Qualitative Data Analysis
Coding process used to develop themes - I developed a pre-coding system using P1 to P9
Provide a detailed discussion of the coding process(es) used to develop
themes/perceptions to include specific software tools and methods. - digital software, NVivo 10
Use sufficient detail that another researcher could replicate your study and obtain the same results.
Support the selection of process used with appropriate references from the literature.
Data Analysis
The process of analyzing and interpreting qualitative research data involves several steps to understanding and making sense of the data. Although varying techniques exist for conducting the analysis process, the common premise includes deconstructing and reconstructing the volume of data collected to identify codes and themes to facilitate interpretation and understanding of the participants’ views and experiences (Bengtsson, 2016; Cho & Lee, 2014; Noble & Smith, 2014). Yin (2014) suggested playing with the data as a starting point with an objective of searching for patterns, insights, or concepts. Elo et al. (2014) recommended using the approach of (a) preparing the data for analysis, (b) coding and organizing the data to identify themes and patterns, and (c) interpreting and reporting the results. Bengtsson (2016) described four stages for analyzing the data, which include decontextualization, recontextualization, categorization, and compilation. These stages involve the researcher becoming familiar with the data and identifying units or codes; checking the data to ensure all aspects of the content have been covered in relation to the research goal; identifying themes and categories; and organizing and eliciting meaning from the data to draw realistic conclusions (Bengtsson, 2016).
Conduct a content analysis of the data collected from the recorded face-to-face semistructured interviews of the research participants using the four stages of analysis described by Bengtsson (2016). First, I conducted a verbatim transcription of the interview recordings to facilitate immersion into the data and read the transcribed data to achieve familiarity with the data and gain an understanding of the information presented by the participants. Reading through the transcribed data enables the researcher to gain a sense of the whole before identifying smaller units (Bengtsson, 2016). Gale et al., (2013) highlighted the importance of gaining familiarity with the interview using audio recording, transcript, and any other data collected; and conducting a verbatim transcription of the audio recordings to facilitate immersion into the data. The audio recordings facilitate verification of any discrepancies identified during the analysis phase Giduthuri et al. (2014). Next, I cross-checked the audio recordings and transcribed data for accuracy to ensure the data collected adequately answers the research question.
Third,develop a pre-coding system using P1 to P5, matching the interview questions outlined in Appendix B with the participants’ responses. Coding the data enables classification of the data and comparison of other aspects of the data set (Gale et al., 2013). I then conducted triangulation of the data to ensure the credibility of the research findings by examining documents related to the EHR implementation process such as organizational policies, procedures, and reports, as well as notes from the reflexive journal. Triangulation of the data using multiple methods to collect data can facilitate a deeper understanding of the research topic and supports the validity of the research findings (Carter, Bryant-Lukosius, DiCenso, Blythe, & Neville, 2014; Morse, 2015b). Next, I reviewed and coded the data collected from the written documents, and from the notes of my reflective journal to get a sense of the underlying meaning of the information presented and compare with the themes developed from the interview transcript.
Use the digital software, NVivo 10, to facilitate analysis of the research data collected from the research participants, organizational reports and protocols, and my reflexive journal to gain an understanding of the strategies employed by health care leaders to implement EHR systems. Researchers described NVivo as a tool used to sort and organize research data and facilitate the analysis of the data and understanding of the phenomenon under study (Gould et al., 2014; Sotiriadou, Brouwers, & Le, 2014). I organized the data utilizing the NVivo software to identify codes and grouped similar and recurring patterns into identified themes to aid in the interpretation of the data and facilitate an understanding of the EHR implementation process.
Computer assisted qualitative data analysis tools such as NVivo, facilitate the management, organization, and analysis of data (Sotiriadou et al., 2014). Hays et al. (2016) used a coding system during the data collection and analysis process to facilitate linkages between data set and achievement of a comprehensive and consistent list of variables. Wong, Lavoie, Browne, MacLeod, and Chongo (2013) used an interpretative thematic process in the coding and analysis of data to identify strategies relating to confidentiality issues within group medical visits. Gould et al. (2014) combined selective and open coding methods in their data analysis process. Vaismoradi, Turunen, and Bondas (2013) described content analysis and thematic analysis as analytical strategies used in qualitative research. I explored the data derived from the transcribed interviews and documents to address the research question.
