The Use of a Qualitative Case Study

The Med Rec process is a complex process for patients transferred from acute care to long term care is comprised of several steps, involves different types of health care providers, and spans two venues of care. The qualitative case study method provided a useful strategy to gain an understanding of the perspectives and experiences of health care providers with the Med Rec process in the real life context (Stake, 2005; Yin, 2009) of the completion of the steps of the process.

It was helpful to visualize the Med Rec process as one case with the health care providers as the embedded units (Yin, 2009) who complete the steps of the process within the context of transition of a patient from acute care to long term care. The case study approach helped the researcher maintain a focus on the embedded units (the health care providers) instead of getting sidetracked by the other complexities of the Med Rec process such as the mechanics of the physical and administrative transfer of the patient between acute care and long term care. The case study method facilitated a focus on the experiences and perspectives of health care providers who completed a step of the Med Rec process.

A feature of the case study method is the use of multiple data sources to get an

understanding of the case under study (Stake, 2005; Yin, 2009). In this research, additional data sources included consultations with key health region personnel involved with the development and implementation of the Med Rec process for patients transferred from acute care to long term care and related documents, materials, and audit information. These additional sources of data of the real life context of the Med Rec process were important for the researcher to develop as best as possible a complete look at the initiative as a whole (Stake, 2005; Yin, 2009). The use of

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additional data sources helped the researcher focus participant recruitment and also helped inform the development of guiding questions for the digitally recorded participants’ interviews.

In this research, additional data sources included the documented Med Rec process for patients transferred from acute care to long term care that the health region developed using the Plan Do Study Act (PDSA) cycle strategy (Appendix D). Study of the details of the process assisted with the identification of venues of care that were involved – acute care units, long term care facilities, and community pharmacies. The detailed process also identified the order of the steps that would contribute to safe transition of medication administration from acute care to long term care and the health care providers along the process who completed the steps. This helped inform the researcher where to focus the recruitment of participants for the digitally recorded interviews.

Other data sources included standardized forms developed for the Med Rec process, and memos and training materials (such as health region newsletter updates and an online voice over training PowerPoint presentation housed on the region’s internal website) that were developed to educate health care providers about the implementation of the Med Rec process for patients transferred from acute care to long term care in the health region of study.

The researcher also included consultations with key health region personnel as a source of data to add to the understanding of the Med Rec process. This included pharmacists who guided the development of the Med Rec process and who supervised the implementation of the improvement initiative. The health region’s Pharmacy Manager and Med Rec Pharmacist Lead were also instrumental in sharing key findings from the health region’s audit of the Med Rec process for patients transferred from acute care to long term care. Audit information reported by the health region’s Pharmacy Manager and Med Rec Pharmacist Lead, such as the locations

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patients were transferred to and from, assisted the researcher to focus recruitment of participants for interviews. Consultations with health region staff about elements of the information they tracked such as the meeting of process timelines and key acute care units, long term care facilities, and region staff involved with the Med Rec process helped the researcher focus

recruitment activities in the right places to achieve a sample that reflected the various health care providers that completed at least one step of the Med Rec process.

5.1.1 Recruitment of Participants

Recruitment of participants took longer than anticipated. Having worked in the health care field for many years, the researcher anticipated the potential need to sustain recruitment activities in order to recruit a sample that reflected the health care providers who completed a step of the Med Rec process. Health care settings and providers are busy. It can be challenging for health care providers to take time out of an already full day and busy workload to participate in a study that may not provide them any direct benefit.

Recruitment took nine months and was sustained throughout the period of data collection as described in Chapter 3. The researcher broadened efforts to recruit participants. This

included repeated visits to site managers to distribute letters and posters of invitation and making use of a snowball technique – referral by a participant to one of their colleagues (Richards & Morse, 2007) – in addition to the purposive sample recruitment strategies. Four of the 10 participants were recruited through referral by one of their colleagues. A sample that reflected the health care providers who completed at least one step of the Med Rec process was achieved and the participants provided a rich description of their perspectives and experiences with the Med Rec process for patients transferred from acute care to long term care. It is interesting to

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note, however, that the most challenging group to recruit was registered nurses, which will be discussed later on in this Chapter.