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Understanding the Design of Health Care Organization: The Role of Qualitative Methods


Provide an overview of qualitative research methods ... Gertrude Jaeger Selznick, PhD. Fundamental Assumptions. of Qualitative Research ... – PowerPoint PPT presentation

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Title: Understanding the Design of Health Care Organization: The Role of Qualitative Methods

Understanding the Design of Health Care
Organization The Role of Qualitative Methods
  • Julie K. Johnson, MSPH, PhD
  • University of Chicago and the American Board of
    Medical Specialties

Aims of Presentation
  • Provide an overview of qualitative research
  • Discuss complementary roles of quantitative and
    qualitative methods
  • Explore strengths and limitations of qualitative
  • Delve more deeply into methods that are better
    suited to capture the complexity of healthcare
    (observations, focus groups, and interviews)

What is Our Collective Experience with
Qualitative Methods?
Qualitative Research Defined
  • An array of interpretive techniques which seek
    to describe, decode, translate, and otherwise
    come to terms with the meaning, not the
    frequency, of certain more of less naturally
    occurring phenomena in the social world.
  • To operate in a qualitative mode is to trade in
    linguistic symbols and, by so doing, attempt to
    reduce the distance between the indicated and the
    indicator, between theory and data, between
    context and action (Van Maanen 1979)

Qualitative Research
  • A process of inquiry into a social or human
  • data in the form of words
  • conducted in a natural setting emphasizing rich
    description and discovery
  • evaluated subjectively by systematically reducing
    data to themes and categories
  • emphasis is on theory development

Quantitative research
  • A process of inquiry into a social or human
  • based on testing a theory composed of variables
  • data in form of numbers
  • analyzed objectively with descriptive and
    inferential statistics
  • emphasizes hypothesis testing and verification

Qualitative vs. Quantitative Research
  • The goals of the researchers are similar
  • to achieve a robust theory

Qualitative vs. Quantitative Methods
  • Most importantly, the method (qualitative or
    quantitative) depends on the question you want to
  • Example from the 1999 Dartmouth Atlas of Health

(No Transcript)
Percent of Diabetic Medicare Enrollees Receiving
Annual HbA1c Testing
What Can This Quantitative Analysis Tell Us About
Diabetes Care?
  • There is significant variation in HbA1c
    monitoring among diabetic Medicare enrollees
  • HbA1c monitoring (8.9 - 70.2)
  • Similar maps show significant variation in
    retinal exams and LDL monitoring
  • Retinal exams (25.1 - 66.1)
  • LDL monitoring (6.8 - 68)

What Cant We Know From This Quantitative
  • We dont know why there is variation in the care
  • We dont know what the barriers are to providing
    the required services
  • We dont have any ideas about how to change the
  • We know little about the systems of care (the
    interactions of people, information, technology,
    and the physical environment) that produced these

Answering Those Types of Questions Requires
  • Qualitative interviews and observations
  • To understand the system that is producing the
  • To explore how interdependent individuals and
    groups function (or fail to function)
  • To connect the research to reality

Behind every quantity there must lie a quality
  • Gertrude Jaeger Selznick, PhD

Fundamental Assumptions of Qualitative Research
  • Holistic perspective
  • Seeks to develop a complete understanding of a
    phenomenon by studying it in its entirety
  • Inductive approach
  • Begins with observations and moves toward
    developing patterns as they emerge from the case
    under study
  • Naturalistic inquiry
  • Discovery oriented approach in the natural
    setting of the phenomenon

Strengths of Qualitative Methods
  • Can be relatively inexpensive and quick to
  • Do not need a lot of advance work
  • Enable organizations to gain a deeper
    understanding of processes and phenomenon as they
    exist in its own unique environment
  • Can also provide the cross-level or meso
    research that examines individual provider
    behavior within the context of the clinic or
    group that, in turn, may be embedded within a
    larger organizational structure such as an
    integrated health

Limitations of Qualitative Methods
  • Labor intensiveness (and extensiveness) of
    collecting, coding, and processing data
  • Data overload
  • Possibility of researcher bias
  • Adequacy of sampling
  • Focus on individual cases may limit the
    generalizability of the findings

Limitations can be addressed through careful
study design
  • External validity
  • Study multiple cases
  • Internal validity
  • Verify results with participants
  • Triangulate data collection
  • Reliability
  • Careful documentation of data collection and

  • The most widely recognized types of qualitative
    research methods
  • Evolved from cultural anthropology with a focus
    on cultural patterns of village life and asked
    questions about what can be learned from the
    people (or the natives)
  • In health services research, the focus is on
  • Effects of culture on health care
  • Institutions or professional groups as a cultural
  • Peoples perceptions or thoughts as they go about
    their work

  • Methods include
  • Participant observations
  • Interviews
  • Focus Groups

Observational Studies
  • The researcher
  • Spends time in the setting under study a
    program, organization, or community
  • Makes firsthand observations of the activities
    and interactions
  • Take voluminous field notes, which are organized
    into readable narrative description with major
    themes, categories, and illustrative case

Observational Studies
  • Decide what it is that you want to observe
  • Pilot test observations to find out what the
    opportunities are
  • Develop a method for your own use to make it easy
    to capture the data

  • To gain knowledge of individual perspectives
  • Informal conversational interview
  • Questions flow from the immediate context, varies
    from interviewee to interviewee
  • Interview guide
  • A list of questions or issues that are to be
    explored during the interview, everyone is asked
    about the same issues, but the questions may vary
    based on individual response
  • Standardized open-ended interview
  • Asks the exact same questions of each person
  • Minimizes interviewer effect

Focus Groups
  • Originated in Business administration and is used
    to obtain a range of opinions on products, with
    the goal of enhancing market strategy
  • Participants attitudes and perceptions are
    developed through interaction with each other

Focus Groups
  • Data from interview questions reflect experience
    from the individual participants, but very
    different from one-on-one interviews because of
    the ability to interact with other participants
    around the focus group questions

Moderating Focus Groups
  • In the best focus groups, the moderators role
    is more as a listener and a learner…so that the
    group itself can seek out affirmation and
    feedback from each other. Thus, the group takes
    its own direction. As a result, more natural
    themes are brought out.
  • David L. Morgan, 2004
  • Conducting Focus Groups, U of M Summer Institute

Types of Questions Qualitative Methods Could
  • What is the role of noise and lack of sunlight in
    influencing patient moods, drug needs and
  • What is the role of adjacencies and space lay out
    in supporting team functions in complex health
    care settings?
  • Why do hospitalized patients fall out of bed on
    their way to the bathroom?
  • What happens when patients get transferred from
    one ward to another? What information is lost?
  • What is the role of team members in ensuring safe
    delivery of care?

What Are the Design Issues You Face?
  • How might observations, interviews, or focus
    groups provide insight in to these issues?
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