Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

John Peters

Committee Members

Trena Paulus, Ernest Brewer, Diana Moyer


Behavioral health organizations have new requirements to participate in quality improvement practices, thus prompting the need to proactively improve service delivery. A behavioral health team in western North Carolina embraced Levelising as a quality improvement tool. Levelising is an aspect of reflective practice that engages participants in multiple perspectives on ways of practicing. In this study, I used DATA-DATA, an action research model developed by Peters (2004), to reflect on and study an aspect of my practice as quality management director.

I taped recorded team meetings, conducted interviews, and wrote about my observations in a reflexive journal. Outside rater-observers listened to the audio recorded meetings and rated the levels in the Levelising model engaged in by participants. Their ratings, along with my journal notes, addressed the first research question, “What levels in the Levelising model did participants engage during the study?”

In the interviews, participants described their use of Levelising as a continuous quality improvement (CQI) tool and their experiences of the meetings. The interview transcript data, along with my journal notes, addressed the second and third research questions: “What difference did Levelising make in participants’ development of a CQI project?” and “What was each participant’s experience of the meetings?”

The study’s findings from the multiple strategies are discussed in terms of six points: (1) the levels in Levelising; (2) improvements in consumer care; (3) improvements in team functioning and relationships; (4) change resistance; (5) reflection on practice; and (6) the roles of teaching and facilitating. The rater-observers and I observed the team primarily engaged in levels 1 and 2 of the Levelising model: pre-reflection and reflection respectively. The team reported an improvement in consumer care when they created a structured meeting, implemented team agreements, and reviewed each consumer daily. Initially, the team did not want to change an aspect of its practice, and had to overcome this resistance. In spite of early resistance, participants described that slowing the process for reflection in order to inquire into others’ perspectives improved team functioning and resulted in a positive change in their practice.

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