Interviews, meetings and documents as data

The data were derived from three main sources: interviews that were used as primary data in four case studies (1, 3, 4 and 5); meetings that were used as primary data in two case studies (2 and 5); and documents which were used as additional data in every case study. Approvals for data gathering were received from the executive committees of each site. In outpatient clinics and the child psychiatry clinic, I presented the research design for the consecutive boards before they granted permission, and after data collection

7 No. 348, Section 56: Requirements and references relating to the suitability of candidates and tenderers.

I presented them some initial findings of the study. In the supported housing unit, I was granted permission to use the pre-collected meeting recordings⁸ and conduct one interview to get the necessary background information on the meetings.

Interviews

There were altogether 23 semi-structured interviews conducted in the sites (see table 3 on page 32). In outpatient clinics and the child psychiatry clinic, I conducted 18 interviews with practitioners involved in client work, and four interviews with administrative workers. In the supported housing unit, I conducted one interview with an executive person.

In outpatient and child psychiatry clinics, the 18 interviewed practitioners were from the following professional groups: social workers, psychologists, psychiatric nurses and psychiatrists, all immersed in client work. Practitioners were asked to participate by a literal invitation, which was circulated at the weekly meetings of the staff. From the sample frame of 55 practitioners in outpatient clinics and 85 in the child psychiatry clinic, two practitioners from each occupation were invited to participate, to get an equal amount of interviewees from each professional group.

Interviews mostly consist of descriptions of daily working practices. The underlying idea for me as an interviewer was to generate talk on the relations between auditing arrangements, everyday practice and individual professionals’ views on these.

Practitioners explained their typical working day, two types of client cases (one which they regarded as successful and another which they perceived as unsuccessful) and the way they organised their interventions and schedules. In addition to these descriptions, I posed questions about their views regarding problems they had experienced in their current practice. At the end of the interviews I asked specific questions on audit techniques that practitioners had mentioned while describing their work and client cases.

After I interviewed practitioners, I wanted to know more about audit instruments.

Thus I interviewed some members of administrative staff (N=4) who were either main users of EHRs, administrative secretaries or executives. These interviews focussed on two themes: the background of the implementation processes of audit instruments and the issues and management models “behind” them. By logging into EHRs during the interviews, they also demonstrated to me how the systems are used in practice.

In addition to interviews from outpatient and child psychiatry clinics, I conducted one interview with an executive person of the NGO that maintains the supported housing unit. The interviewee was first asked to explain the connections of SPA to

8 These data were collected by Suvi Raitakari for another study (Juhila et al. 2005–2007) which examined the controlling and supporting dimensions of social work.

tendering procedures the unit takes part in. Second, the interviewee went through the contents of the SPA documents under study, and explained their background to me.

Third, I asked about the nature of the meetings, which constitute the principal data from the supported housing unit.

Interviews lasted one hour and a half on an average, and were digitally recorded.

They were transcribed verbatim, resulting in 529 A4 sheets with 1,5 line spacing. The initial reading of all collected interviews convinced me that with these samples, data saturation was achieved for practitioners’ views on audit (Gibbs 2007, 151). This was due to the same themes regarding practitioners’ descriptions and opinions of audit arising in the interviews from all three sites, even though they were conducted in different points of time⁹.

Meetings

In the supported housing unit, inter-professional team meetings (N=21) among psychiatric nurses, substance abuse workers and practical nurses were recorded (see table 3 on page 32). From the sample frame of 38 meetings already collected from the supported housing unit, I selected 21 because they were carried out when the unit’s participation in tendering was strongly on the agenda. Hence these meetings contained considerable discussion on the issues relating to SPA, in addition to more common talk about clients’ current situations and general issues related to the unit’s routines. The objective of the meetings was to facilitate the everyday work by planning interventions and ways of supporting clients. As verbatim transcriptions, the meeting data amounted to 693 A4 sheets with 1,5 line spacing.

9 The data from outpatient clinics were collected in 2002 for a master’s thesis which was a pilot study for this research (Saario 2005). For the purpose of this dissertation, the data in child psychiatry clinic were collected in 2007, utilising similar interview structure and a similar collection of informants as in outpatient clinics. The interview in the supported housing unit was conducted in 2007, and meeting data from the same site was collected in 2006.

Table 3. Practitioners participating in interviews and meetings.

The number of practitioners interviewed (N= 23)

(Total number of interviews: 23)

The number of practitioners participating in meetings (N=6) (Total number of meetings: 21)

Occupation Outpatient

clinics (site 1)

Child psychiatry clinic

(site 2)

Supported housing unit (site 3)

Social worker 3 3

Psychiatric nurse 2 2 2

Psychiatrist 2 2

Psychologist 2 2

Substance abuse worker 2

Practical nurse 2

Executive staff member 1 1

Main user of EHRs or

administrative secretary 1 2

Both interviews and meetings illustrate practitioners’ views on audit instruments as a part of their work. However, regarding interaction between the researcher and participants, these two sets of data were collected in rather different circumstances.

The meeting talk was carried out among practitioners themselves as a weekly routine.

The free-flowing and informal conversation was an ordinary part of practitioners’ work.

The researcher was a silent observer who was primarily there for the audio-recording.

Interviews, on the other hand, were special occasions for practitioners. Their responses were guided by the structure of the interview schedule and the researcher posing the questions. This dyadic talk enabled me as the interviewer to ask specific questions if I felt it necessary. In contrast, in the meetings this was not possible since they were clearly an arena for mutual discussions of practitioners who were there to do their ordinary work.

Documents

Documentary data (N=24) includes relevant administrative documents from the sites, like annual reports and statistics produced by the studied EHRs. Used as supplementary data, documents enabled me to locate the interview and meeting talk in the organisational context. They made audit instruments more conceivable and offered information on the broader structures they are a part of. In table 4 (on page 33), the

documents are organised into two groups depending on their type: documents that are produced by audit instruments and can be seen as their outputs (e.g. statistics that can be printed out from the system), and documents that describe audit instruments and are texts about them, but are produced by means other than audit instruments.

Table 4. Documentary data.¹⁰

Various statistics from Aho Various statistics from

Oberon Service Purchasing

Agreement Prints of Aho views Prints of Miranda and

Oberon views Attachment of Service Purchasing Agreement:

products and prices Attachment of Service Purchasing Agreement: Targets of outpatient clinics Final report of

development project:

calendars of practitioners Operating model for child

psychiatry Strategy of [NGO]

Planning templates for

Public service survey Criteria for access to treatment

10 More detailed references to documentary data can be found in the journal articles, under the subtitle “Documentary data” in References.