Reflections on my role as a researcher

My background as an NHS manager working in two designated AHSC partnerships has had a profound influence throughout this research process. I tried to use the benefits of this status (gaining access and a pre-existing understanding of the organisational context) to best effect, whilst mitigating against the drawbacks with robust validation throughout the research (in line with a realist approach). This is illustrated in the following three examples.

Firstly, practitioners have the benefit of being consistently ‘in the field’ and regular (if time limited) opportunities to consider what research questions may be appropriate (Tietze, 2012). The initial idea for research on the realities of how to integrate an AHSC developed while I was employed by a partnership Trust at Delta AHSC. In addition to my day job as a service manager, I was asked by a Director of the Trust to support one of the work streams established to set up the AHSC middle

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professional (though clinician scientist dominated) executives drawn from across the four partnership organisations. Listening to (and trying to minute) conversations at these meetings, I constantly reflected on what a complex and difficult process it was trying to draw together four linked but different organisations around one shared mission. I then changed jobs and was employed by the trust in Gamma AHSC, and was struck by the differences in organisational structures, culture and corporate framing of the concept of the AHSC between the two cases. I had regular conversations with colleagues at both organisations about potential research opportunities on the topic in advance of applying for the NIHR fellowship which funded the study.

Secondly, as noted above, 'insider' researchers have different (sometimes

competing) roles and identities (Adler & Adler, 1987). I occasionally struggled with a tension between being a researcher and being a manager. As a manager, I was acutely aware of how complex and challenging making changes in the NHS and mobilising knowledge between research and clinical practice often is. Therefore, when I began collecting data on the Connect project, which effectively bridged boundaries in a novel way and identified ways around issues such as IT in the NHS, it was hard not to become too excited by the project and ‘go native’. I made a conscious effort not to romanticise events in this case. Linked to this, as I gradually became more aware of the project it was very challenging not to participate in meetings. I developed very good relationships with the research participants and found it challenging not to ‘help’ in certain situations, where for example I knew a potential way round a particular problem the team were grappling with. The process of presenting my findings and discussing them with the team at the end of the data collection process helped with this potential conflict of interest.

Thirdly, this ‘insider or outsider’ status (Merton, 1972) was visible and occasionally manifested in situations where my previous background was problematic to my status as a non-participant observer. I mitigated this risk by selecting tracer cases that were unfamiliar to me, but could not completely avoid it. For example, in one observation the Connect team met with a former colleague of mine. I informed the Connect team and the former colleague about the situation and all agreed to me observing the meeting. On the day, I travelled to the meeting with the Connect team and, as I knew where the meeting room was, led the way:

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I opened the door to the meeting room, with Sue and Joan behind me. Mark, a former consultant colleague, looked up, saw me, stood up and with his arms outstretched, cried “Catherine!.. Great to see you!” And embraced me with a big hug.. [observation 32:28/11/12]

The meeting then progressed, but my status as a non-participant observer was challenged. Thankfully however this was a rare situation across the whole data collection process.

Overall I felt my background was of benefit to the study, but that the reflexive process was vital to ensure validation of the findings.

3.6 Conclusion

This chapter has outlined the research process for this study and highlighted some of the key decisions and choices made along the way. It describes the critical realist approach underpinning this study and how this has influenced the case study

design, selection of cases and quality control of what is a fascinating if potentially overwhelming and complex topic. I have outlined how the data were collected and analysed and how I attempted to use the benefits of my career background (such as gaining access to the cases) whilst mitigating the risks associated with my prior assumptions and biases. My approach however has had (practical and theoretical) limitations, particularly in relation to case selection. I return to this in the final discussion chapter (Chapter 8), as it is more logical to discuss them following the presentation of the empirical cases.

The following four chapters present my study findings. Chapter 4 details the organisational boundaries and boundary work in the AHSCs. Chapter 5 introduces the two tracer cases. Chapter 6 details the properties of boundaries within the tracer cases and wider AHSCs, and Chapter 7 the mechanisms of boundary work across them.

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Chapter 4

Findings: AHSCs as an emerging