Qualitative Research and the Profound Grasp of the Obvious

Health Services Research, Dec, 1999 by Robert E. Hurley

Objective. To discuss the value of promoting coexistent and complementary relationships between qualitative and quantitative research methods as illustrated by presentations made by four respected health services researchers who described their experiences in multi-method projects.

Data. Sources. Presentations and publications related to the four research projects, which described key substantive and methodological areas that had been addressed with qualitative techniques.

Principal Findings. Sponsor interest in timely, insightful, and reality-anchored evidence has provided a strong base of support for the incorporation of qualitative methods into major contemporary policy research studies. In addition, many issues may be suitable for study only with qualitative methods because of their complexity, their emergent nature, or because of the need to revisit and reexamine previously untested assumptions.

Conclusion. Experiences from the four projects, as well as from other recent health services studies with major qualitative components, support the assertion that the interests of sponsors in the policy realm and pressure from them suppress some of the traditional tensions and antagonisms between qualitative and quantitative methods.

Key Words. Qualitative methods, health services research, policy studies

I argue...the test of the value of any formal social policy is to be found in everyday experience rather than in the highly selective abstractions of the statistics, accounting devices and indicators found in official documents. While all these devices are necessary tools for a large and complex society, they are only as useful as one's capacity to interpret them wisely. And one's capacity to interpret them accurately depends on the depth of one's acquaintance with the everyday experience of those concrete people doing their work in their own way.

Eliot Freidson, in preface to Doctoring Together (1975)

It is instructive to re-read the pages of one of the legendary pieces of qualitative research just cited, and at the same time to read on the pages of the financial press the apparent demise of the short-lived physician practice management industry. Perhaps the developers and promoters of this industry, and certainly its investors, would have been well served to have cultivated a richer understanding of what an exceedingly difficult task it is to rationalize a cottage industry or to industrialize the physician collegium. The statistics on industry fragmentation, measures of physician capacity and productivity, and a variety of accounting indicators may have seemed persuasive in concluding that the timing and the model were right. But one is left wondering if what has been missing in this industry is simply a basic understanding of the phenomenon: organized physician practice. And it was there all along in the pages of this extraordinary qualitative study.

It has become axiomatic to characterize good research as being the profound grasp of the obvious. Framed in that fashion, it is hardly surprising, then, that qualitative research has an integral role to play in much of our contemporary health services research. Applied fields of study require a close and clear connection with contemporary reality both for descriptive and interpretive purposes, and for the more prosaic tasks of providing context and story lines that are understandable to sponsors and consumers of this research. This is nowhere truer than in the large-scale multi-method policy research and evaluation studies that have become the bulwark of support for much of the current health services research workforce. For these projects, qualitative research techniques have not been relegated to the "oppositional culture" status that has befallen them in other fields and in many academic environs. In large measure this may be because, without their inclusion, this research would simply not be responsive t o many important questions under investigation. In fact, the expectations of sponsors for timely, relevant, and practical findings have required that research and evaluation designs address explicitly the contribution of qualitative methods to their studies.

This article describes selected evidence from the field of health services research to indicate the standing that qualitative research has attained. Following a brief background, it provides a summary of the diverse contributions of qualitative research to four recent research projects as seen from the vantage point of experienced researchers employing these techniques. The researchers shared their insights and reflections on challenges that they and their colleagues faced when they used qualitative methods in these studies and other work. Finally, some general themes are synthesized and discussed from these projects with implications drawn for current and future health services researchers.

THE QUALITATIVE CONTRIBUTION

Sofaer (1999) has provided a thoughtful and comprehensive discussion of the principal qualitative research methods and a convincing rationale for using them in health services. Qualitative methods offer powerful and versatile techniques to examine the complexities and subtleties in the complicated sets of relationships in health care financing, organization, and delivery. Sofaer's arguments underscore just how false the adversarial relationship between qualitative and quantitative research may actually be in applied, area studies like health services research.