Integrating quantitative and qualitative approaches: an approach applied to the study of Intensive Care Presented by Ruth Kowalczyk

Intensive Care A service for patients with potentially recoverable diseases who can benefit from more detailed observation and treatment than is generally available in the standard wards and departments. Kings Fund Panel (1989)

Why study Intensive Care? Little research done Expensive service Increasing demand Highly politicised mistakes

Why study effectiveness? Within the NHS Within Intensive Care

Performance measures Effectiveness Efficiency Customer satisfaction Staff satisfaction Growth

Factors affecting ICU management ICU management Demand Workload Diagnostic diversity Effect of other units Case mix Location Resources Technology Unit size £ Staffing Work routine Personnel Personalities Policies Structure

Research Questions What does managerial effectiveness actually mean to intensive care? Is there a way to compare units with others like themselves? Can the performance of a unit be improved by adopting the policies or practices of another unit?

Research Questions How do the policies of a unit affect the practices of the unit staff? How does the management structure of a unit affect its performance?

Answering the Research Questions Managerial effectiveness Comparing units Improving performance Impact of policy on practice Effect of structure on performance Statistical analyses & mathematical modeling

Answering the Research Questions Managerial effectiveness Comparing units Improving performance Impact of policy on practice Effect of structure on performance Observation & interviewing Statistical analyses & mathematical modelling

Mixing Methods Qualitative methods –as a prerequisite to quantitative methods –to supplement quantitative methods –to examine areas not amenable to quantitative methods Pope & Mays, 1995

Mixing Methods Quantitative methods Qualitative methods WhatHowWhy

Quantitative & Qualitative methods Correlation, ANOVA and regression Data Envelopment Analysis Case study, including –Observational study –Semi-structured interviews. Semi-structured interviews in 4 ICUs identified by quantitative analysis.

Limitations to DEA in complex situations Conflicting output measures Outputs or inputs? Low correlations Careful interpretation of results

Intensive Care in context - Patient movement

Integration of ICU within the Hospital ICU nurses as distinct sub-culture work knowledge relationship with doctors

Integration of ICU within the Hospital An integrated unit is more likely to have – better patient survival, – more transfers out, – ability to maintain occupancy standards, – nurse post-basic training, – no intercollegiate recognition.

Quantitative & Qualitative methods Method Framework Ontology Realism Evaluative Research

Evaluation research Key features of evaluation :- Value & Worth Real World Research Diversity

Utilisation of research Involving stakeholders Context Process v. outcome Whose needs? Incremental Time span

Key features of Realism Stratified Ontology Retroduction Mechanism in Context Outcome Emergence

References Pope C. & Mays N., Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research, BMJ, 1995; 311: Kings Fund Panel, Intensive Care in the UK, Anaesthesia, 1989; 44:

Other Useful References Mingers J., The contribution of critical realism as an underpinning philosophy for OR/MS and systems, JORS, Vol. 51, No. 11, November Pawson R. & Tilley N., Realistic Evaluation, 1997, Sage, London. Robson J., Real World Research: A resource for social scientists and practitioner researchers, 1993, Blackwells, Oxford. Sayer A., Realism and Social Science, 2000, Sage, London.