Measurement Issues in Conducting Action Research Across Primary Care Professions

• In Event: Clarifying Assessment and Measurement Issues Across Disciplines and Professions

Abstract

Purpose
This paper examines measurement issues encountered within action research projects for developing learning organizations in primary care professions across the United Kingdom (2009-2011). Project commissioners with responsibility for training primary care practitioners chose this project for developing learning organizations within primary care and increasing capacity for training placements.

Perspective
Learning organizations are continually part of a discourse within medical education and are associated with policies re-focusing work-based learning in continuing professional development (DOH: 1998). Theories of learning (Senge: 1994; Argyris and Schon:1974) have been applied using empirical research in health care settings (Rushmer, Kelly, Lough, Wilkinson, & Davies, 2004a, 2004b, 2004c)and identify several features of learning organizations: team work, decision making, and approaches to learning. Theories of assessing work-based learning (Knight and Page, 2007) will be used to judge practitioner accounts of learning within portfolios as fair, reasonable, and supportive of accreditation of experiential learning required for undergraduate/postgraduate professional development courses.

Action research addresses practical problems for research-into-practice within a research-development-action loop (Elliott, 1991). Seven teams developed work-based learning to support their primary care teams who were challenged with keeping pace with constant demands for change: 1) Practicalities and complexities of administering comparable assessments of work-based learning when stakeholders and primary care professional groups interpret project purposes and outcomes differently; 2) Challenges when developing practitioner-conducted assessments of learning arising from everyday practice where heavy workloads couple with high external demands.

Methods
Academics facilitated learning plans and collaboratively identified development projects. They addressed challenges to collaborative and reflective practices, often through individual coaching. Primary care teams—physicians, nurses, receptionists—engaged with developing as learning organizations through 1) reflective logs, 2) audio-taped discussions, 3) artifacts from workplaces, 4) learning plans, and 5) individual projects for developing an aspect of service as providers. The academic team collected data on 6) field notes from learning activities; 7) semi-structured interviews with clinicians, practice managers, and receptionists; 8) focus groups; 9) questionnaires; and 10) narratives from participant-constructed digital stories.

Results
Combined literature and measurement strategies were successful in identifying factors that shaped and challenged individual project participation and teams within primary care practices, but demonstrated the value of action research as teams attempted to clarify their learning organizations. Factors included: Perceived lack of time, fragmented communication systems within small organizations, professional hierarchies, constraints on physical space for learning, and demand-led work-loads experienced as relentlessly high priority and high volume. Though primary care practitioners articulated shared visions of care within their multi-professional learning teams, they understood these differently across teams, which reflected diverse perspectives/values.

Scholarly significance
Contextual challenges required both professional practitioners and academic team members to re-visit work-based learning concepts/structures: Learning strategies and assessment changed because forms of learning, power, and values were difficult to negotiate, resolve, and assess. Professional hierarchies often constrained/determined which roles participants could play in learning groups, even when roles focused on common issues for optimizing delivery of primary care. Without action research, some assessment procedures may have been dropped, rather than adjusted, in order to meet different demand characteristics across primary care groups.

Author

• Anne Christine McKee, King's College London