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Integrating quantitative and qualitative approaches: an approach applied to the study of Intensive Care

Integrating quantitative and qualitative approaches: an approach applied to the study of Intensive Care. Presented by Ruth Kowalczyk. Intensive Care.

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Integrating quantitative and qualitative approaches: an approach applied to the study of Intensive Care

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  1. Integrating quantitative and qualitative approaches: an approach applied to the study of Intensive Care Presented by Ruth Kowalczyk

  2. Intensive Care “ A service for patients with potentially recoverable diseases who can benefit from more detailed observation and treatment than is generally available in the standard wards and departments.” King’s Fund Panel (1989)

  3. Why study Intensive Care? • Little research done • Expensive service • Increasing demand • Highly politicised mistakes

  4. Why study effectiveness? • Within the NHS • Within Intensive Care

  5. Performance measures • Effectiveness • Efficiency • Customer satisfaction • Staff satisfaction • Growth

  6. Factors affecting ICU management Diagnostic diversity Effect of other units Unit size Workload Case mix Technology £ Location Resources Demand Staffing ICU management Structure Work routine Policies Personnel Personalities

  7. Research Questions • What does managerial effectiveness actually mean to intensive care? • Is there a way to compare units with others like themselves? • Can the performance of a unit be improved by adopting the policies or practices of another unit?

  8. Research Questions • How do the policies of a unit affect the practices of the unit staff? • How does the management structure of a unit affect its performance?

  9. Answering the Research Questions Managerial effectiveness Comparing units Improving performance Statistical analyses & mathematical modeling Impact of policy on practice Effect of structure on performance

  10. Answering the Research Questions Observation & interviewing Managerial effectiveness Comparing units Improving performance Statistical analyses & mathematical modelling Impact of policy on practice Effect of structure on performance

  11. Mixing Methods • Qualitative methods • as a prerequisite to quantitative methods • to supplement quantitative methods • to examine areas not amenable to quantitative methods Pope & Mays, 1995

  12. Mixing Methods Quantitative methods Qualitative methods What How Why

  13. Correlation, ANOVA and regression Data Envelopment Analysis Case study, including Observational study Semi-structured interviews. Semi-structured interviews in 4 ICUs identified by quantitative analysis. Quantitative & Qualitative methods

  14. Limitations to DEA in complex situations • Conflicting output measures • Outputs or inputs? • Low correlations Careful interpretation of results

  15. Intensive Care in context - Patient movement

  16. Integration of ICU within the Hospital • ICU nurses as distinct sub-culture • work • knowledge • relationship with doctors

  17. An integrated unit is more likely to have better patient survival, more transfers out, ability to maintain occupancy standards, nurse post-basic training, no intercollegiate recognition. Integration of ICU within the Hospital

  18. Quantitative & Qualitative methods Method Evaluative Research Framework Realism Ontology

  19. Evaluation research Key features of evaluation :- • Value & Worth • Real World Research • Diversity

  20. Utilisation of research • Involving stakeholders • Context • Process v. outcome • Whose needs? • Incremental • Time span

  21. Key features of Realism • Stratified Ontology • Retroduction • Mechanism in Context  Outcome • Emergence

  22. References • Pope C. & Mays N., Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research, BMJ, 1995; 311: 42-5. • King’s Fund Panel, Intensive Care in the UK, Anaesthesia, 1989; 44: 428-31.

  23. Other Useful References • Mingers J., The contribution of critical realism as an underpinning philosophy for OR/MS and systems, JORS, Vol. 51, No. 11, November 2000. • Pawson R. & Tilley N., Realistic Evaluation, 1997, Sage, London. • Robson J., Real World Research: A resource for social scientists and practitioner researchers, 1993, Blackwells, Oxford. • Sayer A., Realism and Social Science, 2000 , Sage, London.

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