BUSI 988 Dissertation 2
July 10, 2020
Healthcare Management
Leveraging Technology to Increase Focus on Value-Based Care in the Emergency Department
Section 2: The Project
Section 2 will include an in-depth review of the methodology and design of the study. An explanation will be provided for the choice to use a qualitative case study over other methodologies for this project. In addition to these explanations, Section 2 will discuss the steps taken to choose participants, the data collection process and analysis, as well as the steps taken to ensure reliability and validity of research findings. In addition to the participants, Section 2 will discuss the role of the researcher. Section 2 will also discuss ethical considerations in research, methods of obtaining informed consent, how to protect participants and maintaining their anonymity. Section 2 will conclude with a transition and summary statement, leading into Section 3.
Purpose Statement
The purpose of this qualitative case study will be to explore the ineffective use of healthcare information technology by hospital administrators in Georgia’s inner-city emergency departments resulting in a lack of focus on value-based care. In 2009 the Health Information Technology for Economic and Clinical Health (HITECH) Act became law. Compliance with the requirements of the HITECH Act enforces adherence to adequate care and evidence-based clinical guidelines. Kruse and Beane (2018) conducted a systematic review that discussed and confirmed that “81%, in this review, demonstrated improved medical outcomes in terms of efficiency or effectiveness as a result of HIT adoption” (p. e41). Inner-city healthcare facilities serve huge populations daily, suggesting a considerable challenge in their efforts to fulfill the needs of population health effectively (Karahanna et al., 2019). The employment of the right technologies of healthcare management, such as EHRs, promises enormous value in improvements to the quality of healthcare delivered, workflow, costs of healthcare, and the safety of data storage.
Healthcare leadership has a responsibility to manage the delivery of care and the environments, culture, and resources that apply such delivery. An essential aspect of the responsibilities of leadership in a healthcare setting is to influence and cope with change to promote the effectiveness of organizational methods and models in fulfilling emerging needs and achieving desirable health outcomes.
Role of the Researcher
In the study, the role of the researcher is vital. The role of the researcher is to gather and analyze data on the topic studied. During the data collection, the researcher will ensure adherence to the guidelines and principles of ethics during data collection. The researcher will be responsible for recognizing personal biases and reducing threats that may affect the findings of the study (Roulston & Shelton, 2015). The researcher will be responsible for participant recruitment, including initial contact through emails. In qualitative research such as this one, the researcher is the primary instrument for data collection and processing, and may utilize face-to-face, virtual or telephone interviews, or questionnaires to explore participants’ perceptions to perform the study (Fusch & Ness, 2015). The researcher will collect data through semi-structured, open-ended questions as a safeguard against bias. Serving as the primary data collection instrument the researcher will analyze collected data on the decision-making processes for choosing when and what EHR to implement in the emergency department, the researcher will not offer incentives for participation in this study.
Roulston and Shelton (2015) stated when the researcher is the primary instrument, there could be the possibility of bias due to the unpredictable nature of participant interactions. Personal perspectives or biases could unknowingly integrate themselves into the research process and data collection, producing skewed data results (Lau, 2015). It is essential for the researcher to identify and understand how personal worldviews inform the study and research methods used in an assessment during the research process. Having worked in the healthcare field, and having firsthand experience using HIT in the urgent care and emergency department setting could potentially influence my research findings. Prior to this study, the researcher has not developed or maintained a personal or professional relationship with the participants, or any supervisory relationship with the participants or position of authority within the healthcare facility studied. After this study concludes, there will be no ongoing personal or professional relationship with the participants, or any supervisory relationship with the participants or position of authority within the healthcare facility. The characteristics of the researcher could also influence the selection of participants of this study (Probst, 2015). In this study, the research questions process includes interviewing other healthcare professionals, which could include biases relating to the knowledge bases of both the participant and interviewer.
