Table 3 Aims, processes and challenges of the participatory action research
Aim | Process | Challenges |
|---|---|---|
Engagement of KNH staff | Formation of core group and involving them in implementing the best-practices. | Capacity building missed out organizational issues such as teambuilding, supervision skills, communication skills and negotiation skills. |
Development of quality indicators (QIs) | Adoption of ETAT+ based QIs with targets using face to face meetings and consensus conference. | Less success for approaches requiring self-administered questioners with preference of face to face thus increasing cost of the activity. |
No preliminary study to inform performance target. Targets set at 100% correct performance based on the perceived simplicity of the tasks. | ||
Institutionalization of audits and feedback | Re-energizing routine ward audits Facilitation of the ward audits Formation of department audit team, development of an audit tool and conducting audit. Adopting a rapid hospital survey approach to assess both structure and processes of care | Managers had insufficient skills and motivation to introduce change in a system. Minimal consultants’ support. Staff not compelled to know their clinical performance. |
Problem-solving challenged by poor culture for self-directed reading on quality care and by deeply engrained practices that had become the norm, thus difficult in recognizing suboptimal care and to do root cause analysis | ||
Multidisciplinary feedback that would encourage system-wide problem and solution identification was compromised by limited repertoire of knowledge on basic patients’ care that required discipline specific audit feedback details | ||
Insufficient structures to support the clinical audits without involvement of the facilitator | ||
Address knowledge gaps. | Initially we held multidisciplinary educational sessions but finally adopted task oriented CMEs analogous to the format for cadre specific pre-service training. | Punctuality problems among all cadres that reflected the norm of the hospital staff. No effective learning culture, no substantive mechanism of holding the management and staff accountable for QoC |
Multi-professional capacity building not achieved due to poor communication and limited of repertoire of basic and procedural knowledge. | ||
No substantial incentives to attend or facilitate CMEs e.g. accreditation of CMEs |