Personal experiences of disclosure
If an adverse event occurred in your ward/unit what role might you expect to play in its disclosure?
How would you feel about disclosing an adverse event?
How well-prepared do you feel if that situation was to arise now?
What would you want to achieve through the disclosure?
What do you think the patients would want from the disclosure?
What factors do you think might influence your approach to the disclosure or the things you might say?
What would your main concerns be about disclosing an event to patients or their friends or relatives?
Have you had any experience of disclosing an adverse event to a patient or their friends or relatives?
If yes go to Q4.
Can you tell me a bit about your experience?
What role did you play in the disclosure?
How did you feel about disclosing the event?
How well-prepared did you feel for that situation?
What did you want to achieve through the disclosure?
What do you think the patient wanted from the disclosure?
What factors do you feel influenced your approach to the disclosure or the things that you said?
What challenges did you face, if any?
How did you feel after the disclosure – would you have done anything differently?
Knowledge and perceptions of open disclosure policy
You might be aware of the Being Open framework which relates to the policy of open disclosure in the NHS. The framework sets out 10 key principles of open disclosure that NHS staff should use when communicating with patients, their families and carers about a patient safety incident. Are you aware of the being open policy or framework?
If yes go to 6.
If no go to 8.
Can you tell me a bit about the policy and how it works in practice from your own experiences?
What do you consider to be the main challenges in its use?
What kinds of things might you expect to see in the 10 key principles that you might need to consider in the process of disclosing an incident?
SHOW PARTICIPANTS THE FRAMEWORK
What are your initial thoughts about this framework?
Do you see any parts that you think might raise some challenges or are there any things that you would feel concerned about looking at this?
Disclosure, quality and patient safety
Can you tell me a bit about the disclosure policy that operates in your trust?
What are you required to do, when and who is responsible for disclosing what types of incidents?
How does it link into the incident reporting system, if at all?
Do you think there is a link between disclosing adverse events to patients and enhancing the quality or safety of their care?
A Guide to Interview Guides
Before conducting interviews, you need an interview guide that you can use to help you direct the conversation toward the topics and issues you want to learn about. Interview guides vary from highly scripted to relatively loose, but they all share certain features: They help you know what to ask about, in what sequence, how to pose your questions, and how to pose follow-ups. They provide guidance about what to do or say next, after your interviewee has answered the last question.
A good interview guide also acknowledges four important facts of human social interactions that influence what people are likely to say to you. These four facts are: (1) Research questions are not the same as interview questions; (2) People's espoused theories differ from their theories-in-use; (3) Interviews are social occasions; and (4) Testimony by itself is relatively weak form of evidence. This guide to interview guides offers some techniques for accommodating these four important facts.
1. Research Questions aren't Interview Questions
The first important fact of interviewing is that research questions are not the same as interview questions. Your research question describes the issue you want to learn about, but you rarely can learn about that issue by asking others that literal question. If you want to learn why students bully one another, you can't just ask them, "Why do you bully him," or "Why do you think he bullies you?" Research questions are usually too broad to serve as productive interview questions. Once you have a research question, you must devise a data collection plan that will help you gather credible evidence, or clues, that are relevant to your research question. Your interview guide is your data collection plan. My human caretaker has posted a sample of an interview guide to show you how you move from research questions to interview questions.
2. If you ask a question, they will answer it
The second important fact about interviewing is that people will answer the questions you ask them, even if they have never really thought much about your topic. If they agree to be interviewed, they will continue to try to be helpful by offering whatever they can about your topic, even if it means inventing answers or exaggerating how much they have thought about your question. This means that the "evidence" you are gathering may not very accurately reflect real views. So you need to think about ways to pose questions that don't elicit overly-helpful responses. One strategy that helps a lot is to have a collection of probes ready to use as needed. A probe is a follow-up question, designed to get the interviewee to clarify or elaborate what he or she has just said. I have another page that gives several ideas about types and formats of probes.
