El papel del Estado en el sistema de salud

"...over tim e the research problem is developed o r transformed, and eventually its scope is clarified and delim ited and its internal structure explored....it is frequently only over the course o f the research th a t one discovers what the research is really all a b o u t"

With the outline research questions to hand, and several guiding principles

in mind, opportunities for potentially suitable field engagements were

screened, pursued and grasped as they arose. Serendipity played its usual

strong hand. The combination and quality of empirical research

opportunities captured was highly appropriate, and considerably exceeded

initial expectations.

4 .1 The Guiding Principles

4 .1 .1 Principle 1- N avigating th e Discourse

" [The] double hermeneutic is o f considerable com plexity, since the

connection is no t m erely a one-way one; there is a considerable slippage

of....concepts constructed , whereby these are appropriated by those

whose conduct they were originally coined to analyse, and hence become integral features o f th a t conduct"

[Giddens 1976 p l6 2 ]

Though discussing sociology, Gidden's comments could be seen to equally

apply to any social scientific endeavour, more critically and pervasively

perhaps in the case of the marketing management arena, where, as

Hackley puts it:

" ..im p licit within the popular managerial school o f m arketing is the

message th a t managers can constitute successful managerial action through the concepts, models, and philosophy o f m a rketin g"

[1998 p95]

The legitim ating u tility of this language game has been strengthened

considerably by the literal institutionalisation of the 'discipline', and its

'ascendancy' to royal charter status. Marketing is now 'officia lly' a

'profession', a British monarch has decreed it so.

"..m arketing m anagers...through th e ir education and wider

professionalisation are socialised', o r dom esticated into the m arketing m anagem ent discourse"

[Brownlie 1997 p275]

Even if managers have no real faith in the techno-rational and quasi-

scientific tenets of the discipline it often works to th e ir benefit to profess

such beliefs and deploy the associated discursive resources. This is

particularly the case, one could surmise, when they are staging 'tru th

effects' [Jeffcut 1994] in th e ir pursuit of a winning argum ent, a

'professional' image, and promotion. In the heavily value-laden context of

the management of marketing it is therefore clear th a t the openly explicit

interrogation of marketing manager respondents as to 'what they are

doing' is problematic, and requires methodological caution.

Indirect Methods and Covertness

" One's own life history, belongingness to a specific research com munity,

and everyday experience inform how one thinks and acts in relation to the subject m atter. These have an im pact on the questions asked, the language used and, by implication, the results produced"

Managers will clearly wish to be seen as being professional, and th e ir

responses to questions from a supposedly expert marketing academic,

however cleverly crafted, are most likely to be somewhat moulded by an

am bition to appear knowledgeable and competent in the 'm arketing

profession'. The immense challenge of escaping the marketing and

management discourses to form ulate questions, and then pose them in

such a way th a t somehow does not 'beg the answer' is therefore one

better-avoided altogether. I therefore decided tha t questionnaires of any

form were a wholly inappropriate technique, that directed structured

interviewing was not a suitable approach, and tha t any explicit

questioning of any respondent should be kept to an absolute m inim um,

and should not, when unavoidably deployed, utilise term inology prevalent

in the m arketing management discourse.

I t was also clear that, even in the context of indirect methods, knowledge

of the research question could possibly influence the exhibited behaviour

of the respondents. The approach was therefore, if possible, to be one of

covert inquiry, but of a form tha t avoided the ethical issues pertaining to

its more radical variants [Gummesson 2000 p32]. In addition, therefore,

the focal managers' awareness of the research question itself was to be

negligible and vague

Confidentiality and Corporate Indifference

Personal factors such as pride, ego and the pursuit of social acceptance

and adm iration can clearly be underpinning drivers of responses to direct

questioning. But ambition and the pursuit of careers in the moral maze of

the modern corporation bring an extra dimension to the factors influencing

'behaviour under observation'. This is especially true when the observer

potentially has the ear of top management [Brownlie 1997 p270]. How

their managers perceive them is a central personal concern of most

managers, and appearing professional and competent in the ir eyes is

obviously one way of influencing the career-critical perceptions of the ir

superiors. Clearly in the arena of marketing management, one with such

prescriptive tendencies, accentuated conform ity to the pervasive norms of

the discourse is a strong possibility.

