Medical records management governance practice

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The previous chapter discussed the literature relating to the records management and models, with specific focus on records management governance practices, recordkeeping systems, records archival processes, recordkeeping technology, records management capacity and competencies. More importantly, certain discussions were specifically related to organisational readiness for enterprise content management as the latest records management system framework. However, this chapter focuses on the research methodology applied in conducting this study. This is because “knowledge that is produced in any scientific field primarily depends on the methodology that is used” (Ngulube 2015: 125). This chapter covers, among other issues, research paradigm, research approaches, research design, survey research, triangulation, population of the study, research method, sampling method, data collection techniques and ethical consideration.
The worldviews or paradigm applied by the researcher in this study was a positivist paradigm. The positivist paradigm informed the application of the quantitative approach in this study as its focus was on the measurements of respondents‟ attitudes and feedback or results, based on the objectives and problem statement. Generally, the focus was on assessing causes and effects to eventually recommend solutions (Babbie and Mouton 2001:49; Creswell 2009:8). The main research approach used in this study was the quantitative approach, which was supported with the triangulation of a limited scope of qualitative data-collection methods to close some gaps or answer some questions. Figure 3.1 illustrates the map of the research methodology.
Nevertheless, the research design, survey research, emanated from the quantitative approach as applied by the researcher. There were four techniques that were used to collect data, which were questionnaire, interviews, observation and documents/system analysis. The questionnaire was mostly used to collect quantitative data. Interviews, observation and document analysis were used to collect qualitative data that was to be used for clarifying questions in quantitative data gaps. Hence, the qualitative data was used to understand the quantitative data during analysis and interpretation. The data was also triangulated after collection to support the main technique, which was a questionnaire for the quantitative method. This was to ensure that gaps are closed or minimised to a reasonable or acceptable level. All the collection tools were tested and reviewed for validity and reliability.
Moreover, the study was conducted under the ethical consideration of the UNISA research ethical guidelines. The following UNISA documents were also used, namely: Procedures for studies for master‟s and doctoral degrees – Part 1 of 2011, Policy on research ethics of 2007, Policy for master‟s and doctoral degrees of 2008, Policy for copyright infringement and plagiarism of 2005, and Language policy of 2010”. The study was also cleared by UNISA with the issuing of an ethical clearance certification. The researcher requested permission to conduct the study in the Limpopo Department of Health and the head of the department granted permission as requested. This means that ethical implications were observed throughout the process of research methodology. Finally, the researcher evaluated challenges and/or barriers relating to conducting the research methodology, which also includes application of the research paradigms, approaches, design and methods. For instance, barriers relating to accessing the population, applying some data collection techniques and meeting certain research needs like participants‟ interests and permission by the organisation of the study, and eventually remedial actions to deal with these barriers and challenges.