Approach your question from the side
One way around this is to approach your topic sideways. For instance, suppose you are interested in whether or how teachers use research. If you ask them to speak specifically about this issue, they will try their best to come up with some uses, refer to studies they have read and talk about how they have responded to those studies. These responses will give you an inflated notion of the degree of reliance on research. An alternative approach would be to ask how they make decisions about particular things-things where research could have been useful--say, deciding whether to promote a student or retain him in grade, or whether to use cooperative groups or not, and then probe extensively for where they got their ideas when they made that decision. If you are lucky, they will refer to research studies when they answer these probes.
3. Espoused Theories Differ from Theories in Use
The third important fact pertinent to interviewing is that people hold two sets of ideas about the world: Their espoused theories and their theories-in-use. Espouses theories are the things they believe they believe, though they may not always act on those beliefs. Theories-in-use are the ideas that actually guide their daily actions. Think of the person who loves mankind but can't stand his neighbor, or the teacher who believes all children can learn except two particular students in her classroom.
This fact creates a problem for your interview. Your task is to learn their theories in use, but they may be unaware of those. Instead, they will offer you their espoused theories. The best way to learn theories in use is to ask about concrete examples rather than about general principles. Here are some ways to do this.
Ask about Hypothetical examples or vignettes
Suppose you are interested in how students respond to teachers' disciplinary actions. Instead of asking them to tell their general philosophy about discipline, give them two or three specific examples of disciplinary moves and ask how they would respond to each one, and why. Vary your hypotheticals to capture the variety of disciplinary actions you are interested in.
This general strategy, by the way, works for surveys as well as interviews. Here is a survey of teachers done a few years back on how teachers think about technology. Note the way the authors gets at the kind of pedagogy that teachers value.
Ask about specific things they have done
Suppose you are interested in learning what kind of homework teachers normally assign. Instead of asking teachers what kind of homework they normally assign, ask them to bring you three specific instances of homework they have assigned this week. Then organize your interview questions around these specific instances.
Or, suppose you are interested in knowing how often teachers ask their students to work in groups during math class. If you ask them them about their average or typical use of groups, they may over- or underestimate how frequently they do this because the practice may be part of their espoused theories of teaching. Instead, ask them whether they used groups during any math classes this week, and then ask why, or why not, and probe for the details of what motivated them to engage in or avoid this practice at these particular times.
Or, suppose you are interested in how teachers use technology in their teaching. Instead of asking them about their general use, ask them when the most recent use was and then interrogate them about that specific event.
Use Stimulated Recall
There may be times when you suspect that teachers may not be completely aware of their own actions, or that students may not recall all the details of even a recent experience. You can stimulate their recall by showing them a videotape of the event you want to discuss in the interview. This is called "stimulated recall." The videotape stimulates their memory and helps you get more detail. The idea is that, by reviewing the tape, teachers and students will recall more details of what they were thinking and what they were trying to do at any given moment. Ask them to explain what was going on, what they thought about it. Ask them why they responded as they did.
4. Interviews are Social Occasions
The fourth important fact about interviews is that they are social occasions, and you cannot avoid the social interaction that occurs during an interview. There are two sides to this. On one side, the interviewee will want to put his best foot forward. He or she will want to be perceived as caring, thoughtful, reasonable, or justified. Even if your interviewee is willing to discuss sensitive areas, there will be a tendency to put them in the best light possible.
On the other side, virtually everything about you conveys a social message to your interviewee. Your clothing and mannerisms convey your position in life and perhaps your social attitudes as well. Regardless of whether they perceive you as an educator, a liberal, a child advocate, or an stuffy academic, they will tailor what they say to be more acceptable to the person they see as their audience.
You can add to or reduce these tendencies by your mannerisms. Your facial expressions, head nods, and verbal "um-hmm's" convey approval or disapproval of what the interviewee is saying. If you respond effusively to some of the things they say, you will encourage more of those things in their responses. If you furrow your brow, express sympathy with their plight, you encourage them to adopt that posture.