To mitigate the possibility of biases in this study, research has suggested using a reflexive journal. The use of a reflexive journal is to encourage the researcher to study and understand their own “presuppositions, choices, experiences, and actions during the research process” (Ortlipp, 2008 p. 695). During this research project, the researcher will maintain a reflexive journal to document awareness of personal experiences and views concerning the use of HIT that could present bias and affect the interpretation of the information gathered. Mason-Bush (2018) described using reflexivity as a process of self-reflection designed to allow the researcher to take responsibility for personal awareness’s such as experiences and beliefs. Darawsheh (2014) identified the primary outcomes of using a reflexive journal as one of maintaining transparency and altering processes during research to ensure validity of findings.
Other methods used to control or mitigate biases in qualitative research are bracketing and epoché. Epoché and bracketing are conscious processes permitting the researcher to set aside firsthand experiences or beliefs concerning the issue under study, and to facilitate new knowledge concerning the study phenomenon (Sorsa et al., 2015). According to Baksh (2018) bracketing is a process that requires the researcher to intentionally set aside experiences with the phenomenon being studied before and during the research process. The challenging aspect of addressing personal biases is that bracketing requires putting aside personal biases (Berger, 2015), while reflexive journaling requires the researcher to thoroughly think about and examine personal biases (Darawsheh, 2014). Having worked in the healthcare field, but not in the capacity of authority or decision-making, the use of bracketing and epoché can help to avoid making assumptions and judgments about the phenomenon.
Adhering to ethical principles set forth in research guidelines is a vital component of any research process (Vilma, 2018). The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research created the Belmont Report for the protection of human subjects of research. The researcher can manage personal biases by observing the Belmont principles of respect for persons, beneficence, and justice (Office for Human Research Protections, 2016). Anabo et al. (2019), referencing the Belmont Report Protocol, outlined ethical research requirements as being grounded in moral principles in relation to research involving human subjects which acts as a guidepost for analyzing ethical concerns associated with research. The general principles outlined in the Belmont Report include (a) respect for human subjects including obtaining informed consent, (b) beneficence as it relates to assessing risks vs. benefit, and (c) justice as it pertains to the selection of participants for this study (Anabo et al., 2019). In this study, the researcher will maintain professionalism within the confines of the Belmont principles to protect the rights of the research participants.
The researcher will respect the independence of the participants by providing a consent form to obtain their permission to voluntarily participate in the study and provide relevant and factual information explaining the risks and benefits associated with the study to ensure they are making an informed decision. To maintain participant anonymity, the researcher will use a numerical coding system P1 – P9 to identify study participants. Hammersley (2013) noted the importance of maintaining the confidentiality of the participants and respecting their rights to refuse to participate or withdraw from the study without consequences. The participants selected for this study will not be from a vulnerable population.
Yin (2009) recommends using an interview protocol when conducting qualitative case studies to promote the validity of the research findings. An interview protocol contains an overview of the case study, the procedures used to collect data, the research questions, and a guide for the case study report (Yin, 2009). In this study, the researcher will use an interview protocol, outlined in Appendix A, to promote the consistency of the interview process and facilitate the understanding of the decision making process for when and how to implement HIT in the emergency department.
Participants
Qualitative research involves the researcher establishing a set of operational boundaries such as inclusion and exclusion criteria to set a boundary for population size (Ranney et al., 20015; Yin, 2009). The researcher will use a purposive sampling technique to identify participants knowledgeable with the decision-making method used to approve or deny the implementation of HIT in the emergency department. Purposefully selecting participants with the expertise and experience in the research topic facilitates the collection of data that adequately
represents the phenomenon under study (McIntosh & Morse, 2015). Robinson (2014) discussed the importance of being intentional in the selection of participants who have knowledge in the phenomenon being studied, as they can provide a valuable, firsthand description of their experience as it relates to the research topic. To gain the most relevant, in-depth information relating to the research topic, the researcher has selected participants that meet the following eligibility criteria: (1) healthcare leaders from one specific inner city hospital in Georgia, (2) participants that have participated in the decision-making process for HIT implementation and (3) participants that will be willing to consent to an audio recording of the interview session.
