In my research proposal, I had defined the main objectives of the study to investigate the implementation of clinical governance in nursing practice and describe its effects on nurses’ roles and the quality of nursing care and identify what practitioners and other stakeholders regard as good practice in clinical governance for improving the quality of direct nursing care. I envisaged that an observational study of a healthcare setting would be a complex activity, but as qualitative methodology is concerned with an in-depth study of human phenomena in order to understand the nature and the meaning they have for the individuals involved, an ethnographic case study approach was to me the clear methodological choice. I wished to engage as a participant observer in the daily life of a particular group in order to focus on one aspect: clinical governance. I was interested in how nurses and stakeholders made sense of the complex variables involved with clinical governance and search for patterns, which I envisaged, would have clear limitations in depth and be difficult to measure in any meaningful way if I employed a quantitative questionnaire or survey approach. I therefore needed to conduct fieldwork to observe behaviour in a particular setting and understand the actors’ perspectives. An ethnographic study would allow me to gain an insider’s depiction of the studied world, bearing in mind that an ‘ironic outcome’ might be the outsider’s report from a research participant’s perspective (Charmaz 2006). I therefore had to be careful in my objective analysis of the situation under study.
Ethnography can be described as a genre of research that presents varying degrees of qualitative and quantitative descriptions of human social phenomena based on fieldwork,
presenting an in depth, descriptive study of a culture. Ethnography presents the results of a holistic research method which has been founded on the idea that a system’s properties cannot be understood independently of each other. Typically, ethnography involves the detailed study of a small group of people in their own environment. Rather than looking at a small set of variables and a large number of subjects Hammersley and Atkinson (1995) state that it is essential to understand both the small and the big picture. The ethnographer attempts to get a detailed understanding of the circumstances of the relatively few people studied. In its most characteristic form it involves the ethnographer participating, overtly or covertly, in people’s daily lives for an extended period of time, watching what happens, listening to what is said, asking questions; in fact collecting whatever data are available to throw light on the issues that are the focus of the research. However, the difficulties of ethnographic research make it much less popular than questionnaires, interviews, or database analysis. I initially proposed studying three organizations but soon realised that I would not gain the depth of understanding that I wanted, so I decided to concentrate on one organization. Ethnographies characteristically include only one organization but I had to consider that my conclusions would not be easily generalizable. The absence of rigorous quantitative data is also problematic for organizational researchers who prefer statistical evidence. Qualitative research is not as popular or generally seen by some as being as academically pervasive as quantitative research; therefore, the choice of an ethnographic approach needed careful consideration.
I believed that ethnography allowed for the process and development of grounded theory77 (an abstract theoretical understanding of the studied experience) throughout the research process. I was not sure what I would observe, so the ethnographic method sanctioned more flexibility in relation to this, allowing understanding, reflection and incorporation of any ideas in the social object under study. It was clear that quantitative methods alone would not allow for the in-depth analytic analysis and detailed description that would be required for such a setting, although it was useful in respect of attendance at corporate clinical governance meetings.78 Miller, Dingwall and Murphy (2004) state that whilst quantitative research designs are useful for examining relationships between inputs and outputs in organizational work, they do not inform about how or why outcomes are effective or ineffective. They explain this by citing Seely Brown and Duguid’s (2000) work; in these cases organizational work is viewed from the outside and too much faith is placed in the ‘formal responses’ of organizational problems. In contrasting quantitative, qualitative, outside, and inside approaches, Seely Brown and Duguid (2000) identify the advantages of
77 See Chapter 4:22 Grounded Theory
qualitative organizational research in that it focuses on the shared organizational knowledge and everyday action and interaction: the explanations answer questions about the ‘how and why of organizational outcomes.’ The knowledge gained from such studies provides important information to stakeholders who ‘might contemplate changing work practices’ and it indicates detailed unintended consequences of any implemented change (Miller; Dingwall and Murphy 2004:205). Having considered the alternatives, I believed that ethnography was appropriate for this study.