Would value colleagues opinions with a stronger qualitative background than mine as to what the optimum qualitative approaches be to try and answer the questions below:
Our original thoughts were to do structured interviewing and focus group interviewing. Are there better/different methodologies that might be more effective for unpicking these differences?
Background
We have reported a study of crowding in the emergency department (ED). An objective score scale was evaluated against clinician opinion of crowding to see how well it performed and assess face validity. Clinician opinion of crowding is consistently used as a soft outcome criterion because there is no gold standard measure of ED crowding. Clinicians rated how crowded they thought the ED was using a likert scale and the nurse in charge opinions were compared with the doctors-in charge using weighted Kappa for inter rater reliability. Similar to other studies using clinical opinion, kappa was only moderate (0.57).
Question
Better understanding of the criterion "clinician opinion of crowding" is key if we are to refine objective crowding measures to best reflect what staff perceive as crowding.
We want to investigate the reasons for why doctors and nurses perceive crowding differently and understand factors that underly this difference. Our hypothesis is that there will be differences in work flow and nature of the work performed by nurses vs doctors that influence this.
Our main questions are:
What factors do nurses and doctors perceive as making the ED crowded?
Where and how do they differ? Where are they similar?
If you relied on quantitative measures and statistical analysis, why do you consider this qualitative research?
One next step would to collect qualitative data to try and understand why your kappa value is is low. This would amount to mixed methods, with what is known as a "sequential explanatory" design, which uses qualitative methods to follow up on poorly understood quantitative results. Given the workload of these practitioners, I think individual interviews would make more sense then trying to assemble focus groups.
Comparing doctors perception of crowdedness to nurses may not be fair to start with. What is the doctor patient ratio compared to the nurse patient ratio to start with? And how much time does each spend with a patient .. so if a doctor spends 10 min with a patient, they may see a 10 patient room less crowded than a nurse who spends 20 minutes with each patient. So I think you may need to look at the incurred workload on each of the health professionals as well.
Structured observation through the use of checklists may also yield quantitative results that could be corroborated with findings from the structured interview.
Thank you gentleman for this and apologies for delayed response, very much appreciated.
- Badges
- Science method
- Similar topics
- Methodology
- Research Methodology
- Qualitative Research