Practical Considerations

May (2001) cites the work of Kahn & Cannell (1983) in a discussion of the conditions required for successful research interviews. Three issues are raised, namely accessibility, cognition and motivation. Each of these is considered in this section, with particular reference to the semi-structured interviews carried out in this study.

Accessibility issues potentially arise when, for a variety of reasons, there are limits to the extent to which the interviewee can provide the information sought by the interviewer. It may be that the interviewee has forgotten the details required; that the information is personally sensitive leading to a reticence about divulging it; or that the

interviewer expects a method of answering which is not familiar to the interviewee (eg within an unfamiliar frame of reference). In addition, and linked to the issue of interviewee motivation, some data may be difficult to access due to perceived political and ethical sensitivities.

In relation to this study, the temporal considerations were of particular relevance. Those interviewees who had taken part in earlier cohorts of the THF leadership programme may have completed the associated improvement work two or three years prior to the research interview, and therefore the recollected detail of this was not as fresh as with more recent Award Holders. In some cases, interviewees had changed jobs or organisations at least once during the intervening period, meaning that they were not in a position to know what had happened with their improvements to services since they had left. This impacted on the amount of data which could be gathered about the sustainability of these pieces of improvement work. On the other hand, in those cases where respondents were from earlier cohorts, had a good memory of the improvement work and were still associated with the same services, there was scope to gather more data about the sustainability of improvements, than from more recent respondents, where the improvements had not yet had time to embed themselves. Within the agreed sampling frame and practical limits of the study, the researchers aimed to interview a mix of earlier and more recent Award Holders. The second condition for successful interviews, according to May (2001) is cognition. This relates to the interviewee having clear expectations about what sort of information is required and also about their own role in the interview. The importance of this is issue is highlighted by May (ibid) in his reminder that,

‘interviews are social encounters and not simply passive means of gaining information.’ (p.128)

For this study, potential issues of cognition related to the various stakeholders in the study. Several sets of organisational and personal loyalties were part of each interviewee’s experience of the leadership scheme. Each interviewee had been funded for the leadership scheme by the Health Foundation, and given permission to take part by their NHS employer, which may have been a different organisation from their current employing body. The interviewee would also have built a relationship with the providers of the leadership scheme, potentially including several individual academics, management consultants and leadership coaches. In addition, the high profile of the THF leadership schemes meant that Award Holders had high expectations of themselves and what they could achieve from their participation. The nature of the interview indirectly invited the respondents to reflect on their own performance during the leadership scheme, and to share their perceptions of this with the interviewer, who was a relative stranger. The need for rapport-building early on in the interviews was therefore of particular importance.

Within the introductory comments before the interview, it was important for the researcher to allow for any of these cognition issues to be raised and clarified where needed, to enable the interviewee to engage in the interview as fully as possible. Thirdly, May (ibid) refers to motivation as a key consideration in providing optimal conditions for the research interview, stressing that,

‘the interviewer must make the subjects feel that their participation and answers are valued, for their cooperation is fundamental to the conduct of the interview. ‘ (p129)

Within this study, amongst those who responded to email requests for participation, there was a high level of cooperation with the evaluation work, and a high degree of motivation to help with the study. In terms of building rapport with respondents and helping them to feel that their participation was valued, there were issues of consistency to take into account, by virtue of three different researchers undertaking the interviews. Inevitably, each interviewer’s style varied to some extent, even within the framework of a uniform interview schedule, particularly in the more free-flowing sections of the interview. As the study progressed, all interviews were transcribed and sent to the author, who undertook the interview analysis for all interviews. This provided an element of consistency verification in the interview process, allowing early transcriptions from different interviewers to be compared for style, and for differences to be discussed among the interviewers so that minor changes in style and emphasis could be made where necessary.

5.4

Interview Analysis Frameworks

Two separate frameworks were required for analysing the interview data; one to code the data about types of improvement work, and the second to code the data about leadership behaviours. This section provides details of the rationale for selecting particular frameworks for this purpose.

Coding has been defined by Strauss (1988) as,

‘the general term for conceptualizing data; thus, coding includes raising questions and giving provisional answers (hypotheses) about categories and about their relations.’ (p.20-21)

In this study, the main questions and hypotheses raised by the coding process related to how to make sense of the extensive and rich, qualitative data pertaining to NHS improvement work and reported leadership behaviours. How could the data be systematically ordered so as to offer insights into the research questions? Were any patterns or associations evident within or between the datasets? If so, what might explain these patterns? If no patterns were evident, what might that suggest about the research methodology or the subject of the research? Did the data provide any new understanding of how NHS improvement and leadership are linked?

In respect of the data about improvement type, the method of coding SSI data and the rationale for this were clear. As detailed in Section 5.2, the extensive work to develop the Healthcare Improvement Typology had as its core purpose to provide a framework for coding the qualitative data gathered during the interviews.

The main piece of improvement work described by SSI respondents was used as a basis for assigning a quantitative 4-integer rating to the work, against the Healthcare Improvement Typology (eg 1111 to 7777). The higher the rating for the improvement work, the more complex its nature, based on the four dimensions of Focus, Level, Process and Intended Impact. This rating was treated as an indicator of complexity for the improvement work undertaken by each respondent. For illustrative purposes, a

worked example of how ratings were assigned to improvement work described during the SSIs is shown in the next section.