Research Instruments and Pilot Study

The questions provided by the researcher through interviews or questionnaires should be subjected to a preliminary test which is known as a pilot study (Sekaran, 2003; Yin, 2009). The completed pilot study was found to be very beneficial in filtering the questions and clarifying the words. Also it helps to measure the effectiveness of the questioning techniques and the approach involved in all the different questionnaires as a part of the phase implementation. The respondents in this study were from developed and developing countries which means that in some cases a unique and more distinct approach was needed.

Moreover, in order to overcome any potential cultural issues, the pilot study was focused on the LMIC. The sample size for the pilot study was 10 managers and policy makers in both developed and developing countries. Interestingly enough, some of the questions were not completed because the questions were not particularly clear to the respondents. This was especially true in the LMIC healthcare setting due to the framing of the questions of using Likert scale questions approach by asking people to respond to a series of statements about a topic, in terms of the extent to which they agree with them. Likert- type or frequency scales use fixed choice response formats and are designed to measure attitudes or opinions (Bowling, 1997; Burns, & Grove, 1997; Rattray & Jones, 2007). Some scholars advocated a pre-test questionnaire of this nature in order to confirm the appropriateness of the data collection instrument (Glaister & Buckley, 1999; Weng, 2004). Malhotra et al. (1996) cautioned that when using a Likert-type scale measurement, researchers need to test the significance and appropriateness of the anchors. In this study, the Likert scale questioning technique was applied for all questions because it allows for easier data analysis and has been tried and verified both through a pilot study and previous similar JV research.

120 A research instrument was developed to collect the required data. Specifically, a web- based survey approach was used for collecting, storing, utilizing and transmitting data. The survey followed these guidelines: ensure that the procedures fulfil the principles of voluntary participation and informed consent, maintain the confidentiality of information obtained from or about the participants, address possible risks to participants and secure the data and access only via a username and password.

Proposition examined for this research required both valid information and perceptual feedback from various prospects involved with JV operations. For further validation, the proposition testing was supported by ISM a well-established methodology modelling technique that enables the development of an implementation strategy for the research which will be further elaborated on in figure 8.1. The ISM was found to be a well- established methodology modelling technique for identifying relationships among specific issues which are based on a defined problem (Jarkharian & Shankar, 2005). The study instrument focused on the impact of establishing an integrated JV model as an outsourcing relationship for the improvement of the quality of care of Taiz, Yemen, which serves a 2.5 million population. Additionally, this will allow for evaluating available data on public and private sector performances across the key domains of health systems competencies. This goal is to understand how the nature of private or public sectors of a given healthcare delivery institution may impact on core healthcare delivery goals.

The research intends to show the need to incorporate the JV model as one of the outsourcing option in health systems in the LMICs. This will allow them to deliver comprehensive solutions to address the rising mortality and morbidity rates. This is in contrast to traditional outsourcing in the developed world where more strategic functions

121 are now being outsourced which many often insufficient arms-length management. As a result, firms started building closer relationships with their vendors. However, in the case of Yemen, used as a model for the LMIC, where political stability and security is an issue, many organizations are hesitant to enter into joint ventures. These safety and stability issues inhibit and prevent the creation of good business environments. Hopefully, there will be a way to encourage vendor client relationships that put a burden on NGOs like HMC to create joint ventures that bring local and foreign partners to manage technology driven services; i.e. diagnostic imaging and laboratory that will allow other public hospitals to benefit from.

This research has avoided relying on objective measures such as profitability or other financial measures of performance for several reasons: first, different funding sources financed different functional categories of expenditures (Jwasson, 2006). Most of the LMIC healthcare systems were having different funding sources for capital investments and operational cost; second, as outsourcing grows in the healthcare industry, the size and complexity of outsourcing contracts grow at an equal pace (McGee, 2012). Developing practices for outsourcing can vary in difficulty while keeping with needed quality of healthcare. Finally, the last is the lack of structure, functional roles and activities within the LMIC healthcare system and processes that create unmanageable levels of organisation effectiveness and efficiency. Then, changes are constantly being made to the system structure and design throughout the project development on an ad hoc basis adding to the complexity of the system (Abdullah & Verner, 2012).