Obtaining access to research participants can be a tedious, uncomfortable task that requires time and dedication. Bergman Blix and Wettergren (2014) highlighted the significance of setting a foundation of credibility when starting the process of gaining access to participants. Fostering a relationship of trust and respect with a gatekeeper could facilitate access to the participants and their knowledge. Crowhusrt (2013) defined a gatekeeper as the person the researcher makes initial contact with and who endorses the researcher’s work. Using a personal connection as the gatekeeper, the researcher developed a professional connection to function as the gatekeeper for access to the hospital staff who have firsthand experience in the decision-making process for HIT implementation.
Maintaining access to research participants is also tedious and demanding work. Past literature has suggested the need to maintain a relationship of trust, open communication and mutual respect for participants and researchers (Høyland et al., 2015; Yin, 2009). The researcher in this study, will provide the participants with complete and accurate information regarding the study, the purpose of this study, and the researcher’s role in this study to foster an atmosphere of honesty and transparency. The researcher will initiate first communications through email introducing myself and providing the participants the research goal and objectives. The researcher will adhere to the ethical principles outlined in the Belmont Report by using a coding system to identify participants as P1 – P9, as well as provide them with complete information on the risks and benefits of the study to ensure each participant will have the opportunity to make a fully informed decision.
Research Method and Design
Since the focus of this study is to explore leadership decision making when implementing HIT in the emergency department to promote value-based care, a qualitative single case study will be the most appropriate. In a qualitative study, the researcher can gain a deeper understanding of when and how a phenomenon occurs in a setting (Sawatsky et at., 2019). The central concepts of this study will include the complex adaptive theory and Input/Throughput/Output Model as defined by Welsh (2014) and Asplin et al., (2003) respectively. The advanced nature of HIT is not a phenomenon, but detailed information collected from participants could add to the body of knowledge regarding promoting value-based care by decreasing and preventing crowding in the emergency department.
Research Method
For this study, the researcher will use a qualitative research method to explore the strategies healthcare leaders might use when determining what HIT to implement in the ED to promote value-based care for the patients. Qualitative research facilitates an inductive approach, enabling researchers to employ open-ended questions of inquiry to identify and understand the research phenomenon as experienced by the participants (Yin, 2009). Qualitative researchers share a constructivist worldview through which constructivists define reality as a mental construct that can be subjective (Berg & Lune, 2012). Using the Constructivist Theory, this qualitative research study will attempt to explain the phenomenon of ineffective leverage of HIT in this inner-city hospital ED by analyzing the experiences of the participants using diverse data collecting agents. This qualitative research allows the researcher to immerse themselves into the phenomenon to gain a complete experience of value-based care in the ED as it relates to the CAS framework and the input/throughput/output model by exploring the interconnectedness and multidisciplinary interactions required for the system to function together (Bircher & Kuruvilla, 2014).
Research Design
For this study, the researcher will use a case study design. The exploratory nature of a case study entails examining the interaction of multiple variables presented through documents, quotes, samples, and artifacts; a case can be a person, program, an organization, or a group (Yin, 2009). An exploratory case study will provide a deeper understanding of why healthcare information technology is not used effectively to promote value-based care, which may result in increased staff turnover in the emergency department. Patton (1990) suggested that case studies are valuable in creating a deep understanding of particular people, problems, or situations, in comprehensive ways. From an analysis of a single case, one can identify and describe underlying phenomena and uncover new relationships and new perspectives on a topic (Merriam, 2001).
The exploratory focus of this design will provide a more in-depth insight into the subject of research and uncover relevant underlying trends. Qualitative methods gather information from the standpoint of the participant and are used to collect data on experiences and phenomena (Hammarberg et al., 2016). Stake (2006) posited qualitative research relies heavily on human perception and comprehension. This study will consist of gathering information in the form of a single case study. The case study method features the researcher’s focus on exploring a ‘bounded system’ (the case) in a period, such that the elements of time and place are specific in the investigation. The researcher focuses on exploring an issue within determined structures (Taylor & Francis, 2013).
