7. Method
7.2. Research Method Justification
Several research methods are employed in this new research in answering the three
key research questions. Firstly, in order to understand what factors influence patients’
decisions about whether or not to use PHI in a public hospital, a survey is conducted
with patients to capture first-hand data around their decision-making process. This
proposed study is concerned with inpatients who are admitted to a hospital, the
studies exclude any patients who visit the hospital but are not admitted (i.e.
outpatients).
There are four public hospitals (Balmain Hospital, Canterbury Hospital, Concord
Hospital and Royal Prince Alfred Hospital) within SLHD and more than 220 public
hospitals and health services in NSW. It is not realistic to conduct such research on
every public hospital within NSW, nor is it feasible to conduct the research on all four
hospitals within the SLHD, due to the amount of patients that would be involved, and
resources that would consequently be required. This research was conducted at
Canterbury Hospital as an exemplar. Case method or case-study method is an
empirical inquiry that investigates phenomenon within a real-life context; data would
usually come from archival records, interviews, direct observations, documentation,
physical artefacts and participant observations (Yin, 1994). At a hospital level, a
typical survey focuses on a sample and tries to generalise the study findings to the
broader population. The study of a subset of a population maybe cheaper and easier,
and if done right could obtain the same results as a census. However, there is the
1996). Even though at times, sample based-study is the only way to collect data, a
number of factors still need to be considered for determining the appropriate sample
size: the level of precision, the level of confidence or risk, and the degree of
variability in the attributes being measured (Miaoulis & Michener, 1976). It is evident
that the combination of these conditions is likely to add to the complexity of a study
involving samples. Additionally, the data sampling, if not appropriately selected,
could be open to bias, inaccuracy and/or poor generalisability.
It is due to the combination of these reasons that a decision was made to survey the
entire inpatient population of one hospital where possible, so to maximise the
number of relevant respondents and thus improve inaccuracy and generalisability.
The study collects a range of both quantitative and qualitative data, focusing on the
research questions, which requires multi-level perspectives and real-life contextual
understanding regarding the decision-making and processes for PHI utilisation.
Based on the discussions above regarding research methods, it is most appropriate
that a case method be employed in this study for one hospital only. Canterbury
Hospital, an entity within the former Sydney South-West Area Health Service and the
current SLHD, has been selected as the case study subject due to its relatively large
bed numbers (220 inpatient beds) and the representation of a typical SLHD
population group (the Canterbury LGA is ethnically diverse). In addition to this, the
researcher has experience of working with staff at Canterbury Hospital, and is
familiar with the hospital’s procedures and processes employed in capturing more
patients with PHI. Furthermore, the data that will be used for the financial modelling
can be obtained through the Area Health Service’s financial information system. The
combination of these positive factors supports the proposal of conducting a study on
use on patients and the hospital is a rational and realistic approach. Canterbury
Hospital’s medium hospital-bed base numbers means that a full-scale hospital-wide
patient survey is possible. Such a study would attempt to sample the majority if not
all of the patients staying at the hospital for a period to ensure that the population
sampling is complete (where possible) in identifying all patients, regardless of their
PHI status. Logistically, conducting such a study on the entire hospital’s inpatient
population is possible. According to Israel (1992), using the entire population (where
possible) for a study is preferred over sampling, as it is more likely to resemble a
real-world scenario. Attempts will be made to ensure that given the set date range,
all inpatients will be surveyed, where possible. Individual patients’ health conditions
and their preference of whether or not to participate in the study would affect the
likelihood of the response rate. For example, at Canterbury Hospital, there is an
intensive care unit, a stroke and psycho-geriatric ward; it is expected that the
response rates from these ward areas are likely to be low due to the nature of these
clients’ physiological and mental conditions. Also, it is possible that some patients
may be sleeping, eating, away from the ward for surgery, or receiving active
treatment, so are unable to complete the questionnaires. It should be noted that
while conducting a census-like study such as this one does capture most patient
responses in the hospital, any generalisation is based on the assumption that its
representation of the larger population is reliable.
The information sheet attached to the survey is used to provide patients with
informed consent; it is reasonable to assert that once a patient has read the
information sheet and decides to complete the survey, the researcher has obtained
informed consent from the patient. A contact number is provided for patients to
contact the researcher, should they require further information in relation to this
study and that the maximum possible patient response rate is obtained for this
research.
The content of this survey is based on the researcher’s understanding of the
literature and the topic area, experience through everyday work, and stories shared
by staff and patients. Within the survey structure, there are also some traces of
qualitative research elements as possible question answers – views and factors that
may influence patients’ decisions have to be listed as part of the survey question
options. The survey itself will be a quantitative research tool used to collect data and
to determine whether any correlations exist between the observed data and the facts.
A unique aspect of this research is that it will be conducted in a hospital that services
a local population that is highly diverse in terms of their language, culture and
religious background.
The second part of the research utilises financial modelling through available
archival data to determine the impact of encouraging patients using PHI in a public
hospital on the individual patient and the hospital. Financial data that will be used for
this study will be made available through the Health District’s financial information
systems. Pricing data for payable bed-day benefit can be obtained from PHIAC and
NSW Health. Canterbury Hospital has a set of regular data-capturing tools employed
in recording the number of patients who come through the hospital as an inpatient.
The reporting function of the Patient Registration System is able to provide reports
on inpatient admission by financial classification in Microsoft Excel or comma
separated value formats. NSW Health releases pricing updates every July on the
inpatient bed cost payable for private inpatient bed days. The Health District is able
This new research intends to explore the two aforementioned questions. There will
be no hypothesis for the study, as it is an exploratory study. The first research
method of a patient-survey study is relatively easy to replicate, the results can be
retested by conducting the same survey again, and the survey can also be
conducted in other hospitals. Financial modelling of the impact on patients and the
impact on the hospital would be conducted without a hypothesis. Throughout the
literature review, no previous study of this type or scale has been found, thus
reinforcing the exploratory nature of the study, as the modelling is not aimed at
proving a hypothesis that could be biased in nature. In relation to the testability of the
model, a replicate of the study can easily be conducted again. For example, if
another researcher were to conduct the same study in the target hospital, they could
employ the same model mentioned here by applying a more up-to-date dataset and
reconstructing the model based on the target hospital’s specific financial data.
The last part of research would utilise secondary data obtained from a clinical
redesign project conducted at Canterbury Hospital in 2012. This redesign project
was undertaken by a number of staff from the SLHD aimed at improving private
inpatient revenue at Canterbury Hospital. The project made a number of findings,
some of which resulted in recommendations that are currently being progressively
rolled out within Canterbury Hospital.