HERODES AGRIPA I

The study design and execution of the study produced both strengths and limitations for transferability of the study findings. A more detailed discussion of both strengths and limitation is provided below.

98 5.3.1 Strengths

The use of the embedded single case study design did result in the collection of data on health care provider’s experiences with and perspectives on the Med Rec process for patients transferred from urban acute care to urban long term care settings in the health region of study. The thematic analysis of the data resulted in a rich description of the study participants’

perceptions of the challenges and opportunities with the Med Rec process.

The study sample included the health care providers, as identified in Appendix D, who completed at least one step of the Med Rec process. This accurate reflection of health care providers, along with saturation of data, provides the potential for the findings to reflect the perspectives and experiences of health care providers involved with the Med Rec process in the health region of study. In addition, the range of professional experience of the participants, from two years to over 30 years, suggests that both newer and more experienced health care providers are a part of the sample. This diversity in years of experience reflects the various health care providers who implement the Med Rec process and adds strength to the make-up of the study sample (Stake, 2005; Yin, 2009).

The researcher conducted all of the participant interviews and analyzed all of the interview and health region Med Rec document data. This, in addition to the use of semi- structured interview questions, provided consistency in data collection and analysis. Analysis of the qualitative data also revealed that there was consensus amongst participants regarding the benefits and challenges of the Med Rec process for patients transferred between acute care and long term care facilities and this consistency in participants’ perspectives provided the themes for this study. Consistency was also provided through transcription of digitally recorded interviews by one single transcription service.

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The researcher used additional measures to enhance the trustworthiness of the research. This included the maintenance of a detailed audit trail and field notes, and the ongoing tracking of data collection and data sources (Yin, 2009). The researcher also used the techniques of personal note taking and the involvement of another researcher with expertise in qualitative methods but not in the content area of the research in the analysis of the first interview to check for any subjective bias by the researcher.

The consideration of Normalization Process Theory and the Extended Normalization Process Theory (general theory of implementation) provided a theoretical framework through which to understand and suggest explanations for the storyline presented by the participants in the study. The use of a theoretical framework provided a starting point for an understanding of the participants’ experiences with and perspective of the Med Rec process for patients

transferred from acute care to long term care. It is possible that this approach will assist with the transferability of the findings of this study.

5.3.2 Limitations

The Med Rec process itself is complex and the complexity of Med Rec as a single case increases in that the context of the process crosses three care settings (acute care units, long term care facilities, and community pharmacies) with numerous different health care providers from varying professional backgrounds involved in completing the steps of the process. Although the case study design offers an approach where multiple sources of data can be used to understand the case of study (Yin, 2009), it is possible that this study may not be all encompassing of the Med Rec process because of its’ complexity. The case study approach may not have captured the precise details of each health care provider’s activities when performing a step of the Med Rec process. For these reasons, transferability of the findings of the study may be limited

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(Boblin et al., 2013; Stake, 2005; Yin, 2009). Because the intent was to gain an overall

understanding of the perspectives of the health care providers, the method chosen for this study could be considered to be a good fit.

In using a purposive sampling technique, there is a possibility that health care providers with a particular interest in the topic being studied are over-represented (Polit & Beck 2012). There is a chance that the pharmacists, physicians, and nurses who agreed to participate in this research did so because of a personal or professional interest in and agreement with the Med Rec process being studied. Because both benefits and challenges with the Med Rec process were identified by participants, even with a possible influence of participant self-selection, the data suggest a balanced view of the perspectives and experiences of the health care providers with the Med Rec process.

Because the findings of this study focused specifically on a quality improvement process (Med Rec on transfer from acute care to long term care) in one health region, transferability of the findings may be limited. The methodology used to conduct the study, however, may be useful in the study of other complex processes in the health care system. The case study method provides a good strategy to explore various factors within a complex process for the purpose of contributing to an understanding of the interaction and meaning of the process being studied (Stake, 2005; Yin, 2009).