Providing Feedback and Providing Feedback and Involving Stakeholders in Involving Stakeholders in

the Research Process: the Research Process: TRIAGETRIAGE

Monique Carrière PhD, Sylvie Tétreault Monique Carrière PhD, Sylvie Tétreault PhD, Eve-Line Bussières MPsPhD, Eve-Line Bussières MPs, & , &

Martine Giroux, MAMartine Giroux, MA

Rehabilitation Department, Rehabilitation Department, Laval University, Quebec CityLaval University, Quebec City

Monique.Carriere @rea.ulaval.caMonique.Carriere @rea.ulaval.ca

Abstract Abstract

Stakeholders are the first actors concerned by the results of evaluation and research. In a perspective of transparency and exchange, it is important to involve participants in the reflection process and to give them feedback.

This study focusing on managers’ contribution to partnership between families and rehabilitation therapists illustrates this process in two phases :

1° managers are interviewed individually

2° the actions proposed by managers during the individual interviews are examined by managers in group sessions conducted with TRIAGE

The purpose of TRIAGE is to provide feedback and allow managers to select which actions are compatible with their context. TRIAGE facilitates interactions between researchers and participants, which in turn favors transparency.

Illustration of the ProcessIllustration of the Process

““Contribution of managers to Contribution of managers to partnership between families and partnership between families and rehabilitation therapistsrehabilitation therapists””– Granted by the FQRSC (2001-2003)Granted by the FQRSC (2001-2003)– Qualitative and exploratory study in six Qualitative and exploratory study in six

rehabilitation centers in Quebec provincerehabilitation centers in Quebec province– Theoretical approach : Structuration Theory Theoretical approach : Structuration Theory (Giddens, (Giddens,

1987)1987)

– A dialectic and constructivist approachA dialectic and constructivist approach

Main Research GoalMain Research Goal

Better understanding of managers’ perceptions and contribution to partnership between families and rehabilitation therapists

Specific ObjectivesSpecific Objectives1) 1) To describe and explain managers’ intentions

and actions regarding the families and the therapists’ partnership

2) 2) To determine contextual elements that facilitate or limit managers’ actions

3) 3) To highlight self-evaluation of managers’ influence on collaboration

MethodologyMethodology

Phase I:Phase I: Data collectionData collection Individual interviews with participantsIndividual interviews with participants

Phase II:Phase II: Data treatment by participantsData treatment by participants TRIAGE : TRIAGE : TTechnique forechnique for R Research of esearch of IInformation by nformation by AAnimation of a nimation of a GGroup of roup of EExperts xperts (Plante & Côté, 1993)(Plante & Côté, 1993)

ParticipantsParticipants

Phase IPhase I (N=48)Participation rate ~ 52%

Phase IIPhase II (N=26)Participation rate ~ 65%

(5 meetings for TRIAGE)Top Managers n=13

Middle managers n=16

Board members n=15

Professional advisors n= 4

29 women / 19 men29 women / 19 men

Top managers n=3

Middle managersn=23

21 women / 5 men21 women / 5 men

Phase IPhase I

Themes for the Individual Interviews (individual production of TRIAGE)(individual production of TRIAGE)

    Contextual data Contextual data     Managers’ experienceManagers’ experience     Perceptions of collaboration between familiesPerceptions of collaboration between families and therapistsand therapists    Managers’ intentionsManagers’ intentions    Managers’ actions and resourcesManagers’ actions and resources    ReflectionsReflections

Between Phase I and Phase Between Phase I and Phase IIII

Interviews’ analysis Interviews’ analysis (n=48)(n=48)

Development of 100 statements Development of 100 statements and more from individual and more from individual interviews.interviews.

Extraction of 20 statements from Extraction of 20 statements from scientific literature and previous scientific literature and previous research research (St-Onge, Tétreault, & Carrière, 2002)(St-Onge, Tétreault, & Carrière, 2002)

RESULTS RESULTS Phase IPhase I = MEMORY = MEMORY Phase IIPhase II

Action propositions of managers Action propositions of managers toward:toward:

Partners Partners n=39n=39

Parents and Parents and Therapists Therapists

PropositionsPropositions

Pull

AssociationAssociationss

CommitteeCommitteess

n=12n=12

TherapistTherapistss

n=54n=54ParentsParentsn=18n=18

Literature Literature RecommendationsRecommendations

Examples of Managers’ Actions Managers’ Actions Regarding ParentsParents– “ “ Meet with parents whoMeet with parents who

complain ”complain ”– “ “ Give resource information ”Give resource information ”– “ “ Survey parents’ opinions ”Survey parents’ opinions ”– “ “ Support parents ”Support parents ”– “ “ Consult parents about Consult parents about servicesservices offered ”offered ”

