Mixed Ethnographic and Quantitative Methods to Understand and Measure Organisational Culture in UK General Practice

Lead Research Organisation: University of Dundee
Department Name: Division of Population Health Sciences


General practitioners now work under a new contract, changing how they are paid for their work, with more emphasis on measuring the quality of their care across a range of clinical conditions. This is part of wider reforms that have been taking place across the NHS over the past 20 years which have attempted to strengthen managerial control over professional work to ensure that centrally defined quality is achieved. However, the extent to which general practice teams will conform to expectations and respond in ways desired by policy makers is unclear. The aim of this study is to investigate general practice responses to recent changes by innovatively mixing two distinct research methods. The study begins with ethnographic case studies in four general practices to gain a detailed understanding of the nature of changes at practice level. The project then goes on to develop a new survey instrument based on the ethnographic findings that can be used to measure differences in practice-level responses to these changes. Findings from this study will help to inform the future development of primary care by identifying new ways to understand, measure and communicate how small, multi-disciplinary health care teams respond to wider policy changes.

Technical Summary

Aims and Objectives: The overall aim of this project is to investigate and synthesise mixed ethnographic and quantitative survey methods in order to understand, measure and communicate variations in organisational culture in UK general practice to inform research and key NHS stakeholders. Specific objectives are:
1. To synthesise findings of previous ethnographic studies in UK health services research through a meta-ethnography of relevant studies.
2. To develop ethnographic methods in health services research through a multi-sited ethnography of organisational culture in UK general practice.
3. To develop, test and validate a formative and diagnostic quantitative survey instrument using mixed ethnographic and quantitative methods to manage and develop organisational culture in UK general practice.
4. To assess the strengths and potential limitations of combining traditional ethnographic methods with more complex quantitative methods to inform the development of future research, policy and practice.

Design: The proposed research is a mixed-methods design in which qualitative and quantitative data will be collected and analysed sequentially and simultaneously at different stages of the project, with different methods having priority at different stages of the study. The central aim of the proposed research is to understand where these methods overlap and how they can contribute to each other.

Methodology: A meta-ethnography of ethnographic studies conducted in general practice will be conducted of papers adopting ethnographic methods of data collection and analysis within general practice. Drawing on the meta-ethnography, detailed ethnographic data collection and analysis will be conducted in a small number of practice and PCO settings, which will inform the design of a quantitative instrument to measure organisational culture in UK primary medical care that it is grounded in the views and experiences of the key stakeholders. This instrument will be piloted in four additional practices which will themselves participate in focused ethnographies to explore the validity of the instrument, and the relationships between measured culture and deeper meanings. Finally, a revised version of the instrument will be used in a large sample of practices to examine its psychometric properties.

Scientific and medical opportunities of the study: Key opportunities are the development of innovative mixed methods research in health care through the synthesis of ethnographic and quantitative survey methods, and the development of a quantitative survey instrument for measuring organisational culture informed by ethnographic methods, with considerable potential for research and service use in quality and safety improvement and team development work


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