A scoping review protocol to map the evidence on the use of action research methodology by healthcare professionals and in healthcare team settings

Introduction

Action research (AR) is a philosophy and methodology of research that starts with an existing practical situation with which there is a concern or potential for development or improvement (Coghlan, 2019). It is also described as a process that seeks transformative change through the simultaneous process of taking actions and doing research, which are linked together by a critical reflective process (Coghlan, 2019). Winter and Munn Giddings defined AR as the ‘study of a social situation carried out by those involved in that situation to improve both their practice and the quality of their understanding’ (Winter & Munn Giddings (2001), pg. 8). Baum et al. says AR “seeks to understand and improve the world by changing it. At its heart is collective, self-reflective enquiry that researchers and participants undertake so they can understand and improve upon the practices in which they participate and the situation in which they find themselves” (Baum et al. (2006), pg. 854). It relies on a cycle of reflection, planning, acting, further observing and reflection, and the researchers are engaging together in these processes (Baum, 2016).

AR is experiential and participatory in nature, which led Kemmis & McTaggart (2000) to describe it as participatory research. Other variations of AR include community-based AR, participatory AR, community-partnered participatory research, mutual inquiry, collaborative research, co-operative inquiry, action learning, and participatory learning research (Bergold & Thomas, 2012). However, the foundations and basic concept of AR underpins them all.

The characteristics of AR contrast with positivist science and overlap more with the post-positivist and interpretivist research paradigm (Cordeiro et al., 2015; Tekin & Kotaman, 2013). Kurt Lewin, a psychologist, first coined the term in 1944, and it appears in his 1946 paper "Action Research and Minority Problems", where he describes it as "a comparative research on the conditions and effects of various forms of social action and research leading to social action" (Lewin (1946), pg.35) that uses "a spiral of steps, each of which is composed of a circle of planning, action, and fact-finding about the result of the action" (Lewin (1946), pg.38). This idea of research in which teachers are more active participants was highlighted much earlier, however, in the works of John Dewey (Dewey, 1910), who emphasized the importance of experience and interaction between human beings and with their natural and artistic environment. Dewey's criticism of the separation between knowledge and action as well as his other philosophical ideas are instrumental for the creation of the AR approach (Dewey, 1929). Many have since elaborated on Lewin’s ideas, such as Rapaport, who defined the aim of AR as contributing both to the practical concerns of people in an immediate problematic and concerning situation but also to the goals of social science by joint alliance within a mutually acceptable ethical framework (Brown & Tandon, 1983)

AR has traditionally been used in qualitative research to facilitate change in education and business management (Carr & Kemmis, 1986; Elliott, 1991; Shani & Coghlan 2019). More recently, its use has become more popular in nursing and nursing education (Moch et al., 2016; Munn-Giddings et al., 2008; Munten et al., 2010). It has been employed less in other areas of health (Sørensen & Haugbølle, 2008; Swain & French, 2004), a surprising fact, especially as it can enable development of innovative practices and services over a wide range of health care practices and situations (Holter & Schwartz-Barcott, 1993). The need for enhanced and effective team collaboration has been emphasized increasingly in healthcare policy both nationally and internationally (Committee on the Future of Healthcare, 2017; Harris & Schmitt, 2004).

Effective teamwork in healthcare is associated with reduced medical errors, increased patient safety as well as improved staff outcomes such as reduced stress and job satisfaction (Buttigieg et al., 2011; Carter & West 1999; Firth-Cozens, 2001; Manser, 2009).

The National Rehabilitation Hospital (NRH) is the national tertiary centre providing specialist rehabilitation services to patients who due to accident, illness or injury have acquired a physical or cognitive disability. The NRH delivers rehabilitation through the collaborative work of interdisciplinary team (IDT) members. Team members include doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, pharmacists, psychologists, medical social workers, music therapists, dieticians, and health care assistants. In physical medicine and rehabilitation (PRM), team working is considered essential and “interdisciplinary working” is the preferred pattern of team working (Neumann et al., 2010). It is considered the most effective way of delivering integrated, person-centred care and leads to improved outcomes for patients (Xyrichis & Ream, 2008). IDT working is defined as a dynamic process involving two or more health professionals with complementary backgrounds and skills, sharing common health goals, and exercising concerted mental and physical effort in assessing planning and evaluating patient care (Nancarrow et al., 2013). IDT also offers benefits to staff in terms of morale, job satisfaction, feelings of empowerment and improved wellbeing and benefits to the organisation in cost savings, length of stay and reduced staff turnover (Körner et al., 2016). Reflective team processes can enhance team cohesiveness, professional identities, create a safe place for reflection and enhance team focus (Heneghan et al., 2014). Healthcare professionals do not instinctively know how to work together in IDTs and the “work” in teamwork must be acknowledged (Sargeant et al., 2008).

In 2020 the NRH transitioned to a new hospital facility, considered by many to be the ultimate change project (Stichler & Ecoff, 2009). A hospital interdisciplinary working research group had been set up one year prior to the move, and we had identified that this transition had real potential for our IDT’s dynamic to be disturbed and for patient care to become fragmented. Enhancing the effectiveness of IDT working has been studied in a community-based rehabilitation setting using AR methodology with promising results (Nancarrow et al., 2012). We set out to implement a similar Interdisciplinary management tool to the NRH, aimed at enhancing IDT working, and to explore the outcome of this on patients, staff, and the organisation.

An initial scoping search of the literature revealed little regarding team training or interventions in the rehabilitation setting and during transition periods or change projects. Therefore, we felt that this was a worthwhile research study with potential benefits for patients and staff. We also predicted that this study may offer guidance to other teams transitioning in the future in Ireland e.g., the National Paediatric Hospital, Dublin and the new National Maternity Hospital, Dublin. To support our project, we chose a scoping review to map the relevant literature in this area. The objective of this scoping review is to investigate the use of AR methodologies in healthcare team and research settings. Of particular interest to us is the use of AR in rehabilitation settings, in multidisciplinary teams and in teams that are transitioning. This scoping review will be conducted in accordance with the Arskey and O’Malley framework methodology (Arksey & O'Malley, 2005), which has been further developed by Levac et al. (2010), and the Joanna Briggs Institute (2015).

Protocol

Assessment of methodological quality

As it is a scoping review, no assessment is required.

Study status

The final protocol was registered prospectively with the Open Science Framework on the 7^th January 2021 (https://osf.io/wt5n7). Initial searches of databases had commenced and author roles had been delegated at the time of this article publication.

Discussion

Systematic review articles concerning AR in education, business, and nursing exist but appear to be lacking in other areas of healthcare. In particular, there seems to be a paucity of evidence synthesis related to AR to improve IDT working either in rehabilitation settings or teams in transition.

This systematic scoping review will focus on use of AR methodologies in all healthcare teams and in healthcare settings. It will include all studies published between the years 2000 and 2021. We envisage that the results of this scoping review will contribute to literature but also aid policy guidelines for maintaining and enhancing IDT working particularly for teams in transition periods or change projects. Findings of this scoping review will be disseminated electronically, in print, and through peer presentation, conferences, and congresses.

Data availability

No data are associated with this article.