‘Trying to pin down jelly’ - exploring intuitive processes in quality assessment for meta-ethnography

Background: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the ‘quality’ of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. Methods: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. Results: We suggest two core facets of quality for inclusion in meta-ethnography - (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation ‘be trusted?’ Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? Conclusions: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged ‘good enough’ there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies

SARS and hospital priority setting: a qualitative case study and evaluation

BACKGROUND: Priority setting is one of the most difficult issues facing hospitals because of funding restrictions and changing patient need. A deadly communicable disease outbreak, such as the Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, amplifies the difficulties of hospital priority setting. The purpose of this study is to describe and evaluate priority setting in a hospital in response to SARS using the ethical framework 'accountability for reasonableness'. METHODS: This study was conducted at a large tertiary hospital in Toronto, Canada. There were two data sources: 1) over 200 key documents (e.g. emails, bulletins), and 2) 35 interviews with key informants. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. RESULTS: Participants described the types of priority setting decisions, the decision making process and the reasoning used. Although the hospital leadership made an effort to meet the conditions of 'accountability for reasonableness', they acknowledged that the decision making was not ideal. We described good practices and opportunities for improvement. CONCLUSIONS: 'Accountability for reasonableness' is a framework that can be used to guide fair priority setting in health care organizations, such as hospitals. In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less

Priority setting in developing countries health care institutions: the case of a Ugandan hospital

BACKGROUND: Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. However, there is lack of literature that describes and evaluates priority setting in these contexts. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes – Accountability for Reasonableness. METHODS: A case study in a 1,500 bed national referral hospital receiving 1,320 out patients per day and an average budget of US$ 13.5 million per year. We reviewed documents and carried out 70 in-depth interviews (14 health planners, 40 doctors, and 16 nurses working at the hospital). Interviews were recorded and transcribed. Data analysis employed the modified thematic approach to describe priority setting, and the description was evaluated using the four conditions of Accountability for Reasonableness: relevance, publicity, revisions and enforcement. RESULTS: Senior managers, guided by the hospital strategic plan make the hospital budget allocation decisions. Frontline practitioners expressed lack of knowledge of the process. Relevance: Priority is given according to a cluster of factors including need, emergencies and patient volume. However, surgical departments and departments whose leaders "make a lot of noise" are also prioritized. Publicity: Decisions, but not reasons, are publicized through general meetings and circulars, but this information does not always reach the frontline practitioners. Publicity to the general public was through ad hoc radio programs and to patients who directly ask. Revisions: There were no formal mechanisms for challenging the reasoning. Enforcement: There were no mechanisms to ensure adherence to the four conditions of a fair process. CONCLUSION: Priority setting decisions at this hospital do not satisfy the conditions of fairness. To improve, the hospital should: (i) engage frontline practitioners, (ii) publicize the reasons for decisions both within the hospital and to the general public, and (iii) develop formal mechanisms for challenging the reasoning. In addition, capacity strengthening is required for senior managers who must accept responsibility for ensuring that the above three conditions are met

Coping with a Crisis of Meaning: Televised Paranoia

Across all genres, television communicates a host of perceived dangers or risks to human survival as entertainment, responding and reproducing the victim and risk consciousness of the late twentieth and early twenty-first centuries. Terrorism has captured the imaginations of not only politicians but also producer/writers, and as a consequence of this, and the visual spectacle that war and terrorism provide, it has featured regularly and consistently in British and American television programming. This article presents the analysis of some British current affairs entertainment programming (film and documentary) broadcast by the BBC during the height of the misnamed ‘war on terror’. Through the analysis of these programmes, I will demonstrate a psycho-cultural approach to textual analysis informed by early object relations psychoanalysis. Being aware of the degree to which political elites have shaped what is known about the ‘war on terror’ allows us to apply knowledge of the political and historical context of these elites to understanding why the dominant ‘war on terror’ perspective is paranoid in character. I will offer an explanation of why a paranoid style predominates in terrorism related programming in my conclusion