Paradigm refers to “philosophical worldview” and is also called “epistemologies and ontologies or broadly conceived research methodologies” (Creswell 2014:6) or “interpretive frameworks” (Creswell 2013:23) or “metatheoretical traditions” (Babbie and Mouton 2001:20). Creswell (2014:23) states that there are still some contradictions and controversies by different theorists and researchers about whether paradigm, epistemology and ontology are synonymous or mean the same or different things or whether they are just related. For instance, Bryman (2012:630) sees the three concepts at different levels as he stresses that paradigm guides the researcher with the foundation of their investigation based on different epistemologies and ontology. He further describes paradigm as a “cluster of beliefs and dictates”, which scientifically guides the researcher to what they must research on in their field of study, influences the approaches for researching and analysing the data. Brewerton and Millward (2001:197) define paradigm as “a world view underlying the theories and methodologies of a particular scientific subject, leading to a particular way of looking at a given phenomenon”.
Although Gerring (2012:421-430) does not discuss the concepts ontology and epistemology in relation to paradigm as to whether they are synonymous or can be used interchangeably, but he defines ontology as “a vision of reality… and also as a branch of metaphysics concerned with the nature of existence” (Gerring 2012:4430), and epistemology as “the study of the nature and origin of knowledge” (Gerring 2012:421). Ngulube (2015:127) describes ontology as “the nature and existence of social reality” and epistemology as “what constitutes knowledge and the ways of knowing”. Bryman (2012:27) supports the statements of Gerring (2012:421-430) and Ngulube (2015:127) when he confirms that epistemology considers the need for the answer to the question of “what is or should be regarded as acceptable knowledge in a discipline” and Ontology considers “the nature of social entities… whether social entities can and should be considered objective entities that have reality external to social actor, or whether they can and should be considered social constructions build up from the perception and action of social actors” (Bryman 2012:32). Bernard (2013:7) also attests that epistemology is the research method “at the most general level or the study of how we know things”. Krathwohl (2009:693) underscores that epistemology is “the branch of philosophy that studies the nature of knowledge, its assumption and its validity”.
However, the researcher‟s interpretation from the above definitions and descriptions is that epistemologies and ontologies appear to be two main categories of paradigms or worldviews. For instance, Bryman (2012:27-33) points out and discusses positivism and interpretivism as two “epistemological positions” and he further describes objectivism and constructionism as “ontological positions”. Some of these assumptions such as positivism, constructivism and interpretivism are generally discussed by Creswell (2014:5-19) as worldviews, which, according to him, are also called paradigms. Although Bernard (2013:7) never discusses the ontological part, he supports the statement that „rationalism or empiricism philosophical principles, positivism assumption and humanism or interpretivism competing methods‟ are part of epistemological applications or positions. Krathwohl (2009:242) addresses positivist as positivist epistemological position. He elaborates that it entails the assumption that “there is a real world out there to be plumbed and discovered”, because knowledge is created through “social process of corroboration and judgment that something is true”. Social science research can be used to examine the relationships among issues and link that to the causes (Krathwohl 2009:242).
Furthermore, Creswell (2014:6) indicates that paradigm as a worldview is usually influenced by “discipline orientation, students advisors/mentors inclinations, and past research experience”. Bryman (2012:630) further highlights that paradigms are not commensurate, which means that when the researcher applies both questionnaire and observation in his data collection, it does not warrant the use of the mixed method research approach or a combination of qualitative and quantitative research methods (Bryman 2012:629). “MMR combines the strength of qualitative and quantitative methodology to produce a comprehensive and broad-based research” (Ngulube 2015:127). Babbie (2007:31) refers to paradigm as the “fundamental frames of reference” that are used to shape what is researched and its interpretations. He further states that paradigm underlines different theories and explanations. Creswell (2003:6) explains that paradigm is a “knowledge claim” in which the researcher has a certain assumption in mind about their learning outcomes when using certain research approaches. The researcher needs to identify the research paradigm since they are hidden within his view of the world of his study. Hence, it impacts on the research practice as a reason for adopting a certain kind of research approach (Creswell 2009:5). Babbie (2007:33) supports Creswell (2009:5) by saying that the paradigm is used as an assumption about reality in social life and is not always true, and it is either useful or not useful. This is why different kinds of paradigms influence different kinds of research approaches (Babbie 2007:33). This is why it is critical for the researcher to apply the correct type of paradigm. For instance, Creswell (2014:6-11; 2009:10; 2003:4-12) mentions four types of research paradigms named positivist/ postpositivism, transformative/ advocacy/ participatory, constructivism and pragmatism.
Furthermore, the postpositivism worldview, also known as positivist/postpositivist or postpositivism is associated with the quantitative research approach (Creswell 2014:7; Bryman 2012:650) and as a worldview for this study it was discussed in detail in the next section of this chapter. In postpositivism, the probability is that “causes determine effects” (Creswell 2014:7). The transformative worldview, also called advocacy or the participatory worldview, supports or associates with any approach since “there is no uniform body of literature characterising this worldview” (Creswell 2014:9). The constructivism worldview, which is in most cases combined with the interpretivism worldview, is associated with the qualitative research approach (Richie and Lewis 2003:23; Creswell 2014:8; Bryman 2012:650). This implies that, with the interpretivism worldview, “all versions of the truth are shaped by the viewers‟ perceptions and understanding of their world” (Roth and Mehta 2002:132), which is also supported by Leitch, Hill and Harrison (2010:69); Richie and Lewis (2003:7). Creswell (2003:8; 2009:8; 2013:24-25; 2014:8); Richie and Lewis (2003:7) underscore that interpretivism provided for the population with the understanding of the situation in the world or environment they inhibit and work. The pragmatism worldview is associated with the mixed method approach since it “arises out of actions, situations and consequences rather than antecedent conditions” (Creswell 2014:10; Bryman 2012:650).
In addition to the above, Bryman (2012:27-35) also discusses interpretivism, realism (which is divided into empirical and critical realisms) and objectivism. The other interpretative frameworks include hermeneutics, feminisms, racialised discourses, critical theory, Marxist models, cultural studies models, queer theory, post-colonialism, postmodernism and disability approaches (Creswell 2013:23). Babbie (2007:34-37) only highlights conflict and feminist paradigms. This study is based on the positivist/postpositivism paradigms since it is central to the quantitative approach. The researcher required the positivist approach to get the answers about the cause of the situation or the problems being studied (Roth and Mehta 2002:133). This worldview strives to strategize on improving or changing the situation or problem being studied (Leitch, Hill and Harrison 2010:69). Positivist is “characterised by integrity and trustworthiness” (Leitch, Hill and Harrison 2010:68). They further argue that the positivist or empiricist usually depends on the observational technique of the situation, or issues or facts being studied (Leitch, Hill and Harrison 2010:68). The positivist worldviews are discussed in detail in the next sections of this chapter as a key paradigm of this study.


1.1 Introduction and background to the study
1.2 Research problem
1.3 Purpose of the study
1.4 Research objectives
1.5 Research questions
1.6 Justification for the study
1.7 Definition and discussion of the key terms
1.8 Originality of the study
1.9 Theoretical and conceptual framework
1.10 Scope and delimitations of the study
1.11 Research methodology
1.12 Structuring of chapters
1.13 Summary
2.1 Introduction
2.2 Management of healthcare service delivery records
2.3 Summary
3.1 Introduction
3.2 Research paradigm
3.3 Research approach
3.4 Research design
3.5 Research methods
3.6 Ethical considerations
3.7 Evaluation of the research methodology
3.8 Summary
4.1 Introduction
4.2 Response rate and participants profile
4.3 Personal data
4.4 Data presentation
4.5 Summary
5.1 Introduction
5.2 Medical records management governance practice
5.3 The nature of medical recordkeeping system
5.4 The medical record archival processes
5.6 The staff capacity, skills and competencies for management of medical records
5.7 Readiness for implementation of enterprise content management
5.8 Proposed framework to facilitate medical records management practice in the public hospitals
5.9 Understanding of the relationship between medical records management and healthcare service delivery
5.10 Summary
6.1 Introduction
6.2 Summary from the findings of the studyservice delivery
6.3 Conclusions of the study from the findings
6.4 Recommendations
6.5 Implications of the research for theory, policy and practice
6.6 Suggestion for further research
6.7 Final conclusion
List of references

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