The NHS Research Ethics Service (NRES) provide assistance in identifying whether research constitutes, in their terms, research or an evaluation, the outcome of which determines the body from which research ethics approval is required. In view of the possibility that full NHS Research Ethics Committee (REC) approval might be required, and the consequential delays that might ensue, potential research ethics issues were addressed at an early stage of the design.
The general guidance provided by the NRES was unclear as to whether this
research project fell into the category of research or evaluation, and so an outline of the proposal was submitted to them for advice. The submission made to the NRES and the resultant determination, that the study was an evaluation, was presented to the Research Ethics Committee of the School of City and Regional Planning (now Planning and Geography), who gave consent for the research to proceed. The application for consent is attached at Appendix 6, and was approved by the School Research Ethics Committee on 15 August 2011.
There were a number of research ethics issues that had to be considered in the initial design. In view of the prevailing sensitivity over nutritional care and hospital food in the NHS, it was decided that both individual and organisational anonymity had to be designed into the research. Although not a performance evaluation, the
102 influences identified in the literature review suggest that there were potentially different and possibly conflicting perspectives that might emerge and therefore individual identities and roles would need to be protected. Likewise, the political nature of the external environment to the organisation could make the identity of the organisation a sensitive issue, as well as providing a key means by which the informants could be identified. Such issues were pertinent to the formulation of the research aims and questions, the selection of case studies, approaches to the potential case study organisations, the design of the research methods and of particular importance in the reporting of the research findings.
Langley (2009) addresses these issues as particularly pertinent to the study of organisational processes, suggesting that the dilemma is most likely to be in the reporting of the research findings, and that by developing a strategy in the research design, these ethical dilemmas can be resolved. The independence of the
researcher, using open interview techniques to study change as the lived and living experiences of informants and writing narratives as accounts of events and
interactions, rather than seeking meanings, were all intended to overcome the need to identify informants, either by role, or by organisation.
The theoretical framework for the process under study has identified perhaps the most contentious, but contested concept - that of the influence of political behaviour, albeit not as the primary focus of the research. By using aliases for the organisation and informants, multiple units of analysis as context, and considering the
organisation as embedded in an open system, rather than bounded entity, ‘politics’
takes on a contextual meaning beyond the legal boundary of the organisation, and thereby mitigates potential ethical concerns of confidentiality, protection of the participant’s interests, or indeed political bias on behalf of the researcher.
The initial approach to the informants provided them with information on the research topic, the nature of their voluntary participation and offered copies of interview transcripts as well as material from the final draft report as a means of validating the data and the way it was represented. Key passages from the draft dissertation were provided to informants to ensure validity and that there were no concerns regarding their anonymity.
Two notable ethical issues arose during the study. The first was in connection with the study of the NCP in the third LHB. Whilst a number of informants who were approached were happy with the NRES confirmation that the study was an
evaluation, thereby not needing a full REC hearing, one key informant was unwilling
103 to participate until the LHB’s own REC had approved the study. As a consequence, the interview schedule was suspended. However, as informants within the other two LHBs provided evidence of significant differences between the organisational structures and processes, it was decided not to proceed with the third LHB, as neither the project as a whole, nor the validity of any conclusions, was prejudiced by restricting the number of LHBs within which the NCP could be studied.
The second ethical issue was in the use of the data from some of the interviews.
One particular informant related narratives of the practice care they has witnessed or been party to. Some of those narratives included data which, although would not identify the patient to those not present, were intensely personal and emotional as well as relating to a medical condition. Although excellent evidence of some of the arguments being proposed in the thesis, the researcher had concerns that the patient’s permission should have been sought to include such detail, and consequently that particular narrative was not used in the final dissertation.
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