This doesn't mean that every interviewee is purposely deceptive or devious. In fact, just the opposite. These things occur naturally in every human conversation as people reach out to one another and try to find common ground. But the tendency to reach out and to find common ground can create problems in an interview, for the purpose of an interview is to learn what the other person would think if you weren't there asking him.
The best defense against social processes is not to accept people's initial answers to your questions. Don't take their first answers as a final answer. Design your interview to challenge their claims. You don't have to be hostile to do this, but you do need to think about it how to do it without being hostile. Here are some strategies:
Ask for Elaboration
When a person says he wants to accomplish X, push for more detail on about why. Ask things like "Why was that important to you? What would happen if you didn't do X? Or, conversely, if they say they were afraid to do Z, or wanted to avoid Z, ask what would be wrong with Z, why would Z be a problem, what would happen if they did do Z.
Ask about Opposing Ideas
When your interviewee says she wanted to do X, or to avoid Z, you can also challenge her thinking by posing the opposite idea. Say, for instance, "Some people think it is important to do Y. What do you think about that?" Or say, "Last week I interviewed a teacher who said she thought Y was more important than X. What do you think about that?"
Ask if their Rationale is All-encompassing
Often interviewee explain their actions by saying they were required to do something. For instance, a teacher may say she taught this content because it would be on the test, or a student may say he did something because the teacher told him to. These explanations move responsibility for actions to some other location. They give the impression that the person's actions are entirely determined by the demands of the situation or the demands of another person. You can learn more about how they decide what to do by asking them if they always do whatever the requirements are. Does the teacher always teach whatever is on the test, does the student always do whatever the teacher says to do? Chances are, your interviewee will say no to this question, so that you can then ask why they followed the rule in this specific situation. You can ask about the situations when they don't do what is required, or how this situation differs from others.
Ask about Other Influencing Conditions
Ask your interviewee if he or she would respond differently, or act differently, under specific other conditions. Ask, for instance, how they would have responded at some earlier point in their career, or how they would have responded if another teacher had done this, or how they would have responded if they were teaching at another grade level.
These questions are all called "probes." You begin with a stem question about a particular event--what happened, why, how did you respond, etc., and then you probe further. The idea of all these probes is to get past their espoused theories and their notions of what will sound good to you, and into the real details of their thoughts and practices. You want to get your interviewees away from gross generalities and learn the exceptions to their own rules, the nuances, the counterpoints and the "other hands."
5. Testimony alone is weak evidence
The fifth important fact about interviewing is that testimony from interviews is perceived by others to be a relatively weak source of evidence. Advocates of qualitative research generally argue that you need multiple sources of evidence in order to make a claim. For instance, you can't conclude that teachers were skeptical about a new policy if the only evidence you have is their word for it. The best solution to this problem is to rely on multiple sources of evidence. For instance, look at what they say to you in the interviews, what they say to peers in staff meetings, and what they do in their classrooms. The process of reconciling these various sources of evidence is called triangulation.
If your study is based entirely on interviews, you can't triangulate among multiple sources of evidence in the way that qualitative researchers advocate. However, you can try to get multiple "takes" on the same issue through an interview. For instance, to learn teachers' views on a new policy, ask one line of questions directly about the policy, another line of questions about a related issue, slipping some references to the policy into that line, and a third line of questions about practices that are relevant to the policy as well.
Many of the suggestions offered above, in regard to other basic truths of interviewing, will also help here. For instance, if you ask people about two or three vignettes, or about two or three specific experiences, you can treat each of these events as one source of evidence and you can compare them. If you ask people about opposing ideas, or what would happen if they didn't do what they thought they should, you are obtaining multiple sources of evidence.
Sometimes you can obtain multiple sources of evidence simply by rephrasing the same question so that you emphasize a different aspect of it. Researchers have found, for instance, that people respond differently to questions about probability depending on whether the odds are described in positive or negative terms: One question asks if they would bet when the odds were one in ten that they would win, another asks if they would bet if the odds were nine in ten that they would lose. The odds are the same in each question, but responses differ because of the emphasis. It doesn't hurt to re-ask the same question with different phrases or from different perspectives.
© Mary Kennedy, 2006