In this context, I therefore decided tha t the managers of the focal

managers would receive no feedback or information whatsoever from the

research engagement with the respondent; and th a t the focal manager

would be very much aware of this fact. Additionally, all respondents would

be made fully aware of the total confidentiality of the research exercise,

and tha t all subsequent academic output would be completely disguised

and anonymous. The research access to the enterprise concerned would,

if at all possible, be facilitated by a purpose distinct from th a t of the

research. The 'enterprise' of the focal manager concerned would have no

interest in the research project itself; and the focal manager was to be

Empathy

" D on't worry, I'm n o t a consultant...not really an academic; I know what

its really I ike... I'v e seen it all before"

I was in an advantageous position in personally understanding the

embarrassment and vulnerability working managers feel when being

observed, and the reluctance to 'tell it as it is' when being interviewed, for

fear of appearing 'unprofessional'. Full advantage was to be taken of my

non-academic 'old hand' practitioner profile in generating empathy and

openness in interaction with respondents.

4 .1 .2 Principle 2 - Diverse Contexts

The target set was to gain access to marketing managers operating in

divergent contexts. 'Polar types' were to form ideal target cases

[Eisenhardt 1989 p537]. There is, however, no pretence here of a pursuit

of representative or theoretical sampling, a pursuit th a t often prefaces a

claim to generalisability. With in-depth qualitative studies practicalities

clearly m ilitate against such 'm ethods'. In any case, given the

indeterminacy of population boundaries and dimensions, the basis of such

methodological contentions is deeply suspect. As Seale points out:

" [Qualitative research] falls prey to precisely the same weakness o f

some quantitative research....[where] unwarranted assumptions are made

about the characteristics o f the population o f cases n o t y e t stu d ie d .." [Seale 1999 p l l 2 ]

I t was simply felt, tha t given the lim itation to the number of cases that

could be handled in practice, tha t contextual diversity was potentially

more likely to give rise to interesting contrasts, than would a homogenous

selection of cases. In addition, it would be more likely th a t a reader of the

research would have some fam iliarity with a ’receiving con text' of some

sim ilarity to the backdrop of one of the ’sending cases' within the study

[Seale 1999 p l l 2 ] . Any generalisation, like beauty, will be in the eye of

the beholder.

I also felt th a t a particular aim should be to acquire cases with contexts

markedly different from the commercial background of the researcher. My

tacit 'pre-judgem ents' and prior 'h a b iti' [Heidegger 1962; Bourdieu 1977]

would clearly play powerful roles in my engagement with the generated

empirical material. A form of retrospective 'subjective personal

introspection' [Holbrook 2002 p6] would clearly pervade the interpretive

process. Each case would act, unavoidably, as a 'stim ulant lens' on my

prior personal managerial experience. The proposition was tha t the more

contrasting the contexts, the more stim ulant a 'lens' it would be. In

addition, the inescapable retrospective-introspective process would then

represent, in essence, another context-m arketing manager combination in

4 .1 .3 P rinciple 3 - Longitudinal Engagem ent

Marples comes to the following conclusion from her studies of managerial

work:

" The m anager's jo b can usefully be pictured as a stranded rope made o f

fibres o f d iffe re n t lengths - where length represents time - each fibre coming to the surface one o r m ore times in observable episodes, and representing a single issue. The higher the level o f the m anager the longer the average length o f fibre, the more intertw ined the issues become, and the g re a te r the num ber o f episodes p e r issue. A prim e managerial s k ill m ay be to keep a num ber o f 'issues' in play over a large num ber o f episodes, and long periods o f tim e ."

[1967 p287]

At any point in tim e only a few of the strands and threads making up this

'rope of issues' are 'visible'. That is, the manager, at any one point in

time, is actively engaging w ith only a selection of the portfolio of issues 'to

hand'; a certain 'co n te n t' so to speak. Given the 'live ' content of a

manager's jo b potentially varies substantially over tim e, it would appear

that any study o f'c o n te n t' should be longitudinal and prolonged.

It is also reasonable to surmise th a t the nature of the 'surfacing' issues,

the 'liv e ' content, may be of considerable influence on the character of the

manifest managerial conduct. I f this were the case, then in order to see a

broad and potentially representative spectrum of managerial conduct

longitudinal studies would again appear to be unavoidable.

It is clear from the above th a t prolonged longitudinal studies are essential

if the objective of the research is to probe the 'substance of marketing

management and managerial conduct', rather than simply the superficial

aspects of managerial activity.

4 .2 An O ve rv iew o f th e 'R e a lis e d ' Research Design

The research design th a t emerged is illustrated schematically in Figure 1.

The methods deployed are described more fully later in this chapter.

Each of the acquired field engagements adhered to the previously

described guiding principles. All of the individual studies were extensively

longitudinal and were set in contrasting contexts. As planned, observation

and interviewing were unstructured. At no tim e were pre-set categories

utilised in the capture of em pirical m aterial.

In ail cases the unit of analysis was the individual manager. The three

phases captured empirical m aterial on five different managers.

The sequencing of the various fieldwork opportunities proved to be

Th e E m e rg e n t R e s e a rc h De sign J Q

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