4.3.1 A qualitative approach
Qualitative research methodologies are associated with a social constructionist epistemological stance (Darlaston-Jones, 2007), as qualitative methodologies are concerned with how individuals make sense of the world, and thus the quality and texture of experience rather than cause-effect relationships (Willig, 2001:9). Further, qualitative methodologies are related to ‘discovery’ research, where complexity and context are considered central, and experience is viewed holistically, with those studied able to speak for themselves (Wilson, 1998:4).
In this study, I aimed to take a holistic view of the construction and enactment of a clinical leader identity, exploring the issue from multiple perspectives, as described in the theoretical and contextual literature chapters. Further, there has been scant attention to leadership within midwifery research, and the study offered the opportunity to explore an almost untouched area, so a ‘discovery’ approach was entirely suitable. Given the exploratory nature of the work, and my own beliefs about the nature of knowledge, I
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considered a qualitative approach best, particularly in light of Carter & Little’s (2007) suggestions about the integration of epistemology, methodology and methods.
Having explained the decision to apply qualitative methodologies to the study, I now turn to a description of and justification for the guiding methodologies: qualitative case study research, and narrative inquiry. At the end of this section of the chapter, I provide a revised version of the Carter & Little (2007) framework shown in figure 4.1 above, in order to demonstrate the connection between the chosen epistemology, methodology and research methods in the context of this research study.
4.3.2 Case study research
Case study research is considered an appropriate methodology where a rich description of a scene is required, in order to reveal the deep structures within social behaviours (Dyer & Wilkins, 1991), to unravel complex social phenomena (Yin, 2009:4), and to gain an understanding of how the parts of a situation or phenomenon affect each other. This study, as evidenced in the literature review, concerned a complex situation, as clinical leadership has many aspects that need to be unravelled; for example, the place of transformational leadership in a transactionally-organised organisation, the challenge of maintaining a clinical identification, and the complex interactions between and within groups in the NHS. An holistic approach, associated with case study research (Flyvberg, 2006; Yin, 2009:4), enabled me to look at the experience of clinical leaders in midwifery, through detailed exploration of several leadership programmes which I will describe in depth later in this chapter.
Case studies are also considered appropriate when little is known about a phenomenon (Eisenhardt, 1989; Denscombe, 2007:36), very much in keeping with the rationale I offered in relation to the adoption of a qualitative methodology more generally. As I described
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earlier, midwifery has been largely neglected as an area for leadership study, despite relevant concerns having been raised in recent reports. Also, the study aimed to extend ideas of the integration of role and social identity into the field of NHS clinical leadership, again an area not yet fully explored at the theoretical level.
The final justification for the use of case studies relates to the idea that they can act as exemplars of a new paradigm in the Kuhnian sense, acting as examples of new relationships, orientations or phenomena which have yet to be captured by theoretical perspectives (Dyer & Wilkins, 1991). Moving beyond the specific case of midwives, this is certainly the case more generally in clinical leadership: clinical and distributed leadership are relatively recent ideas to be implemented within the NHS, and having identified the significance of adopting an holistic approach to exploring clinical leadership from role and social identity perspectives, case study research appears a useful means of gaining the depth required to achieve a deep understanding of the relevant issues.
It is important that I address potential weaknesses associated with a case study approach, having identified it as a generally appropriate methodology for the study. The methodology has its champions and its critics, as all methodologies do. Its defenders support the principles of in-depth investigation and the holistic approach inherent within case study research (Robson, 2002:180; Flyvberg, 2006; Yin, 2009), in answer to criticisms that the approach offers depth at the expense of breadth. While there has been criticism of the case study methodology per se (Yin, 2009:6; Robson, 2002:179), issues of rigour and subjective bias are not dissimilar to those levelled at qualitative methodologies more generally. Issues of methodological rigour will be addressed later in this chapter, in relation to the design and execution of all areas of the study.
While a case study approach provides a framework for the research, the question of narratives and their place in this research needs separate attention.
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4.3.3 A narrative framework
Described as a “field in the making” (Chase, 2005:651), narrative inquiry is guided by several fundamental beliefs:
That people’s accounts of themselves are storied, and the social world is also storied;
That narrative is a key means through which people produce an identity;
That narratives link the past to the present;
That there is no unbiased account of the past (Lawler, 2002).
There is a holistic value inherent in eliciting narratives, as through telling their stories individuals demonstrate clearly their connections with the social, cultural and institutional environment around them, thus capturing both the individual and the context (Moen, 2006). This last point emphasises a clear link to the constructionist epistemological stance I have taken in the study, particularly in relation to its exploratory nature.
A narrative approach to the study was employed in relation to both the observation and interview elements of the study. This approach relates to three benefits associated with narrative inquiry: first, narratives facilitate the in-depth approach taken to the work (Greene, 1994); second, narratives are closely related to real-life experience, which was part of what I was keen to capture (Lieblich, 1998:5); and third, narratives have been described as a fundamental communication method through which our experiences, interpretations and priorities are revealed (Grbich, 2007:124), so I was hopeful that the approach would reveal much of the complexity of the factors influencing a transition to leadership, both endogenous and exogenous.
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I have offered explanations of and justification for the study’s methodological approach, based on ontological and epistemological principles, and in relation to the aims and objectives of the research. Figure 4.2, below, shows a revised version of figure 4.1, to demonstrate how the epistemology and methodology relate to the study’s methods, which will be addressed later in the chapter.
The next section concerns the research sample, describing the strategies adopted for the selection of cases, interviewees and sites for online interaction.
Fig 4.2: Revised Epistemology, Methodology & Methods (Carter & Little, 2007)
4.4 The Research Sample