Acondicionamiento de señales de entrada

While generic qualitative research provides a useful, pragmatic approach to

addressing real-world clinical problems, its value can be undermined unless careful consideration is given to rigour (Cooper and Endacott, 2007).

Although there is widespread consensus amongst quantitative researchers about the fundament role of the concepts of validity, reliability, and generalisability, there is much debate about how best to establish quality, or rigour, in qualitative research studies (Caelli et al., 2003, Tracy, 2010, Reynolds et al., 2011, O’Reilly and Parker, 2013). Some approaches advocate the measurement of quality in terms of the outputs of research, for example the use of checklists to document the application of specific techniques such as triangulation, or multiple coding. In contrast, other approaches emphasise the need for quality to be embedded at each stage of the research process, through reflexivity and ‘methodological awareness’ (Reynolds et al., 2011).

For the purposes of this research, I worked within the framework proposed by Caelli (2003). This framework focuses on ensuring quality throughout the research

process, and has been developed for researchers who adopt a generic qualitative approach. It is based on four key elements: the need to articulate beliefs about epistemology and ontology, the assumptions and motives of the researcher that

101 underpin a study, to ensure congruence between methodology and methods, and to record the criteria used to establish rigour. These are described in Table 11 alongside details of where I have addressed each of the key elements within this chapter. Following this I discuss the specific quality criteria I used to establish rigour.

102 Table 11: Caelli’s (2003) framework for credible generic qualitative research Element of Caelli’s

I adopted a ‘critical realist philosophy’ for this study, lead a researcher to a particular area of interest, and which subsequently shape the approach taken to a study

There were a number of factors that shaped the approach taken to this study, primarily my prior

experience of working as a manager in the NHS, my role in the MDT Study, and my choice of theoretical framework (described in Chapter 3). I provide a reflective account of the way in which my background influenced some of the key aspects of the research on pp. 98-100.

Congruence between

methodology and methods

The tools used to collect and analyse the data must fit with the broader methodological approach underpinning a study

I used a generic qualitative approach, which required this thesis. I describe this process in the section on

‘Rationale for the

methodological approach’ on pp. 65-66.

Strategies used to establish rigour

The approach taken within a study to demonstrate its these quality criteria in the section below on pp. 103-105.

103 5.6.1 Quality Criteria

In this thesis I use the concepts of credibility, dependability, and transferability in place of validity, reliability and generalisability (Bloomberg and Volpe, 2012). The approaches I used throughout the duration of the study to enhance its credibility, reliability and generalisability have already been described in this chapter, at the point at which they were most relevant. However, they are briefly summarised below to illustrate the overarching approach I adopted to establish rigour.

Credibility

Credibility is closely related to the concept of validity, which is used in quantitative studies to demonstrate that findings accurately represent the world being studied (Bloomberg and Volpe, 2012). Given the interpretative nature of this research, the concept of credibility is more meaningful. In this context, credibility relates to whether my analysis of the MDT decision making process matches with the perceptions of those being studied (Bloomberg and Volpe, 2012).

A key aspect of establishing credibility in qualitative research is founded on recognising the biases or pre-conceptions you bring as a researcher to your study (Bloomberg and Volpe, 2012). I have already described my theoretical positioning, and the process of using reflective field notes during data collection to record my thoughts, actions and decisions relating to data collection and ideas for analysis. In addition, strategies such as re-listening to the audios of my interviews enabled me to reflect on my approach to data collection to track emerging thoughts and perspectives.

I also engaged in analytic meetings, initially during data collection as part of the MDT Study, and subsequently with my supervisors and departmental qualitative methods group when conducting the analysis. These meetings challenged me to think about the data from a range of different perspectives, and provided an opportunity to review and discuss my emerging ideas with other experienced researchers and clinicians. This encouraged me to reflect on my existing

104 preconceptions and expectations during the data collection and analysis processes (Maxwell, 2005).

Another way in which I have endeavoured to establish credibility is through my deep immersion in the field. As described previously, I collected data over a period of a year, attending a total of 126 meetings (including 8 meetings where I piloted the data collection forms, and excluding those attended by Caoimhe Nic a Bháird) across the four sites. This extended period of time in the field gave me a solid grounding from which to conduct my analysis.

In addition, I collected data from a number of sources, including observation and in-depth interviews with professionals and patients. I used these different sources of data to consider issues from more than one perspective, adopting a

‘complementary’ approach to triangulation (Moran-Ellis et al., 2006). Although I did not undertake a formal process of member checking, the interviews were carried out following the observation period in each team. This meant that they provided me with an informal opportunity to reflect on my interpretation of the observation data.

Dependability

While reliability is a key concept in quantitative research, the premise that research findings can be replicated is less central to a good qualitative study (Maxwell, 2005).

However, it is important that qualitative research is dependable, in the sense that it can be demonstrated that the findings are consistent with the data collected

(Bloomberg and Volpe, 2012).

In order to ensure the dependability of my findings, I have endeavoured to create a clear audit trail of data collection and analysis through detailed description of my methods. I have included my coding frameworks in Appendix 11 and Appendix 12 as well as detailing the steps I took to analyse the data and produce my findings. In writing up my results I have extensively used quotes and sections of transcript to

105 illustrate key points (Tracy, 2010). Although I did not assess inter-coder agreement, the analytical meetings I attended to discuss my coding framework provided

scrutiny of the processes I was following during the analysis.

Transferability

While the concept of generalisability is central to quantitative research, this research is based on observation of a small number of purposively selected teams, and interviews with a relatively small number of professionals and patients within these teams. The approach I took to selecting cases, which is characteristic of qualitative research, means that the empirical findings produced are not

generalisable to a wider population (Small, 2009). However, this does not mean that learning cannot be transferrable (Small, 2009). My goal is therefore to address the extent to which my findings, in the context of the four MDT meetings I have

observed, can transfer to another setting or context (Bloomberg and Volpe, 2012).

One approach I have adopted to address the transferability of my findings is to present my findings using rich description (Bloomberg and Volpe, 2012). In this way I hope to encourage the reader to identify a sense of shared experience that

enables them to apply these ideas in a different context (Tracy, 2010). To aid this process, I have also provided detailed information about each of the four teams recruited to the study in the Research Setting section on pages 71 to 75. This background information provides important contextual information to enable readers to determine whether they can transfer findings to their own setting (Bloomberg and Volpe, 2012). I consider this issue further in Chapter 10.