CARE AIMS
METHODOLOGY AND METHODS
4.2 Design Considerations
An exploratory approach was used as it was felt to be the most appropriate due to the lack of research about the Care Aims approach: the aim of the research was to investigate the Care Aims approach and effect of culture and context for integrated team working for AHPs in community settings. An exploratory approach is considered useful when the topic is new and problems are in a preliminary stage and there are few or no earlier studies to which references can be made for information (Sim and Wright, 2000).
This study uses a qualitative approach which historically has tended to predominate in cultural studies (Mannion et al, 2008). This is supplemented by the use of two
standardised assessment tools to facilitate contextual comparison of the culture and climate in each case study. Mannion et al (2008) in one of the largest studies
measuring and assessing organizational culture in the NHS recommend using both quantitative and qualitative approaches to benefit from the strengths the different paradigms provide. This is explored further later in this chapter.
Both ethnographic and positivist methodologies were also considered. An
ethnographic approach was rejected due to a pragmatic rationale as I aimed to explore the implementation of the Care Aims approach in several teams. The aim and
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as would be expected with a positivist approach. There are cultural assessment tools available (Scott et al, 2001) that produce a numerical score and therefore permit statistical analysis. However this approach was considered to not provide the depth of understanding being sought and particularly limiting exploration of the impact of context.
Longitudinal studies were considered compared to cross-sectional designs but rejected due to the potential future impact of organizational change in a rapidly changing
organisational context (section 2.2). A longitudinal study would potentially have focused on one team with the findings possibly being influenced by the individuals in the team rather than the use of Care Aims. Also the number and range of AHPs in the team may have been limited. A cross-sectional design was used as this gave the opportunity to include more teams in the study and gain a better representation of the range of AHPs in teams.
This study is more aligned to the constructivist approach which acknowledges that truth is relative and dependent on one’s perspective (Baxter and Jack, 2008). One of the strengths of case studies is the use of multiple sources of data collection. In this study questionnaire, interview and documentary data were collected, results triangulated and then synthesized.
The study comprises of a series of case studies as this was felt to be most appropriate due to the exploratory methodology and exploring a current situation within its real-life context in some depth (Yin, 2014). To facilitate access to teams and completion of the study I chose to ask teams from my employing organization to participate. This also ensured that teams had received a relatively consistent approach to the teaching of the Care Aims approach. However I was conscious that there was potential for my position within the organisation to influence the outcome and therefore the inclusion criteria included that the team was not directly or indirectly managed by me. This immediately excluded 12 of the 24 teams in the organisation which were engaged in Care Aims learning and implementation at that time. I intended to complete case studies with up to 4 teams as this was felt a sufficient number of teams to enable comparison but which could also meet the inclusion criteria. The two most limiting criteria were identifying teams where I did not have a management relationship and teams not undergoing any other major service change. A list of teams who had completed the Care Aims training was provided by the organisation. Purposive sampling of teams took place to explore contrasting characteristics and context. As described in section 2.2 and later in section 5.2, there was considerable organisational change occurring
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with many teams being restructured which excluded them from being considered for this study. Teams also needed to meet the inclusion criteria and have the agreement of the service manager to participate. The teams were all community based, providing a range of specialist services and range in size between 8-30 staff. All staff were employed by one NHS Foundation Trust. The inclusion criteria are shown in table 4.1 (p.56).
Table 4.1 – Inclusion criteria for case study teams
Teams:
•
The majority of team members have completed the full Care Aims training•
The team includes Allied Health Professions•
The team is not undergoing any other major service change e.g. merging with another team•
The team manager is supportive of the research project and able to provide access to team members, team members time to fully participate in the study and willing for their team’s patients to be approached•
The team is not directly or indirectly managed by the researcherPatients:
•
Patients are able to give informed consent for themselves in order to participate in the study•
Patients are willing (or in the case of dependent patients both they and their carer are willing) to participate in the study•
Patients started their episode of care after the team introduced using the Care Aims approach•
Patients understand English sufficiently to give informed consent and complete the questionnaire e.g. do not need an interpreter to access their treatment.Another design consideration was the order in which to approach teams with respect to how long they had been practicing Care Aims. The decision was made to approach teams in the order in which they completed the Care Aims training to promote
consistency across the case studies. This also enabled teams who were relatively new to Care Aims the opportunity to embed Care Aims prior to date collection and also make the case studies more comparable. However it became apparent that due to several planned organizational changes this was not going to be possible and a more pragmatic approach was required.
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