Precess Overview

Changing practice in a hospital setting can be difficult – fraught with a list of barriers that is uncovered throughout the process. Solving the barriers of today simply reveal the new barriers of tomorrow. A new research methodology, PRECESS, developed by a team of researchers from the US Healthy Children Project, and piloted by Healthy Children Project (USA), Karolinska Intitutet (Sweden), Karolinska Hospital (Sweden) and the Egyptian Lactation Consultant Association (Egypt), uses ethnographic methods combined with hands-on expertise to drive lasting change. PRECESS stands for Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success.

The PRECESS methodology expects sustainable change in a short period of time, only five days. The PRECESS methodology provides an opportunity for clinicians who are experts in the new technique to work in a practical manner side-by-side with the staff of the changing hospital for a limited amount of time. The hospital staff at the changing hospital then have the responsibility to continue the new process. During the time together, the PRECESS team uses video ethnography and interaction analysis, combined with expert education and practical application of the new knowledge, to document the work practice in the hospital, and to assist the staff in seeing their own work via interaction analysis, and to identify the barriers and solutions that, by necessity, would be unique to their situation.

A key component of this method is the basic assumption that the members of the site are the experts of their environment – not the outside experts who are brought in. Although these external experts have vital information about research, experience and practice, as well as all aspects of the PRECESS method, it is the hospital staff that are the experts in their hospital – it’s practice, history and people. The change needs to grow from within the already existing environment in order to succeed. External experts can offer information, but in order for that information to be integrated into the hospital’s practice for long term success, the grounding of the material needs to be integrated by the staff. This was achieved through the use of practical education combined with ethnography, video and workshops.

The methodology has five steps. The first step is to educate the staff about the new procedure with experts in the field. The second step is the practical application of the new procedure, with experts and staff working together, continuing the educational process. The third step is to video tape the evolving process as the hospital staff implement the new procedures. The fourth step is an Interaction Analysis workshop to review and discuss barriers and solutions. The fifth step in the continuing application of the procedure.

The Healthy Children Project/ Karolinska Institutet / Karolinska Hospital team includes internationally recognized experts in midwifery and lactation who provided the practical and educational information about the importance of continuous skin-to-skin care in the first hour and an experienced ethnographer whose expertise includes making meaningful change in work practice. Independently collected data verified that the PRECESS method had resulted in sustained practice of the mother and baby remaining skin-to-skin until the completion of the first breastfeeding.

Please feel free to contact Dr. Kajsa Brimdyr, 508.888.8044, kajsa@healthychildren.cc with any questions