CAMBIOS DE DIRECCION DE EMPRESA

I have followed The British Sociological Association‟s ethical practice guidelines in guiding my ethical approach (British Sociological Association, 2002). Ethical approval has been granted by the Institute of Education Research Ethics Committee through their doctoral school processes. I have been granted exemption from NHS Ethics Committee approval from the National Research Ethics Service (NRES), the central NHS research ethics body. They produce clear guidelines for potential researchers on when NHS ethics approval is required and have a service to answer individual queries rapidly. As my research did not involve patients or access to patient records, exemption from their procedures was granted (see Appendix 4).

The main ethical issues related to this study are around the ethics of insider research and these have guided how I designed the study and how I interpret my findings. The first issue to consider is that of access. I obtained

permission from the gatekeeper to the hospital, the Chief Executive, to carry out the research and also went through the Trust‟s Research and

Development process in the same way as would be done for clinical research. However, I also needed to seek permission from the leadership in maternity. As hospital managerial structures are divided along professional lines, I sought permission from the Clinical Director, Lead Nurse and Associate Director. There was the possibility that there may be some disagreement between them and that one or other may feel coerced into agreement because I am a staff member. I endeavoured to control this by approaching each person

individually, by email initially, and not sharing what the others said. I offered to meet with each individual in person to explain the study and what would be

69 involved, allowing each person to make their own informed decision. One person took me up on this offer and the other two agreed by email.

I also needed to consider what and how to tell other staff members about the research, both before and after participating. As any member of the

organisation could have potentially been involved through observation, I sent out study information to all staff registered as working in maternity via the gatekeepers. I also placed a number of posters in clinical and rest areas announcing the study start date and providing my email address. This information sought to make clear when and how staff might be invited to participate, that they were free to refuse to take part and how they could do this before, during and after the study. Before individual interviews,

participants were emailed a study information sheet and written informed consent was sought (see Appendix 5). Again, the freedom to refuse consent, or to withdraw at any time, was made explicit on more than one occasion. Before any period of observation I announced my presence and purpose to individuals in the room. However, I did not seek individual written consent from all people present as this would have disrupted the sessions and the work of the department. Individuals who did not wish to take part were invited to approach me after the session, in person or by email, so that I could discuss with them removal of relevant data. No-one took up this offer. However, a more difficult issue arose when individuals joined an observation session part way through, an event which happened fairly frequently. In this case, I relied on my posters and electronic study information sheet to alert individuals to my presence.

I also recognised that staff may approach me about the study outside of „research time‟ as we worked in the same organisation. To avoid causing offence or potentially damaging working relationships I made it clear in the study information that while I was prepared to answer questions about the study methodology I could not discuss my own thoughts or my data analysis in detail. A further ethical issue concerns the use of incidental data; information that may have relevance to the study that I picked up otherwise in the course of my working life within the organisation. I acknowledge that I have used this

70 information as an entry point to the study, to select key informants and events for observation. My own research diary, which outlined my journey through the research process, will contribute to my data analysis. It records the result of barriers that I came across during the course of my research and

illuminating observations that I made about the organisation. This includes information about the maternity department that I gathered in the course of my daily work, such as through Trust level Boards and Committees. If particular individuals disclosed information relevant to the study to me, either during an informal chat or in other meetings, I verbally sought specific permission to include the information anonymously in the study and recorded it in the diary. This information will contribute to my analysis.

A major ethical issue centres on confidentiality. I have aimed to keep all participants anonymous in my reporting. Techniques used included the use of non-descript job titles, minor changes to role description, indeterminate or changing genders and ethnicities, alteration of timescales and adaptation of sections of text to remove recognisable features. However, it is possible that many participants will be recognisable internally through their comments or opinions. By using key informants from the main sectors of the organisation, I have not needed to identify them by job title. Observation data and personal interview data are more difficult to keep confidential as people within the organisation may know who attended each meeting or agreed to interview. Therefore, my presentation of findings needs to explicitly consider anonymity and adapt to this. Within post-observation interviews, I directly discussed this issue with participants and agreed with them the approach to achieving this. However, it needs to be recognised that absolute confidentiality cannot, and should not, be guaranteed.

At this point, the question also arises about what happens to the data. As my study aims to be interpretive rather than simply descriptive, my analysis will interpret individual accounts and events in the light of my theoretical framework and my own subjectivity, and my account as a researcher may be very

different from the participants‟ own understandings of their experiences. If individuals recognise themselves within the study, my interpretation of events

71 they were part of may cause offence. This was explained to participants

beforehand, although it needs to be recognised that the nature of the study is such that I am interpreting information using a theoretical framework that is not fully accessible to them.

Insider researchers need to consider the audience for their research, in

particular the audience inside the institution under study. The Executive Board of the hospital are invested in the change programme taking place and,

therefore, are likely to be interested in the results of my research. I made it explicit in seeking permission from the Chief Executive that a condition of my undertaking the research is that I will not be sharing raw data with the Board. Unlike other insider researchers, who may fear for their own professional role if they do not comply with requests from senior management, I am in the position of being in a fixed term contract and will not complete the research until after this ends. However, I made it clear to participants, and the other gatekeepers, that the research is for my doctorate and not for the Board. However, if I aim to inform practice and policy as a professional doctorate researcher, then I aim for my research to be of interest to the wider NHS and possibly even to

national media. I have, therefore, had to consider how to present my research in a way that acknowledges a potentially wide audience. My approach to confidentiality of individual participants has been outlined above. I also need to consider organisational confidentiality. The story that makes the case noteworthy is one that may be recognised. I have, therefore, omitted a level of detail that I have judged does not add to my analysis and I have altered

timescales slightly. Readers of the thesis need to recognise that these decisions cannot be as transparently discussed as other research decisions I have made.

72 CHAPTER FIVE:

ANALYSING INTERPROFESSIONAL NETWORKS OF CULTURAL