Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

Abstract
Background: Paramedics make important and increasingly complex decisions at scene about patient care. Patient
safety implications of influences on decision making in the pre-hospital setting were previously under-researched.
Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety.
Ethnography ( the study of peopl e and cultures) has be en acknowledged as a suitable method for identifying
healt h care issues as they occur within the natural conte xt . In this paper we compa re multiple methods used in
a multi-s ite, qualitati ve study that aimed to identify system influences on decision making.
Methods: The study was conducted in three NHS Ambulance Trusts in England and involved resear ch ers from
each Trust work ing alongside academic resea rchers. Ex plorator y interv iews w ith key informants e.g. managers
(n = 16) and docu ment review provide d contextu al information. Between October 2012 and July 2013 researchers
obser ved 34 paramedic shi fts an d ten parame dics pro vided addit io nal accounts via audio-recorded ‘digital diaries’
(155 events). T hree staff focus g ro up s (total n = 21) and three servic e user focus groups (total n = 23) explored a
range of experiences and perceptions. Data co llection and a nalysi s was carried ou t by academic an d ambulance
service researchers as we ll as service us ers. Wor ks hops were held at each site to elicit f eedback on t he findings
and facilitate pri oritisation of issues id entifi ed.
Results: The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance
service staff and service users. A key factor in successful implementation of the study was establishing good working
relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated
the recruitment process as well as study progress. Active involvement with the study allowed ambulance service
researchers and service users to gain a better understanding of the research process. Feedback workshops allowed
stakeholders to discuss and prioritise findings as well as identify new research areas.
Conclusion: Combining multiple qualitative methods with a collaborative research approach can facilitate exploration
of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths
and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for
future intervention and research.
Keywords: Multi-method research, Ethnography, Qualitative, Patient safety, Pre-hospital, Ambulance service