Interviews

Interviews were indispensable to data collection for this thesis. All the interviews were semi-structured [214] or general [188]. In other words, the interviews did not follow a strict question-answer format. The topics were listed in the interview guide (appendix 5,6,7), but the interviews reflected the importance of narratives in eliciting important institutional practices and meanings [210, 215, 216]. These narratives became an important part of data collection, even though telling stories is often seen only as a way of contextualizing the interview situation or themes, not as a source of scientific data [204].

Stories and narratives are process-oriented and therefore comprehensible when studying organizational change and practices [202, 203, 205]. This understanding underpinned the planning of interviews about certification processes in the emergency department (case 1) and the certification body (case 2). The interview guides in both case studies consisted of three parts: 1) the interview subjects’ role, the organization and approaches to quality and safety work (in the emergency departments) or the ISO 9001 certification (for the certification body); 2) the certification process; and 3) ISO 9001 certification and regulation in healthcare. Open questions were used, along with bullet points about related concerns. Questions were also often followed by preplanned or spontaneous probing questions, to help interview subjects recall and tell more

Methodology

detailed stories about their experiences with the ISO certification process.

Examples could be: "Can you recall when you first started to think about certification and tell me about that?" or, "Can you tell me about the certification bodies role and their methods?” Typical probing questions were “Who did you experience was a key actor in the process?” “Did you meet any opposition?”

and “Were there any ‘wake-up calls’?"

4.4.1.1 Recruitment and consent to conduct interviews

A clearance for staff interviews was obtained from the hospital and certification body prior to the interviews. All informants received a written invitation to participate, followed by a written and oral invitation prior to the recorded interview. The invitation explained that the interview was part of a research project, that the results would be used anonymously for analysis and publication, and that participation was voluntary and could be terminated at any time. All informants gave oral consent. All interviews were audio recorded and transcribed verbatim by a professional firm. A written data processor agreement covering the terms of data storage and confidentiality was signed by the firm doing the transcriptions before the audio files were forwarded.

4.4.1.2 Interviews in case 1 – Emergency department

An exploratory interview with the head of clinic was conducted in June 2011.

The intention was to get information about the emergency department’s role in the pilot project and the certification process, to identify process documents to study, refinement of themes for interviews, and identify informants for subsequent interviews. The following research interviews took place in the emergency department in June and August 2012. The interviews lasted from 45 minutes to two hours.

The 12 informants purposefully selected for interviews were:

˜ Head of department

˜ 2 heads of section (middle managers in the department)

˜ 3 nurses in the department (possibly included in the process)

˜ 1 health secretary/administrative personnel

˜ 2 doctors affiliated with the department (involved in the process)

˜ 2 persons from support departments, such as radiology or laboratory

Methodology

After eight interviews were completed, a distinct picture of a key local project group (the project management) for the certification process emerged. Five of the eight informants comprised the local project group, and four of them also belonged to the permanent management of the emergency department. The five informants in the local project group were Head of Department, Head of Section, Head of Unit 1, Head of Unit 2, and a Quality Advisor from the Quality and Research Department, acting as an advisor in the local project group. The sixth informant was a leader of the regional pilot project for certification of emergency departments, and an external contact person and advisor for the local project group. The last two interviews were done with the Head of the Quality and Research Department and the Head of doctors in the Department of Internal Medicine. These two interviews produced valuable insights and confirmation about the actors and the legitimacy of the certification process.

The eight interviews together revealed a distinctive local organizing and sensemaking process, especially that of the local project (and the management of the emergency department, since managers were represented in the project group). The interviews did not reveal any clear indications of people who had been unintentionally excluded as informants but were part of the local collective sensemaking process. Therefore, no additional interviews were conducted.

4.4.1.3 Interviews in case 2 – Certification body

Informants were identified and recruited with assistance from the contact person at the certification body. Ten informants were initially selected. Five were key managers and administrative personnel involved in conformity assessment and system certification activities; five were lead auditors performing ISO 9001 certification in healthcare.

Nine research interviews were conducted: five with lead auditors and four with managers and administrative personnel. Three lead auditors had been observed when practicing hospital certification audits weeks earlier. All the managers and administrative personnel interviewed had sporadically served as lead auditors in ISO 9001 certification processes, but not necessarily in healthcare.

All interviews were conducted at the certification body’s central office in connection with a yearly seminar, except one interview that took place by

Methodology

telephone. The informant interviewed by telephone was one of the lead auditors observed earlier. The interviews lasted 45 to 75 minutes.