Integrating%20quantitative%20and%20qualitative%20approaches:%20an%20approach%20applied%20to%20the%20study%20of%20Intensive%20Care

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Integrating quantitative and qualitative
approaches an approach applied to the study of
Intensive Care

• Presented by Ruth Kowalczyk

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Intensive Care

• A service for patients with potentially
  recoverable diseases who can benefit from more
  detailed observation and treatment than is
  generally available in the standard wards and
  departments.
• Kings Fund Panel (1989)

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Why study Intensive Care?

• Little research done
• Expensive service
• Increasing demand
• Highly politicised mistakes

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Why study effectiveness?

• Within the NHS
• Within Intensive Care

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Performance measures

• Effectiveness
• Efficiency
• Customer satisfaction
• Staff satisfaction
• Growth

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Factors affecting ICU management
Diagnostic diversity
Effect of other units
Unit size
Workload
Case mix
Technology

Location
Demand
Resources
Staffing
ICU management
Structure
Work routine
Policies
Personnel
Personalities
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Research Questions

• What does managerial effectiveness actually mean
  to intensive care?
• Is there a way to compare units with others like
  themselves?
• Can the performance of a unit be improved by
  adopting the policies or practices of another
  unit?

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Research Questions

• How do the policies of a unit affect the
  practices of the unit staff?
• How does the management structure of a unit
  affect its performance?

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Answering the Research Questions
Managerial effectiveness
Comparing units
Improving performance
Statistical analyses mathematical modeling
Impact of policy on practice
Effect of structure on performance
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Answering the Research Questions
Observation interviewing
Managerial effectiveness
Comparing units
Improving performance
Statistical analyses mathematical modelling
Impact of policy on practice
Effect of structure on performance
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Mixing Methods

• Qualitative methods
• as a prerequisite to quantitative methods
• to supplement quantitative methods
• to examine areas not amenable to
• quantitative methods

Pope Mays, 1995
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Mixing Methods

• Quantitative methods Qualitative
  methods
• What How Why

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Quantitative Qualitative methods

• Case study, including
• Observational study
• Semi-structured interviews.
• Semi-structured interviews in 4 ICUs identified
  by quantitative analysis.

• Correlation, ANOVA and regression
• Data Envelopment Analysis

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Limitations to DEA in complex situations

• Conflicting output measures
• Outputs or inputs?
• Low correlations

Careful interpretation of results
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Intensive Care in context - Patient movement
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Integration of ICU within the Hospital

• ICU nurses as distinct sub-culture

• work
• knowledge
• relationship with doctors

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Integration of ICU within the Hospital

• An integrated unit is more likely to have
• better patient survival,
• more transfers out,
• ability to maintain occupancy standards,
• nurse post-basic training,
• no intercollegiate recognition.

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Quantitative Qualitative methods
Method
Evaluative Research
Framework
Realism
Ontology
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Evaluation research

• Key features of evaluation -
• Value Worth
• Real World Research
• Diversity

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Utilisation of research

• Involving stakeholders
• Context
• Process v. outcome
• Whose needs?
• Incremental
• Time span

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Key features of Realism

• Stratified Ontology
• Retroduction
• Mechanism in Context ? Outcome
• Emergence

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References

• Pope C. Mays N., Reaching the parts other
  methods cannot reach an introduction to
  qualitative methods in health and health services
  research, BMJ, 1995 311 42-5.
• Kings Fund Panel, Intensive Care in the UK,
  Anaesthesia, 1989 44 428-31.

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Other Useful References

• Mingers J., The contribution of critical realism
  as an underpinning philosophy for OR/MS and
  systems, JORS, Vol. 51, No. 11, November 2000.
• Pawson R. Tilley N., Realistic Evaluation,
  1997, Sage, London.
• Robson J., Real World Research A resource for
  social scientists and practitioner researchers,
  1993, Blackwells, Oxford.
• Sayer A., Realism and Social Science, 2000 ,
  Sage, London.