– “ “ Meet with therapists who Meet with therapists who         complain ”complain ”– “ “ Give resources to therapists ”Give resources to therapists ”– “ “ Supervise therapists Supervise therapists (coaching) ”(coaching) ”– “ “ Recall the center’s philosophy Recall the center’s philosophy ””– “ “ Support therapists ”Support therapists ”

Examples of Managers’ Actions Managers’ Actions Regarding TherapistsTherapists

– ““ Simplify administrative procedures Simplify administrative procedures ””– ““ Promote partnership Promote partnership ””– ““ Evaluate programs Evaluate programs ””– ““ Hire people who are willing toHire people who are willing to work in work in partnership partnership ””– ““ Maintain coherence between the Maintain coherence between the center’scenter’s orientations and the rehabilitation orientations and the rehabilitation objectives objectives ””

Examples of Managers’ Actions Managers’ Actions Regarding Partners and Other Partners and Other

ManagersManagers

Examples of Managers’ Actions Managers’ Actions Regarding Parents’ AssociationsParents’ Associations

– ““ Clarify problems and find a Clarify problems and find a solutionsolution””– ““ Help and support parents’Help and support parents’ associationsassociations””– ““ Defend parents’ associationsDefend parents’ associations””– ““ Promote exchanges between Promote exchanges between associations and rehabilitation associations and rehabilitation centerscenters””

Examples of Parents Parents and Therapists Therapists

propositionspropositions

– “ “ Hire more staff ”Hire more staff ”– “ “ Maintain a rehabilitation team Maintain a rehabilitation team stability ”stability ”– “ “ Consider parents’ preoccupations ”Consider parents’ preoccupations ”– “ “ Support parents ”Support parents ”

– “ “ Share rehabilitation approach with Share rehabilitation approach with school setting ”school setting ”

–“ “ Develop interventions at school, Develop interventions at school, kindergarten and home ”kindergarten and home ”

Examples of Literature RecommendationsLiterature Recommendations

– “ “ Consider parents as experts ”Consider parents as experts ”– “ “ Form therapists with the family Form therapists with the family centered approach”centered approach”– “ “ Support families ”Support families ”– “ “ Let families take part of the Let families take part of the decisiondecision making process ”making process ”

– “ “ Develop a communication andDevelop a communication and information system ”information system ”

Phase II: PreparationPhase II: Preparation

Participants receive a package Participants receive a package containing :containing :

- - the TRIAGE process description the TRIAGE process description

- the questions that will be examined- the questions that will be examined

in TRIAGE in TRIAGE

- the statements taken from the six - the statements taken from the six

rehabilitation centersrehabilitation centers

Phase II Phase II : : TRIAGETRIAGE Realization of TRIAGE groups Realization of TRIAGE groups (between 3 and 10 (between 3 and 10

participants)participants)

in participating rehabilitation centersin participating rehabilitation centers Collective and interactive production Collective and interactive production Continuous visual supportContinuous visual support Consensus-focused techniqueConsensus-focused technique 3-step process :3-step process :

• Validation of statements• Regrouping and reformulation of statements (if necessary)

• Selection of statements (priorities) Involves participants and gives them feedbackInvolves participants and gives them feedback

Phase II : TRIAGEPhase II : TRIAGE

MEMORYMEMORY GROUPING / GROUPING / REFORMULATION REFORMULATION

/ SELECTION/ SELECTION

FRIDGE :FRIDGE :Statements to be Statements to be discussed laterdiscussed later

VETO :VETO :Statements to be Statements to be treated later by treated later by external expertsexternal experts

TRASH :TRASH : Statements not Statements not relevantrelevant

TRIAGE Follow-upTRIAGE Follow-up

Feedback to participants by sending them the list of priorities established in TRIAGE sessions

Evaluation of TRIAGE by the participants

Results’ analysis of TRIAGE by the researchers

• for each center in its context• for all the centers

Report writing and its distributionPull

TherapistsTherapists 1. Recall center’s vision1. Recall center’s vision2. Give resources 2. Give resources (training in family intervention)(training in family intervention)