Looking Good: Mediatisation and International NGOs

Many international NGOs value those parts of their work that are suited to media representation: campaigning, advocacy, projects that produce the right sort of images. In this article I make three points about this change. First, those parts of the NGO most reliant on media – such as the campaign desk – may be becoming more powerful. This can change the internal dynamics of NGOs. Second, the increasing use of media means that NGOs, like other organisations, hold themselves accountable in new ways. Third, NGOs may appear to look more and more like media organisations. These changes have received relatively little attention in the literature on NGOs, though they reflect a broader set of debates about the role of media in society. Using a case analysis of an international NGO, I suggest that the concept of mediatisation might be a useful way to understand some of the changes observed in the NGO sector

Learning informally to use the 'full version' of teaching games for understanding

This paper examines an experienced teacher’s employment of the teaching games for understanding (TGfU) model in a UK secondary school. The study sought to investigate how the teacher delivered TGfU and those factors that influenced his informal learning of this instructional model. Occupational socialisation was utilised to determine the factors that influenced his use of TGfU. Qualitative data were collected from interviews, lesson observations and documentary evidence. Inductive data analysis indicated the teacher delivered the ‘full version’ of the model largely congruent with the creators’ intentions. The traditional approach to games teaching seen in his childhood and partially learned in higher education were ‘washed out’ by the influence of teaching colleagues and the development of a student-centred approach to teaching games. This study indicates it is possible to overcome traditional approaches to games teaching and informally learn to use TGfU successfully given conducive circumstances and sufficient time

Priority setting: what constitutes success? A conceptual framework for successful priority setting

BACKGROUND: The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. METHODS: Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). RESULTS: This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. CONCLUSION: The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts

Populist communication in the new media environment: a cross-regional comparative perspective

The changing terms of mediation place new demands, opportunities and risks on the performance of the political persona. Visibility has become a double-edged sword, leaving representatives vulnerable to exposure while new tools provide opportunities for emerging entrepreneurial actors. This double risk to elites’ mediated personas—exposure and challenge from entrepreneurs—renders their armour of authenticity dangerously fragile, which nourishes a public sense of being inefficaciously represented. It is this climate in which populism currently flourishes around the globe. Three primary criteria of mediated self-representation by politicians—visibility, authenticity and efficacy—form the focus of this paper: how do populists negotiate such demands in different democratic contexts, and wherein lies the symbiosis between populism and the new media environment suggested by the literature? To answer this, the paper compares two populist cases responding to different democratic contexts: UKIP, a right-wing party from an established democracy (UK), and the Economic Freedom Fighters (EFF), a left-wing party from a transitional democracy (South Africa). The objects of study are disruptive performances by these parties, which are considered emblematic manifestations of populist ideology as they establish a Manichaean relationship between the elite and populist actors who embody the people. The paper introduces disruption as a multi-faceted and significant analytical concept to explain the populist behaviour and strategies that underlie populist parties’ responses to the demands for visibility, authenticity and efficacy that the new media environment places upon political representatives. Using mixed methods with an interpretive focus, the paper paints a rich picture of the contexts, meanings and means of construction of populist performances

Local Narrative-Making on Refugees: How the Interaction Between Journalists and Policy Networks Shapes the Media Frames

AbstractCity narratives are crucial in shaping public attitudes and perceptions, and in defining the viable policy options and cities' responses to hot issues, such as migration and asylum. Nevertheless, the literature on relations between media and political actors is scarce and often unable to account for the complex local mechanisms leading to the production of media frames. This chapter investigates two urban crises: the rapid increase of transit refugees at the Central Station of Milan, and refugees' illegal occupation of four buildings in the ex-MOI area (former Olympic village) in Turin. Both events started in 2013 and have been studied from their beginnings up to mid-2016 by using qualitative techniques and media frame analysis. By matching the media and policy analysis, the authors show the central role that the local institutions can play in shaping media narratives on migrants and how the cohesion of the policy networks strengthens their ability to affect the local media frames. The dynamics of local journalism also matter: the presence of reporters with specific expertise, a commitment to migration and stable engagement in the issue, as well as collaboration within and between newsrooms, namely the existence of a sort of local media community, contribute to the development of consistent narratives over time and the prevalence of humanitarian rather than security frames