For this study, the researcher will apply a case study approach to better explore and describe in-depth leadership strategies that address the problem of the absence of HIT in the emergency department which results in a lack of value-based care for patients. A case study approach will better answer the research questions and address how to make those decisions. A further reason the case study method will be the ideal approach for this study is that numerous researchers effectively used this approach in the past to examine various healthcare leadership phenomena such as Song (2019) who addressed deploying mobile technology to improve the quality of healthcare delivery and Alhuwail (2016) who addressed leveraging HIT to improve home health care. In both studies, the researchers used a qualitative case study to address the phenomena of how to improve healthcare delivery through different means.
To obtain research quality and validity, data saturation is key (Fofana et al., 2020; Fusch & Ness, 2015). Data saturation is the point in data collection where no new information emerges from additional interviews (Fofana et al., 2020; Saunders et al., 2018). Researchers posited that data saturation occurs at different levels in qualitative research. The sample size for qualitative research depends on the attainment of data saturation, however O’Reilly & Parker (2013) maintain that many studies aim for data or theoretical saturation but fail to completely achieve it. Saunders et al., (2018) argued that that data saturation does not occur with ‘just one additional interview’, rather the previous interviews become richer or more insightful. Therefore, for this study, the researcher will attempt to reach theoretical data saturation by conducting interviews until the interviews yield no new information or patterns.
Population and Sampling
For this case study, the researcher will use a purposive sample strategy to select participants for this research. Purposive sampling in qualitative research is the process of selecting applicants that may be most affected by a specific issue or have the most first-hand knowledge of the phenomenon studied (Valerio et al., 2016).
The researcher will be responsible for participant recruitment, including initial contact through emails. During the initial contact the researcher will provide each of the participants with a clear account of the purpose of the study, the estimated time commitment for study participation, a formal invitation to participate, and an informed consent form with a requirement to review, acknowledge, and return consent by email or mail to the researcher. The participants for this study will be nine healthcare leaders from one hospital located in one inner-city of Georgia. The chosen participants will consist of members such as Chief Compliance and Privacy Officer, Chief Quality and Patient Officer, CEO, CFO, CIO and CRO. The researcher will select participants that meet the following eligibility criteria: (1) healthcare leaders from one specific inner city hospital in Georgia, (2) participants that have participated in the decision-making process for HIT implementation and (3) participants that will be willing to consent to an audio recording of the interview session.
The potential participants for this study will be selected because they have first-hand knowledge of the decision-making process as it pertains to what HIT is best suited to promote value-based care. These same leaders will have knowledge and make the determination for what HIT is implemented in the hospital emergency department. Participant experience in HIT will assist the researcher with collecting and analyzing relevant data related to the phenomenon studied. In addition, these participants will be selected because they consent to an audio recording of the interview sessions.
The interview questions will consist of semi-structured interview questions. Semi-structured interviews are interviews that contain open-ended questions to facilitate the flow of information, as opposed to yes/no questions. Semi-structured interviews allow the researcher the flexibility to continue asking probing questions specific to the phenomenon being studied (McIntosh & Morse, 2015). Robinson (2014) noted the importance of probing questions as they allow the researcher to develop a clearer and deeper understanding of participants responses and the phenomenon studied.
Using face-to-face interview sessions will enable the researcher to observe the participants during the process and gather information through social cues such as body language and voice levels and tones (Irvine et al., 2013). Face-to-face interviews optimize communication by enabling the observation of both verbal and nonverbal interactions. This aids the researcher to clarify any questions or address any doubt the researcher or participants may have regarding the interview questions (McIntosh & Morse, 2015; Oltmann, 2016). Boddy (2016) argued that using a constructivist theory for a single case study with a small population sample can be highly enlightening. Constructivists define reality as a mental construct that can be subjective (Berg & Lune, 2012). With this in mind, the researcher feels justified in using a small sample size. During the interview process, the researcher will interview participants until the researcher achieves theoretical data saturation.