ParentsParents1. Support families 1. Support families (information on resources and tips)(information on resources and tips)

Parents’ AssociationsParents’ Associations1. Make alliance with parents’ groups1. Make alliance with parents’ groups

PartnersPartners1. Simplify administrative procedures1. Simplify administrative procedures2. Promote partnership2. Promote partnership

Some Priorities of the Some Priorities of the Managers in Managers in RC #1RC #1

ReRegarding…garding…

Some Priorities of the Some Priorities of the Managers in Managers in RC #2 RC #2

RRegarding…egarding…

TherapistsTherapists 1: Give therapists working tools 1: Give therapists working tools (to help families)(to help families)

2: Be available to guide therapists 2: Be available to guide therapists (especially new ones)(especially new ones)

ParentsParents1: Develop interaction tools for the families1: Develop interaction tools for the families2: Evaluate parents’ satisfaction 2: Evaluate parents’ satisfaction (surveys)(surveys)

Parents’ Associations:Parents’ Associations:1: Find a solution when there is a problem1: Find a solution when there is a problem

PartnersPartners1: Build partnership1: Build partnership2: Take action to promote social participation2: Take action to promote social participation

Some Priorities of the Some Priorities of the Managers inManagers in

RC #3RC #3 Regarding…Regarding…TherapistsTherapists 1: Give therapists appropriate work conditions1: Give therapists appropriate work conditions2: Facilitate communication in every way2: Facilitate communication in every way

ParentsParents1: Organize structures to give a place to parents1: Organize structures to give a place to parents2: Examine the waiting lists’ issue2: Examine the waiting lists’ issue

Parents’ AssociationsParents’ Associations 1: Give information, promote parents’ participation1: Give information, promote parents’ participation

PartnersPartners1: Promote partnership1: Promote partnership2: Promote coherence between center’s functioning and2: Promote coherence between center’s functioning and rehabilitation goals rehabilitation goals

Ultimate FeedbackUltimate Feedback Diffusion of the final report in rehabilitation Diffusion of the final report in rehabilitation

centers, rehabilitation center associations, centers, rehabilitation center associations, and government officesand government offices

Presentations and discussions in each Presentations and discussions in each rehabilitation centerrehabilitation center

Presentations in scientific and professional Presentations in scientific and professional conferencesconferences

Continuous education and university trainingContinuous education and university training

Participants ’Participants ’ Feedback Feedback about TRIAGEabout TRIAGE

Main contributionsMain contributions - Reflexive activity about managers’ contribution - Reflexive activity about managers’ contribution

to collaboration between parents and therapists to collaboration between parents and therapists - Creative problem solving - Creative problem solving - Better understanding of organizational values- Better understanding of organizational values- Development of an overall picture of parents’ - Development of an overall picture of parents’

position in rehabilitation centersposition in rehabilitation centers

Main difficultiesMain difficulties- Time-consuming process - Time-consuming process - Treating statements coming from other centers- Treating statements coming from other centers- Scheduling a meeting with several managers- Scheduling a meeting with several managers- Make consensus- Make consensus

StrengthsStrengths - Flexible - Flexible (different contexts, group sizes and questions)(different contexts, group sizes and questions)

- Production of valid material- Production of valid material- Easy to use - Easy to use (visual support, usual animation (visual support, usual animation

technique)technique)

- Gives feedback while involving participants- Gives feedback while involving participants

PitfallsPitfalls- - Challenges of animationChallenges of animation- Time-consuming process- Time-consuming process

Researchers ’Researchers ’ Feedback Feedback about TRIAGEabout TRIAGE

RésuméRésumé Les acteurs sur le terrain sont les premiers concernés par les résultats des évaluations et de la recherche. Dans une perspective de transparence et d’échanges, il s’avère important d’impliquer les participants dans un processus de réflexion et de leur fournir des rétroactions.

Cette étude portant sur la contribution des gestionnaires à la collaboration entre les familles et les intervenants en réadaptation illustre ce processus composé de deux étapes :

1° entrevues individuelles avec les gestionnaires

2° les actions proposées par les gestionnaires lors des entrevues individuelles sont examinées par les gestionnaires lors de sessions de groupe animées avec TRIAGE

L’utilisation de TRIAGE fournit des rétroactions aux gestionnaires et leur permet de déterminer des actions qui sont compatibles avec leur contexte. TRIAGE facilite les interactions entre les chercheurs et les participants et favorise la transparence.