Defining or describing Action Research
In the introduction to their “Handbook of Action Research” Peter Reason and Hilary Bradbury said that “there is no ‘short answer’ to the question, ‘What is Action
Research?’ (Reason and Bradbury 2001). They listed phrases that might be used in a working definition, such as “a participatory democratic process” and “developing practical knowing in the pursuit of worthwhile human pursuits”.
Ernest Stringer began his book on Action Research with:
Action research is a systematic approach to investigation that enables people to find effective solutions to problems they confront in their everyday lives. Unlike traditional experimental/scientific research that looks for generalizable
explanations that might be applied to all contexts, Action Research focuses on specific situations and localized solutions. (Stringer 2007)
Reason and Bradbury said in the preface to their Handbook of Action Research: The Action Research family includes a whole range of approaches and practices, each grounded in different traditions, in different philosophical and psychological assumptions, pursuing different political commitments.
In the foreword to Stringer’s book, Egon Guba described Action Research, and in particular the community-based Action Research on which Stringer focused, as a form of “human inquiry” that exhibits decentralisation, deregulation and cooperativeness in execution, and he defined these terms in detail. Stringer himself emphasised a further feature of Action Research that differentiates it from research based on a hypothesis- testing approach, which is that Action Research should deliver a tangible outcome to the participants of the community wherein the problem being tackled resides.
To summarise, Action Research is typically focused on areas of human inquiry where:
• The participants (researchers and members of the community within which the research problem resides) work together to address the research problem;
• The research aims to find a local solution to the research problem which takes into account the specific characteristics of the situation at hand; and
• The research delivers a tangible benefit or outcome to the community. The Royal Children’s Hospital pilot study as Action Research
Two consultant surgeons from the Royal Children’s Hospital in Melbourne approached my colleagues and me at the CSIRO ICT Centre in May 2005 to describe the situation facing their patients who lived outside Melbourne, which was that the effort of bringing their children into the hospital for outpatient consultations was placing a heavy burden on the children and their families. Based on field observations in the hospital and discussions with the surgeons, we researchers took the lead in developing a telehealth system that would meet the clinical and interpersonal requirements for conducting remote outpatient consultations, under guidance and review from the surgeons. During the pilot study at the hospital the roles were reversed, with the surgeons taking the lead as they conducted their outpatient clinics using the telehealth system under technical
guidance and support from the researchers. In the exit interviews after each clinic, the surgeons and the researchers discussed together what had happened during that clinic and, where necessary, planned fine-tuning for subsequent clinics.
The aim of the project and the resulting pilot study was to explore the telehealth concept that had emerged from the interaction between researchers, surgeons and other clinical staff at the hospital in the very specific context of post-operative paediatric surgical outpatient consultations.
The benefit of this research project to the community of clinicians in the Department of Surgery at the hospital was two-fold. The evaluation of the pilot trial showed that it was indeed possible to conduct outpatient consultations of this type over a telehealth link and that those consultations could be satisfactory to both patients and clinicians. This evaluation is embodied in the initial report on the trial presented by CSIRO to the hospital in December 2007 (Stevenson, Hutchins et al. 2007). Based on this evaluation, the hospital approached the state government for financial support to develop a full clinical trial of this concept between it and one of the regional hospitals in Victoria. The second benefit accrued directly to the clinical staff involved in the project in that they now have direct personal experience of using a broadband telehealth system to conduct their clinical practice. This puts them in a situation where they can make judgements about issues of telehealth in their field based on their own experience. In view of the three-point summary above, this research project can be regarded therefore as an Action Research project.
Involvement of the differing groups of participants in this research There were three distinct groups of participants involved in this research – the
consultant surgeons, the staff who took the role of clinic assistant, and the patients and their families. Each group had a different level of involvement and this involvement had different time frames:
Consultant surgeons. The consultant surgeons were involved at an early stage of this project and took an active part in shaping the way the system would support their work during the training sessions. During the trial they took the lead in running the
consultations, within the limits and opportunities of the telehealth system, and engaged deeply with the researchers during the exit interviews. After the pilot trial they actively engaged with their hospital and state government to pursue funding for a one-year trial of this telehealth method. When I interviewed two of them nine months after the pilot trial, both reflected extensively on their experience during the trial. One commented, “We miss it more now than we did at the end of the trial”.
Clinic assistants. The staff who took the role of clinic assistant – registrars, surgical fellows, a clinic nurse and a specialist physiotherapist – had a different style of involvement in the trial. Within their role of clinic assistant, they took their responsibilities seriously in responding to the situation and the needs of their lead surgeon. They were generous and thoughtful with their comments in their exit interviews. When I contacted the hospital nine months later to request follow-up telephone interviews, most of these people had moved on to other roles within the public hospital system as part of their overall surgical training.
Patients and families. All the patients and families had agreed to take part in this research trial and played a supportive role during the consultation. In the exit interview, one parent observed that the hospital had been so good to her and her family during the
treatment of her child’s condition that she was glad that she could contribute something back by being part of the trial. While they engaged willingly during the 45 minutes of consultation and exit interview, there was no opportunity to engage with them prior to the trial and the trial did not last long enough to re-engage with them at their next appointment.
In addition to the three communities who took part in the trial there is a fourth
community: the support staff within the hospital, who recruited the patients, scheduled them for our clinics, relocated them within the hospital and coordinated the clinicians around our pilot trial requirements. Supported by their close working relationships with the clinical staff, these people went out of their way to make sure the logistics of this trial were put in place and maintained.
From an Action Research point of view, these involvements and time frames will have a major bearing on the design and conduct of any future long-term trial of this telehealth concept. While the current pilot trial engaged with the community of surgeons in this particular hospital’s Department of Surgery, it drew upon existing relationships (surgeons-junior surgeons, surgeons-patients and surgeons-support staff) and existing goodwill to carry the other participants into and through the trial. If a year-long trial between two different hospitals (for example, the Royal Children’s Hospital as the tertiary hospital and a regional Victorian hospital to host the remote patient’s clinic) were undertaken then an Action Research approach would require the researchers to consider how to sustainably engage all four of these communities.