Data collection

Data collection with questionnaires

The study design for data collection from the staff that participated in team supervision was longitudinal (see Figure 2). As the main interest of the study was to explore professional development in teams and in its individual members, the ‘Prerequisites for professional development’- and ‘Professional individual development’- questionnaires were considered a suitable data collection method for this purpose. The self-report questionnaire was developed for this purpose through modifying and combining Ruohotie’s (1993 see also Ruohotie and Grimmett 1996) and Paunonen’s (1989) instruments. This process is described in chapter 4.4.

During the team supervision intervention, the follow-up inquiries for staff were repeated after every six months. The decision to repeat the inquiries at half-year intervals was based on the fact that the timing of CS was organised in terms, that is, the inquiries were repeated at the end of every spring and autumn term.

The researcher delivered the questionnaires and the covering letters, but the actual data collection procedure on the wards was co-ordinated by the ward managers who delivered the questionnaires personally to their staff. The ward managers reminded staff of the timetable for returning the questionnaire and of including the respondent’s code number in the questionnaire. At the beginning of the study wards managers were asked to devise a list of staff who had agreed to participate in team supervision and to give each participant a number that was in use throughout the study. These lists were stored in the ward managers’ locked offices and the numbers were checked during the study only if a respondent had forgotten their code number. An envelope always followed the questionnaire for returning it via mail or internal mail to the author. The data collection procedure was repeated three times (6 / 96, 12 / 96, 6 / 97) on wards B, C and E, which participated for two years and five times (6 / 96, 12 / 96, 6 / 97, 12 / 97, 6 / 98) on wards A and D which participated for there years in team supervision and the study.

As the aim of this study was to explore the effects of team supervision on the quality of care, the data collection was seen possible through inquiries into the staff’s continuous self-monitoringt of work and the systematic follow-up of patient satisfaction feedback. The two self-report questionnaires were developed for this purpose by the researcher (see chapter 4.4.). The staff’s continuous self-monitoring of work through questionnaire started in January 1996 and ended in May 1998, coinciding with the ward’s participation in team supervision. Continuous monitoring of work was accomplished weekly with a structured self-report questionnaire with two open-ended questions. The completed questionnaires were returned monthly to the researcher via internal mail. However, during the summer months from June to August the data collection was interrupted, since the team supervision sessions were not organised because of the holiday season.

48 TEAM SUPERVISION

Figure 2. Design of the study: intervention and data collection

Data on ‘patient satisfaction feedback’ were collected on three wards: A, C and D. Data were collected with a structured self-report questionnaire including two open-ended questions. The timing of this data collection was parallel to the staff’s self-monitoring of work. Staff delivered the ‘patient satisfaction feedback’ questionnaires and managed the data collection procedure. Staff were asked to explain the purpose of giving feedback to patients and to provide the materials: the questionnaire, the cover letter from the researcher and an empty envelope. The goal was to acquire feedback from approximately ten patients each week or from 30 – 40 patients each month. The recommended number of respondents was stated explicitly to ensure the possibility of using statistical methods for data analysis. Patients answered the questionnaire on the day of discharge and were asked to leave the completed questionnaire in a sealed envelope in the ward office. Patient participation was voluntary. Ward managers collected the returned questionnaires in envelopes monthly and sent them to the author via internal mail.

Data collection with group interviews

As the intervention was implemented and focused on groups in the form of team supervision, group interview was considered an appropriate data collecting method for producing information from the teams’

perspective (e.g. Frey and Fontana 1991, Kitzinger 1994, Moilanen 1995). The other important fact that FOLLOW-UP INQUIRIES

- supervisees’ assessments of the effects of the intervention by answering the follow-up inquiries semi-annually

CONTINUOUS MONITORING OF WORK - supervisees assess their own work once a

week during the intervention - data analysis and reports monthly

PATIENT SATISFACTION FEEDBACK - continuous data collection (goal: minimum

number of 10 patients/ week, 40 patients/

month)

- data analysis and reports monthly

TEAM INTERVIEWS

- at the end of the intervention - team’s perceptions of the effects

of the intervention on the quality of care

supported the selection of this data collection method was that the main interest of the study was to explore the effects of team supervision on quality of care (see Fitzpatrick 1994). This aim implies that the quality of care is produced jointly by the members of a team or collective, but not by its single individuals. Thus, the implication was that the teams’ descriptions of the effects on quality of care exceed and differ from an individual’s description (see also e.g. Harvey 1996).

