IHI's R&D team, recently were involved in developing and testing an innovative approach to actively engaging physicians to provide evidence-based and effective care through "clinician-friendly standardization." The two engaged the Faculty Mindwalk attendees in a hands-on exercise.

Beyond the National Forum, Roger and John hope to try out "participatory action research" with the attendees to test novel solutions to tough problems. They want to create a network of the attendees to be involved with IHI as innovators who will "create new approaches to seemingly intractable health care delivery issues."

Katharine Luther, RN, from Texas Medical Center, gave an example. A local team did on-site work on the area of fall prevention while communicating with Roger at IHI to test out concepts, engaging in an iterative collaboration approach between the "field" and the resources back in Cambridge. The idea was to ask clinicians to discern between "usual" and "special" patients, 80% and 20%, respectively. About 50% of the falls occurred in each category, which, interestingly did not correlate with the usual Morse score for fall susceptibility. This led the team to a create a bundle of three items (more easily reached call buttons, lower bed height, better placement of IV stand) that could be used to reduce falls across the broad population of patients, notwithstanding the Morse score.

The lesson of this example, Roger concluded, was about co-learning between the field and the IHI R&D group, with the immediate benefits accruing to the local partner, but eventually offering advances that might also go beyond the particular local partner to a broader audience.