Data saturation can guide the researchers’ sample selection during the data collection process. Researchers have determined that data saturation can drive sample size (Tran et al., 2017). Depending on the scope of the research, sample sizes can vary widely in qualitative research and as such, there is no universally accepted criteria to determine what is the exact, right sample size (Hancock et al., 2016; Saunders et al., 2018; Tran et al., 2017). Complete data saturation and its corresponding sample size has been heavily debated amongst qualitative studies (Boddy, 2016; Marshall et al., 2013). Qualitative studies present the flexibility of using smaller sample sizes as opposed to quantitative studies. Qualitative studies can use smaller sample sizes due to the primary focus of the study being to understand the complexity, depth, origin, or variation of a phenomenon (Boddy, 2016; Gentles et al., 2016). In their study of mental health in the emergency department, Shefer et al., (2014) used 39 participants, while Flink et al., 2012 used 20 participants. Saurman et al. (2015) sent invitations for participation to 169 individuals and used just 12 participants. For this research study, the researcher selected a preliminary sample size of nine participants.
Ethical research
The Belmont Report outlined the ethical principles that researchers must follow while conducting research when it involves human subjects (Anabo et al., 2019). These principles include respecting participants’ autonomy to consent to the study, informing participants of all risks and benefits, obtaining a consent form, and maintaining participant privacy (Anabo et al., 2019; Lerner & Lerner, 1979, Miracle, 2016). Respect for participant autonomy includes divulging adequate and truthful information regarding the risks and benefits involved to ensure participant understand all pertinent information about the research study and their choice to participate or not (HHS.gov, 2016). The researcher for this study will email the consent form to study participants outlining the background of the study, consent process, risks and benefits, as well as contact details for those declining to participate in the study.
Participants will be informed that their participation is completely voluntary and did not include any monetary incentives or compensation. Miracle (2016) noted the importance of informing participants of the ability to withdraw from the study at any point. Participants will be informed that they are able to withdraw from the study at any time without penalty or consequences. In this research study, the researcher will request that the participants who decline participation in this study, do so through the contact details provided when requesting participation. The researcher will secure all email correspondence on a password protected computer accessible by the researcher only. Adhering to The Belmont Report the principle of confidentiality promotes the protection of the rights and dignity of the participants (Romm, 2020).
The researcher will seek approval from Liberty University Institutional Review Board (IRB) before contacting the research participants. The final doctoral manuscript will contain the Liberty IRB approval number. The purpose of the IRB is to provide a system of protection to guide researchers when working with human subjects (Grady, 2015). Kotsis & Chung (2014) stated that the federal government does not require IRBs to review the scientific validity of the proposed research, however, the government does require IRBs to verify that subject risks are reasonable in relation to the knowledge that may be gained during the course of study. Zink et al., (2005) posited that IRB members are there to provide oversite to ensure researchers ensure the protection of the participants rights and well-being during the research. This doctoral manuscript will not contain any personally identifying information regarding the participants or healthcare organization.
To maintain the anonymity of the healthcare facility and the research participants, the researcher will use a coding system using the pseudonyms P1 – P9. Previous research has highlighted the importance of using pseudonyms to maintain confidentiality (Gumede et al., 2019; Miracle, 2016; Zink, 2005). The researcher will use the NVivo software system to perform data analysis and identify recurring themes in the collected data. All written or audio recorded information collected will be stored in a locked box accessible only by the researcher. All electronic information will be stored on a password protected computer. The researcher will keep the collected data for 5 years before shredding all written information. The researcher will also wipe the hard drive, rather than formatting or deleting disk partition; this process will render the data files unrecoverable. The researcher will share a summary of the findings with the participants according to the member-checking process. Cope (2014), posited that member-checking promotes the accuracy of the data and validity of the findings.
Data Collection
Instruments
In a case study, researchers routinely utilize various data collection methods. In this study, the researcher served as the primary data collection instrument, using semi-structured interviews as the primary data source. The interviews were conducted with individual participants at one inner-city hospital in Georgia. A secondary source of data collection was a thorough review of documentation, such as decision-making processes, policies and procedures, meetings, and financials, regarding previous HIT decision-making conducted in the hospital. Data collection in qualitative research requires the researcher to use multiple data collection sources to strengthen the validity of the research (Yin, 2009). Case studies provide the researcher with the opportunity to match multiple forms of data, allowing for a more in-depth understanding of a phenomenon, which is importance in the healthcare field, where the decision-making process is difficult to evaluate (Runfola et al., 2017). The research was able to obtain a great deal of knowledge from the interviews, meeting the purpose of addressing the ineffective use of HIT resulting in the lack of value-based care in the emergency department. The additional document review assisted in reaching theoretical data saturation.