In the literature (e.g. Frey and Fontana 1991, Kitzinger 1994, Asbury 1995, Vaughn et al. 1996), group interview is referred to as a unique method for collecting data from group members that cannot be obtained through individual interviews or questionnaires. Interaction between group members, but also with the interviewer/researcher influences the knowledge generated. This process allows to deal with complex issues, which is further enhanced by the possibility to elaborate upon the subject and to examine it synergistically. The method may also bring out the ‘polyphony’ or range of conceptions of the topic in a group. It has been claimed that group interview as a data collection method gets closer to the reality and practice, if compared with other methods, because the interview takes place in the social setting in which people live and operate together. The researcher shares the group’s experiences and reality during the interview. (Frey and Fontana 1991, Kitzinger 1994, Asbury 1995, Vaughn et al. 1996)

In this study, the group interviews were undertaken on each participating ward 4 - 6 months after the termination of team supervision. There were 6 to 10 interviewees per group and altogether six interviews were conducted. Two interviews were made on ward C because of the difficulties in staff and work shift arrangements. The total number of participants in the six interviews was 62, which differed from the number of those (46) who had completed the questionnaires. However, as the researcher was not aware for ethical reasons of the respondents’ names behind the code numbers, it was not possible to classify active vs. passive respondents or participants in team supervision.

One hour was reserved for each interview. The interviews were carried out on the same premises, outside the ward, as the team supervision sessions to eliminate interruptions. However, two of the interviews (wards C and E) were accomplished on the ward’s coffee or day room, because it was impossible for staff to leave the ward because of an extremely busy work situation. Participants had agreed beforehand to tape recording the interviews and it had been emphasised that the participation was voluntary. Two tape recorders were used simultaneously to assure the quality of recording. During the interviews, the author observed the group and made notes. The notes were not detailed nor was the observation systematic, but descriptive, since the author managed the data collection and the tape recorders single-handed.

PREREQUISITES FOR PROFESSIONAL DEVELOPMENT I) INDIVIDUAL FACTORS

- answering scale 4 – 10 II) TEAM FACTORS - answering scale 4 – 10

III) ORGANISATIONAL FACTORS

- answering scale 4 – 10 EFFECTS OF TEAM SUPERVISION DURING THE

INTERVENTION AS DESCRIBED BY SUPERVISEES CHANGES IN EDUCATIONAL NEEDS - effects on: work patterns, ward operations,

BACKGROUND VARIABLES - sufficiency of in-service training: answering scale 4 – 10 in relation to team, oneself, human relations

- ward - willingness to participate: answering scale and quality of care

- age 1 - 5 (extremely willing - not at all) - open-ended and coded answers: 1=yes, 2=no, 3= hard

- occupational title - frequency of participation (within and outside organisation): to say - service position answering scale 1 - 5 (not at all - 11 times or more)

- time in healthcare field EFFECTS OF TEAM SUPERVISION AT THE END

- time in present position CHANGES IN THE SELECTED EFFECTS OF CS OF INTERVENTION ASSESSED BY TEAMS

- participation in another CS - expertise, theoretical approach to practice, self-awareness, practical - group interview themes: 1) team supervision and the team, facilities, teamwork, personal strengths, own contribution to ward’s 2) team supervision and the work, 3) team supervision and functions and multi-professional collaboration the quality of care

ASSESSMENT AND FEEDBACK

- continuous self-monitoring of one’s work and systematic patient satisfaction feedback: answering scale 4 - 10

- other assessment methods on ward: answering scale 1=yes, 2= no, 3 = no opinion

Figure 3. Operationalisation of the concept