Developing practice and staff: enabling improvement in care delivery through participatory action research

We describe the process and outcomes of a programme to enable improvement in care coordination in a children's hospital. Staff identified care coordination issues they wanted to improve and were facilitated to achieve change using a participatory action research (PAR) approach. The seven participating wards were each offered the same opportunity and yet the degree to which they were able to engage in the process, and the level to which they achieved outcomes, varied considerably. The most successful wards were those with proactive leadership and stable management and where a trusting relationship was established between the staff and the programme facilitator. The least successful were those experiencing ward closure, mergers or changes in management structure. We consider how the different levels of achievement can be understood and what implications this has for using participatory action research to promote service improvement and to facilitate staff development.