Triangulation of data sources can enhance the reliability of the findings (Santos et al., 2020). Triangulation of the data collected through the semi-structured interviews and thorough review of the documentation maximizes the likelihood of gaining a rich, in-depth perspective of the phenomenon and saturation of the data (Fusch & Ness, 2015; Santos et al., 2020; Tran et al., 2017). Cho and Lee (2014) noted that triangulation of data collected using multiple sources can help minimize research bias and the opportunity to misinterpret the findings.
This research study will consist of seven semi-structured interviews, which will allow the participants to openly discuss matters that are of importance to them regarding the topic being researched. Semi-structured interviews are “meant to be a personal and intimate encounter in which open, direct, verbal questions are used to elicit detailed narratives and stories. The interviewer’s task is to obtain information while listening and encouraging another person to speak” (Dicicco-Bloom & Crabtree, 2006, p. 317). The researcher will ask the same seven questions to maintain consistency and ensure trustworthiness of the data collected. To further enhance the trustworthiness and validity of the data, the researcher will use the member-checking strategy. Cope (2014), posited that member-checking promotes the accuracy of the data and validity of the findings. Member-checking is a qualitative research process in which the researcher shares preliminary findings with the participants to ensure data accuracy (Cho & Lee, 2014, Naidu & Prose, 2018).
A review of documentation containing past decision-making processes, policies and procedures, meetings and financials regarding previous HIT decision-making for the hospital was used to validate the data collected during the interviews with triangulation (Fusch & Ness, 2015; Santos et al., 2020). Although a document review does not generate as insightful a response as face-to-face interviews (Bergman Blix & Wettergren, 2015), a document review does propose a convenient way to gather data as most documentation is available vis the internet, library databases, new outlets or from the participating organization.
Data collection technique
The researcher will obtain permission to conduct research semi-structured interviews using the interview protocol outlined in Appendix A as a standard guide in the data collection process. Yin (2009) discussed having a case study protocol to outline the general rules and procedures the researcher will follow while collecting data which includes (1) and overview of the research being conducted, (2) data collection procedures, (3) research questions and (4) a guide for the case study report. The data collection process will also include a review of organizational documents. Triangulation of this data facilitates comparison of the information, helps to minimize researcher bias and gain a deeper understanding of the phenomenon (Fusch & Ness, 2015). The use of semi-structured interviews allows the researcher and participants the flexibility to deviate from the predetermined questions, enabling the opportunity to ask probing questions and he introduction of new information, resulting in a rich, in-depth collection of data (McIntosh & Morse, 2015). After conducting interviews, the researcher will conduct a review of organizational documents pertaining to decision-making processes, policies and procedures, meetings, and financials for implementing HIT in the ED. The researcher will obtain permission from the organization before reviewing documentation. Before accessing the necessary documents, the researcher will request permission to review documentation.
Data organization technique
The researcher will use the NVivo digital software to organize the collected data. Using digital software such as NVivo helps sort, organize, and classify data. Organized data enables the researcher to better interpretation the data and identify patterns to better answer the research questions (Castleberry, 2014). The NVivo software is designed to organize the data, setting the codes and data interpretation is up to the researcher. The researcher will enter the codes and themes identified into the NVivo software to organize and analyze the research data. During the interviews, the researcher utilized a coding system using P1 – P9 to identify the participants; this was done to maintain the confidentiality of the participants and healthcare facility.
The hard copy and written data will be stored in a locked drawer on a personal desk. The key will only be held by the researcher. The digital and audio recordings will be stored on a personal password protected laptop, accessible by only the researcher. Because the location of a smartphone can be traced, the interviews will be recorded on an audio device and uploaded to the NVivo software program for transcribing. The digital data collected will also be backed up to an external hard drive. Both the hard copy and digital data will be stored in a locked drawer for five years from the conclusion of the doctoral manuscript. After which time the hard copy data will be shredded and the external hard drive will be wiped of all digital files.
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