My research position was jointly funded by the Merseyside Health Action Zone and the University of Liverpool as part of encouraging a broad collaboration between the HAZ and other organisations and institutions within Merseyside. The HAZ co- funded three postgraduate research posts, two at Liverpool John Moores University
and one at the University of Liverpool. All three students were given carte blanche
to decide what aspect of the HAZ we would like to research. We were given three months to familiarise ourselves with the HAZ and to choose our topics for research. In addition to our academic supervision, all three research students were jointly supervised by the Monitoring and Evaluation Co-ordinator at the HAZ, through monthly meetings. When this person took a leave of absence, this role was taken on by the Merseyside HAZ Co-ordinator. This regular supervision at the HAZ not only aided our familiarisation with the work of the HAZ, but also allowed us to observe changes in the HAZ over time. This, our participation in HAZ events, presentations of our research to people connected to HAZ and public health in Merseyside, and general access to the HAZ office helped to create good, friendly working relationships with the core HAZ team, the district HAZ Co-ordinators and others connected with HAZ.
Following the resignation of the Monitoring and Evaluation Co-ordinator, we were not so closely supervised and I spent less time in the MHAZ office, which meant that my contact with the people working there was therefore much less. However the support I received from the HAZ team during my mother’s illness, and my collaboration with Marie Armitage on a paper for the Health Equity Network all helped me to reconnect with the HAZ and make me feel a part of the HAZ process, albeit loosely. The friendliness and openness of all people connected with the HAZ, and the ease with which I have been able to access them, is, I feel, a reflection of not only the people, but also the philosophy of the Merseyside Health Action Zone and their enthusiasm for it.
My colleagues at Liverpool John Moores University had to work to tight timeframes to produce research proposals and documentation for ethics committees. I had the luxury of a less structured approach to my research development. This gave me a longer period of time to observe and feel my way into my research topic before having to formalise my data collection methods. This is typical of research using participant observation and ethnographic methods. Whyte (1984) argues that the initial stages of ethnographic research need to be about exploring the field, making contacts and connections and building relationships, helping to establish trust (Fontana and Frey, 2003). DePoy and Gitlin (1994) and Flick (2002) suggest that these early stages enable broad observations to describe what is seen, which are followed by a narrower focus to discover the meaning of the phenomenon under investigation.
I have stated earlier how on starting my research with Merseyside HAZ, it became almost immediately apparent to me that there were a lot of top-down pressures on the HAZ such as the cuts in funding, changing priorities, and time consuming continual requests for information and a resource heavy performance monitoring system. I wondered how this would affect the ability of the HAZ to deliver a programme based on local needs, engaging both communities and frontline staff. I was also interested in the extent to which such an area-based initiative would be able to address health inequalities and modernise services in the context of wider social and political constraints.
As my data collection continued, it became apparent that people were key to the implementation process as ‘makers’ and ‘breakers’ of opportunities, and that the chance to build good working relationships had also been important in the operation
of the Merseyside HAZ. Another key finding was how important it was for people, especially in the statutory sector, to have the opportunity to take risks and to do things differently. These emerging findings have since been corroborated at a ‘stakeholder’ event (which I took part in) hosted by Jane Springett and colleagues as part of their evaluation of the MHAZ. There, in an exercise to identify the key lessons learned from MHAZ, the four items voted most important were (Springett et al, unpublished, pp.68/9):
People are both makers and breakers. It’s about managing relationships. Importance of support structures.
Think beyond the obvious. Take a flexible approach.
As I gathered my data, observed the patterns emerging and undertook an initial analysis of the early information I had gathered, my interest developed from trying to understand the tensions between local work and central demands to recognising the ‘personal’ in public policy implementation. People are the means through which policy is implemented, and I wanted to understand what helped and hindered the capacity, or even desire, of individuals and groups to do that. As this is a New Labour policy initiative, the New Labour political agenda and approach to public service provision became part of the context within which the policy was being implemented. It was clear that New Labour had both created a policy context that created stress, and developed opportunities for collective working that people enjoyed. This research then became an exploration of the experiences of the people involved in the implementation of a New Labour public policy, with particular emphasis on those aspects of the HAZ implementation in Merseyside that generated stress and enthusiasm.
Figure 2.2 ‘The real research cycle’ Figure 2.1 The qualitative research cycle
This unfolding of the research focus alongside the data collection has been described by DePoy and Gitlin (1994) as an iterative process, represented in Figure 2.1 as a spiral. This diagram is a useful representation of the process of qualitative research. However, in my experience, the research process is much less orderly. There are periods of uncertainty, periods of certainty and confidence, periods of confusion and times when nothing visible happens. But at all times the work is progressing, if slowly2. Figure 2.2 is a pictorial representation of this process.
What this diagram lacks is a third dimension to the research process which is the context within which the research is conducted. This is the complex interaction of the personal and professional lives of participants, including the researcher, with the equally complex social and political environment within which the intervention is working. This affected data collection in two ways: firstly, in my access to people in terms of finding convenient times to meet; secondly, in the information they shared with me in our conversations, not all of which was pertinent to the research question, and some of which was very personal.
As I have said, my own story extended the period of research, which allowed me to observe the HAZ process over a longer period of time. During this time the pressures on the HAZ team were constantly changing, and the HAZ team’s reaction to these changes also changed over time. In essence, I was able to observe the HAZ process through a panoramic window, rather than a picture window. This extended period ‘in the field’ enriched my opportunities for observation (Flick, 2002).
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