Multiple triangulation and collaborative research using qualitative methods to explore decision making in...

Area of Science:

• Emergency medicine
• Qualitative research methodology
• Patient safety systems

Background:

• Pre-hospital decision-making by paramedics is complex and impacts patient safety.
• Previous research has under-explored influences on paramedic decision-making.
• A systems-based approach is advocated for understanding patient safety.

Purpose of the Study:

• To identify system influences on paramedic decision-making in the pre-hospital setting.
• To compare multiple qualitative methods for studying healthcare issues in context.
• To explore patient safety implications of paramedic decision-making.

Main Methods:

• Multi-site, qualitative study across three NHS Ambulance Trusts.
• Ethnographic methods including direct observation of 34 paramedic shifts.
• Interviews with managers (n=16), digital diaries from 10 paramedics, staff (n=21) and service user (n=23) focus groups.
• Collaborative data collection and analysis involving academic researchers, ambulance service teams, and service users.

Main Results:

• A multi-method qualitative approach enabled cross-validation of findings.
• Strong working relationships and site research leads were crucial for study success.
• Collaborative involvement enhanced understanding of the research process for all participants.
• Feedback workshops facilitated stakeholder engagement in prioritizing findings.

Conclusions:

• Combining qualitative methods and collaborative research effectively explores system influences on patient safety.
• The study highlights practical aspects, strengths, and limitations of this research approach.
• Feedback workshops proved valuable for validating results and identifying future research priorities.