SELECTION OF THE RESEARCH METHODS

Alternative study designs were considered as a means of tackling the research question posed. Since little control could be exerted over the process of closure programmes, any attem pt at randomised allocation of patients to rapid or protracted closure programmes was impossible.

Observational methods were the only feasible approach and a prospective cohort of hospitals in varying steps of closure appeared to be the best means of examining the general question of the managerial efficiency of rapid versus slower programmes. However, since closure programmes are extremely complex, it was felt necessary to explore this using micro level case studies. Consideration was given as to whether the research should be conducted using quantitative or qualitative methods.

Qualitative and quantitative research are, it is suggested (Blinkhorn et al, 1989), each appropriate to answering differing research questions. This implies that the research inquiry determines which method is employed (Bryman, 1988). It is proposed “that certain questions cannot be answered by quantitative methods while others cannot be answered by qualitative ones" (Walker, 1985). This view implies that the decision over whether to use qualitative or quantitative methods is determined by two major factors, the questions to be answered and the situational constraints (Tones et al., 1990).

Quantitative research is associated with a range of study designs: cross sectional surveys, case control designs, cohort or prospective studies and controlled trials. Quantitative research aims to obtain information from a sample of the relevant population which is representative o f the population as a whole. Such designs are often used to test a theory or hypothesis. Quantitative research tries to provide answers to “w hat”, “where”, “w hen” and “how” but may also be “fact finding” or exploratory. (Bell, 1987).

Qualitative research has characteristics which differentiate it from quantitative research. Its most fundamental characteristic is that it emphasises the importance of people’s perspectives, perceptions and actions, and the meanings attributed to them (Nettleton, 1986). This type of approach often involves the researcher empathising with those being studied, and also requires a capacity to penetrate the frames of meaning in which respondents operate (Bryman, 1988). This results in data which is textual rather than numerical in character and based in the language and on the experiences of the respondent. Qualitative research aims to achieve this by means of deliberate interaction between researcher and those being studied (Walker, 1985). One o f the main purposes of qualitative research is to describe a detailed social setting of those being investigated which should be consistent with the perspectives of the individual in that social setting. According to this view human behaviour is not to be understood in causal terms based on laws governed by external forces but through the revelation of meanings that people attribute to their own lives and actions. The underlying logic is inductive and, from a detailed understanding of specific situations, the suggestion of a more generalised explanation, i.e. a hypothesis or theory, may be arrived at. The emphasis therefore of qualitative research is a need to interpret events and experiences in terms of an understanding of the meaning they have for the respondents (Bryman, 1988). An unstructured and open research method is favoured by qualitative researchers rather than an approach which has decided in advance what is to be investigated and exactly how it should be done. In this method the researcher explores the many facets of the respondent’s concerns, treating subjects as they arise and pursuing relevant leads. It is thought that this open approach increases the likelihood of uncovering entirely unexpected, relevant material which may be of interest to the researcher. Thus a qualitative

approach might seem the most obvious means of examining the quality of reprovision of particular programmes in the case studies.

Several factors make this approach inadvisable

i) qualitative data collected can be difficult to compare both between sites in this study and with other published work;

ii) qualitative research requires more lengthy contact with the respondent to understand the respondent’s action and reasoning. The patients involved in psychiatric closure problems would not be easy to interview in-depth, which would require specific skills and would be time consuming.

iii) Closure programmes tend to be emotive - for staff, patients and relatives - and cause concern to local communities. The perceived subjectivity o f qualitative methods might be a relative disadvantage in providing evidence for or against a hypothesis that has a strong political content.

Quantitative methods therefore form the basis of all the questionnaires in this study. In making this choice it is accepted that some of the questions asked of the patients would benefit from an in-depth unstructured interview approach and this might have produced helpful results and might form the basis for further work on this topic.

Following government policy

O ver the period of the study attempts have been made to follow changes in governm ent policy. Many o f the issues studied here are the subject of policy reviews and intense public interest. The official source of government proposals for changes prior to legislation is through the Green Paper Consultative Process and where these have been available they have been incorporated in the research. A Green Paper represents the Government’s formal position on a particular subject prior to parliamentary debate. However, pre-dating the publication of a Green Paper there is much informal consultation with specialist organisations usually to establish their degree of support or tolerance. Little of these debates are publicly available. When negotiations breakdown or demands become too extravagant however, both the Government and interested parties resort to the press to air their differences or strengthen their position as they see it by moving it into the public arena.

To gather this data a system was set up where the quality newspapers were monitored over three years through their health or science correspondents’ articles to track and monitor the debate. In the text, where current policy issues are being discussed, references will be found from these correspondents. In using this information it is accepted that these reports are far

from unbiased, they are occasionally eccentric and wherever possible the counter argument, when published has also been examined to temper the views expressed. Wherever possible only attributable comments have been quoted.