Content analysis was used in respect of the information obtained from participants in these qualitative aspects of the study. This was undertaken by drawing up a list of coded similarities and differences in the answers, as suggested by Berg (2004), and then making a comparison with the expert letter survey findings. A manual process of open coding, followed by the construction of coding frames was used (Saunders et al., 2003; 2007), with the result that the information offered by participants was distributed into different types of text: sentences, phrases and words, the results of which are discussed in Chapter 5.
3.16.1 Content Analysis Description
The process of content analysis is described as „a dull and time consuming activity‟ (Bryman and Bell, 2007, p308), particularly where words are to be counted. In this study, phrases and themes were enumerated, rather than the words themselves. Individual words or word pairs (such as breach or patient confidentiality) served to trigger consideration of the context (phrase or sentence) in which they occurred.
The contexts (phrases or sentences) were then examined to see what recurrent elements were present. These recurrent elements were identified as themes. The labelling of the themes drew on the previously considered literature. The literature provided a „long list‟ of potential themes, which did not directly permit clear application to the field of patient confidentiality. The first expert letter was part of the approach to clarify these issues in terms of importance and to rank the subsidiary elements under the several themes. The themes were also considered against criteria relating to their frequency of occurrence: more regularly occurring themes were seen as more salient or important. Combining themes drawn from the interviews and focus group, moderated by the expert letter responses, was used to determine the list of factors and elements that were taken forward in the study. In this phase, it became evident for example that for these respondents, „technology‟ was a relatively uniform and undifferentiated concept. The content of response from individuals directly involved in the IT field might well produce a different and more nuanced perspective. For further information please see section 5.3, and 5.3.1.
The following chapter addresses the development of the UK confidentiality model into the patient confidentiality simulation model using the System Dynamics approach already mentioned in this chapter.
CHAPTER FOUR:MODELLING
4.1 Introduction
The preparation and planning process focused on ideas that eventually led to building a patient confidentiality system model that shows the processes associated with patient medical records. Intended for use in the general domain, the model is not concerned with explaining country-specific requirements, or exceptional cases such as access to the data of Very Important People (VIPs), because in the case of the latter, such information is extra sensitive, especially in respect of individuals who are in positions of power such as leaders and Prime Ministers, making these cases atypical of the day-to-day practice. Patient confidentiality in the cases of patients who have communicable diseases such as epidemic diseases, HIV, MRSA, STDs, hepatitis C and rare diseases will not be included in the model for the same reason.
Consequently, the model will focus on the general process of patients‟ medical records and highlight those places within the Health System environment where a breach might happen either by mistake or deliberately, and by whom.
The model was structured using the STELLA® software version 6.0.1. The model was built to develop the UK‟s confidentiality model (NHS, 2003) to describe the practice of patient confidentiality through several stages rather than focusing on protection, improvement, information and providing choice. As indicated earlier, the UK confidentiality model does not present the whole picture of the protection
of patient confidentiality such as where breaches might occur; nor does it give the percentage of such breaches, as mentioned in Section 2.4.
A development of the UK confidentiality model will address these shortfalls, and hence the newly-constructed model will provide health care mangers with the information to make future plans to minimize breaches of patient confidentiality within health organizations. Initially, some values from the secondary data and also dummy values were used in the proposed model of patient confidentiality to run the model and to observe the changes in the dynamics of behaviour over time.
The simulation model was used to investigate the movement or the processes of patient medical files within health systems through different departments, and accordingly to make comparisons of the amount of medical information breach within each such location. Hence, it is expected that the application of the proposed model will increase understanding of the dynamics of patient confidentiality, and also protect patient confidentiality within health systems and lead to a minimization of future information breaches.
The following sections introduce the development of the model structure; Section 4.2 covers the System Dynamics Model in general; Section 4.3 shows how the model was built; Section 4.4 shows the System Dynamics Model of patient confidentiality; Section 4.5 introduces the model structure; Section 4.6 covers the model itself; Section 4.7 introduces the model parameters; Section 4.8 shows the model equations; Section 4.9 presents breaches of patient confidentiality; Section 4.10 covers running the model; Section 4.11 presents the model running ; 4:12 discovers testing the model; Section 4.13 introduces extending the model; and
Section 4.14 covers developing the model and 4:15 covers the evaluation of the model.