NHS site 3 CTR4+ Dr, SpR, N/TS NHS site 1a CTR1+Dr, SpR, N/TS NHS site 5 CTR6+Dr, SpR, N/TS NHS site 4 CTR5+Dr, SpR, N/TS NHS site 2 CTR3+Dr, SpR, N/TS NHS site 1b CTR2 +Dr, SpR, N/TS PERCEIVED IMPACT: Professional and Organisational COLLECTIVE CASES IDENTIFIED 105
Key:
CTR – Consultant Therapeutic Radiographer Dr – Clinical Oncologist
SpR – Specialist Registrar
N/TS – Nursing and Therapeutic staff
4.3.4 Debate of case study research
Case studies have had their share of criticism; often being accused as the “weak sibling” among social science methods (Soy, 1997); or dismissed as descriptive (Hammond and Wellington, 2012), or too subjective. However, the subjective richness of individuals recounting their experience through such an approach is seen as advantageous (Day, 2006) and as Key (1997) reports that meanings embedded within case studies help guide decisions. Other advantages of case study research including promoting a deeper understanding of a phenomenon ideal when exploring complex social situations and its ability to derive new hypothesis as it can uncover unknown variables not previously identified (Day, 2006),
The issue of generalisation is usually quoted as the main limitation and a concern (Bryar, 2000), case study research is often criticised for not being widely applicable to large populations. Although the data collected is in depth, it is argued that case study research is context specific and therefore not possible to generalise the findings (Gray, 1998). Schwandt (as cited in Tsang, 2013) defines generalisation as a general statement or proposition made by drawing an inference from observation of the particular. An example of generalisation is theoretical generalisation which considers relationships observed within variables (Tsang, 2013) and this type was of interest to Yin (2009). Yin (2009) acknowledged that theoretical generalisation was applicable to his work surrounding case study research, in particular evident when using multiple case study design. Multiple case studies consider similarities and differences across cases providing a stronger basis of theoretical generalisation than a single case. Moreover, findings across multiple cases can also enhance generalisation. However, Thomas (2011) acknowledges that a case study is about the particular rather than the general and hence you cannot generalise from a case study; the findings in a case study are specific to the situation and therefore its purpose is not to generalise. The essence of case study research is in fact not a
formal generalisation but the aim is particularisation, whereby taking a particular case and understanding its uniqueness (Stake, 1995, Simons, 2009).
The strength of this research is by utilising a multi-case study design, allows comparisons to occur across the case studies and draw generalisable conclusions. In addition the cases taken together do represent the population of interest.
Case study generalisation is an on-going debate and this section has attempted to demonstrate the perspectives of generalisation which should be considered.
4.3.5 Application of case study methodology – in relation to this research
The rationale for applying a case study methodology to this research is as follows:
1. It provides a credible way to study the constructs associated with consultant practice. These constructs as discussed in Chapter three section 3.1 include perceived impact, identity, and power.
2. It focuses on perspectives and experiences, thus allowing the study to examine and explore the concept of consultant practice.
3. The approach will provide information about the concept of consultant practice and its perceived impact (professional and organisational impact) on current clinical practice.
Figure 4.2 provides a schematic representation of the case study research design, which has been adapted from Rosenberg & Yates (2007) who used this method when researching the impact of change on a palliative care organisation. The authors highlight that the use of schematics demonstrate the important concepts and procedural stages of case study design to provide clarity and promote methodological rigour. In relation to this research, the schematic representation has been developed to illustrate the logical components of the overall research design. The seven stages of case study research, from clarification of the research question, through data collection and analysis as outlined by Rosenberg & Yates (2007) have been incorporated into the present study as discussed below.
Figure 4.2 Schematic demonstration of the case study research design
Identity Dimensions
of impact
Power
CONTEXT: Radiotherapy & Oncology Organisation Phenomenon: Consultant Practice
Perceived Professional impact (including identity) Perceived Organisational impact (including power)
Collective Case Study Design in six settings
Focus Group
Phase 1
Individual
Semi Structured interviews and document analysis of CTR job
descriptions Phase 2 Individual Semi Structured interviews Phase 3 Thematic Analysis
Data reduction and display
Drawing and verifying conclusions
Case Description
What has been the perceived professional and organisational impact of the introduction of the consultant therapeutic radiographer role?
Presenting the research question:
Identifying the phenomena of interest is the key step to this case study research. In this case the perceived professional and organisational impact of the CTR was the research question to explore.
Identification of themes and theories:
Establishing the context of the research is equally important, therefore identifying themes and underpinning theories sets the foundations to the case study research design. In this research, perceived organisational and professional impact was appropriately identified to examine the role of the CTR. Yin (2009) acknowledges that theoretical principles are integral in case study research.
Establishing the case, its context and phenomena of interest:
Defining the case from the onset is paramount and needs to be focussed. In this study the cases are the six CTRs working within the radiotherapy and oncology organisation (the five NHS trusts). The phenomenon of interest is the concept of consultant practice and its perceived impact on professional and organisational aspects, yet also to examine identity and power under the aspects as well.
Ascertaining the specific case study approach:
As mentioned earlier, Stake (1995) highlighted the three types of case study research: intrinsic, instrumental and collective. In this study a collective case study has been chosen as multiple cases are being examined to understand the phenomena.
Determining the data collection methods:
Yin (2009) cites that using multiple methods is crucial when upholding rigour. Hence in this study qualitative methods (focus group, semi-structured interviews and document analysis) have been chosen in order to answer the research question.
Choosing the appropriate data analysis method:
In this research, as the data collection methods were of a qualitative nature, thematic analysis was deemed appropriate.
Data reduction and display:
With the large volume of data, it is important to reduce and group them to manageable sizes for further analysis. Miles, Huberman & Saldana (2014) suggest using descriptive and interpretive matrices to assist in this. In this case a thematic framework was developed to organise the data and identity the themes.
Drawing up the conclusion:
The final stage is the conclusion, drawn up to formulate the case description from the data analysis and discussion.
This study makes use of a case study approach and the remainder of this chapter will be dedicated to discussing the study design and data collection methods that were selected for this research.
4.4 Research study design
The study was conducted over three phases. The table below outlines the phased approach: