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This chapter describes two change efforts involving participatory action research within the pharmacy operations division of Kaiser Permanente. Focus is on a parallel learning mechanism that has been used to support communications and change during two large-scale information technology interventions. It begins with basic background information on participatory action research in organizations. Since the case setting is Kaiser Permanente, the chapter provides some information on the U.S. healthcare industry context and then shifts to Kaiser’s communication forum, a learning mechanism that has been in place for 35 years. Cognitive, structural, and procedural aspects of the learning mechanism are explored, and the chapter features interviews with some of the key forum players. Both in the forum’s infancy and in its current more institutionalized state, the pharmacy organization has been in crisis. Implications for the use of parallel learning structures on a long-term basis to support long-term participatory action research are explored along with contributions to theory on insider/outsider action research.