The Mexican Health Record

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Methodology and Method

In the following chapter of this thesis we will go through methodology used for the case and through the design of the interviews made.

Research Philosophy

The idea that there are different views of the world, and the processes that operate within it, is part of what is known as philosophy. Philosophy is concerned with views about how the world works and, as an academic subject, focuses, primarily, on reality, knowledge, and existence. The research philosophy contains important assumptions about the way in which you view the world (Saunders, Lewis, & Thornhill, 2012). Also, the research philosophy could assist the research with methodologies to avoiding inappropriate and unrelated works. By understanding and defining the benefits of research philosophy, the research could be more creative and exploratory in their method of research. Positivism: it’s based on “reality is independent of us and the goal is the discovery of theories based on empirical research”. Meanwhile, interpretivist involves researchers to not only research but to interpret elements of the study; thus, this type integrates human interest into a study (Myers, 2008). According to Saunders, M., Lewis, P. & Thornhill, A (2012) it is important for the researcher as a social actor to appreciate differences between people. In general, interpretive research findings are not derived from statistical analysis of quantitative data, instead, the findings are qualitative. (Collis, J., & Hussey, R. 2009).
This research will follow the interpretivist philosophy due to the complex situation this research wants to address; Therefore, although it is true that we need data to have access to certain conclusions, these conclusions will not be significant due to the data per se, but a complex knowledge and interpretation of the interaction between the main actors is needed. We based the decision as interpretivist rather than positivism because “interpretive researchers assume that access to reality (given or socially constructed) is only through social constructions such as language, consciousness, shared meanings, and instruments” (Myers, 2008). The researcher interacts with that being researched because it is impossible to separate what exists in the social world from what is in the researcher’s mind (Smith, 1983; Creswell, 2014).

Research nature:

If we are classifying research according to its purpose, we can describe it as being exploratory, descriptive, analytical or predictive (Collis & Hussey, 2014). Exploratory research design does not aim to provide the final and conclusive answers to the research questions but merely explores the research topic with varying levels of depth. It has been noted that exploratory research is the initial research, which forms the basis of more conclusive research. It can even help in determining the research design, sampling methodology and data collection method (Singh, 2007). This research will follow an exploratory research because of the aiming to get a deeper understanding of a topic with little previous research. Furthermore, exploratory research can be used when there is little knowledge about the topic of the research question and the researcher aims to understand the topic well (Saunders et al., 2012).

Research Approach:

Discussion of research approach is a vital part of any scientific study regardless of the research area. The main approaches are deductive, inductive, and abductive. (Saunders et al., 2012). On one hand, deductive research describes a study in which a conceptual and theoretical structure is developed which is then tested by empirical observation; thus, particular instances are deduced from general inferences (Collis & Hussey, 2014). On the other hand, inductive research describes a study in which theory is developed from the observation of empirical reality; thus, general inferences are induced from particular instances (Collis & Hussey, 2014). This research will follow the inductive approach, due to the way it aims to explore the phenomenon and analyze the data; which identify themes and patterns and create a conceptual framework and generalizing from the specific to the general. (Saunders, Lewis, & Thornhill, 2012).

Research design & strategy:

The purpose of qualitative research is to explore the meaning of the people’s experiences, the meaning of people’s culture, and how the people view a particular issue or case. The purpose of quantitative research is to examine the relationship between variables, such as the dependent, independent variables, and extraneous (Creswell, 2009). Qualitative studies aim to ensure a greater level of depth of understanding and qualitative data collection methods include interviews and questionnaires with case studies. This research will follow a qualitative focus; thus, the researchers are aiming to collect the right data in order to arm a strong case study that brings out the right conclusion for the research question.
On the other hand, Saunders et al (2009) defined a research strategy as “the general plan of how the researcher will go about answering the research questions”. On a similar note, Bryman (2008) identified research strategy as “a general orientation to the conduct of research” Both Yin (2003) and Saunders et al (2009) acknowledged that although various research strategies exist, there are large overlaps among them and hence the important consideration would be to select the most advantageous strategy for a research study. Some of the common research strategies used in business and management are experiment, survey, case study, action research, grounded theory, ethnography, archival research, cross-sectional studies, longitudinal studies and participative enquiry (Easterby-Smith et al., 2008; Collis and Hussey, 2009; Saunders et al., 2009).

Case Design

This research focuses on the two main institutions of public health in Mexico -IMSS and ISSTE-. These institutions were chosen since they are the two institutions that give attention to the largest amount of the Mexican population. Likewise, by choosing these two entities, we make sure that, even though they can or cannot be in the same state; the procedure and indicators are standardized (at least) inside the institutions, which allows us to make general conclusion without worried about the geographic factor. Also, being both public entities, the conflict of the difference in the budget or sources of financing is avoided.
The research aims to corroborate the two main factors exposed in our purpose and in the literature review: conclude that the HR is wrong –in the sense of structure, information, and procedures- and that they are the 20% that cause the 80% of the problems. The research will not only ask the right questions to the expert but look for a deeper understanding of the general context that surrenders not only the physician but the HRs. In order to achieve this, the selection of a case study was key, because it allowed the research to add the value of not only the answer but the context in the real life that is needed.
Objections to single case research can arise from concerns about the representativeness of the chosen case, the extent to which generalizability is possible and the vulnerability to confirmation bias. (Rose, Spink and Canhoto, 2015). However, in applied research, the situation may be different because the focus is on a specific situation. (Yin, 2009) Which is the case of this research; it is established on two standardized institutions that are the most important in Mexico, in this way, the researchers will able to generalize from one case.

Data Collection

According to Dudovskiy (2017) Data collection is a process of collecting information from all the relevant sources to find answers to the research problem, test the hypothesis and evaluate the outcomes. Data collection methods can be divided into two categories: secondary methods of data collection and primary methods of data collection ergo primary data and secondary data. Secondary data is data that has already been published in books, newspapers, magazines, journals, online portals, etc. The application of an appropriate set of criteria to select secondary data to be used in the study plays an important role in terms of increasing the levels of research validity and reliability (Dudovskiy, 2017). On the other hand, the primary data source refers to the information to the generated from an original source, such as interviews, focus groups or surveys. (Collis & Hussey, 2014)

  • Primary data: The main source of primary data in this research is peer-to-peer interviews to expert physicians of both intuitions as well as seminars and workshops.
  • Secondary data: The secondary data in this research is based on journals, official documents of the Ministry of Health, as well as scientific articles; which are describes in the literature review.

Interview Design

According to Kvale (1996: 174) an interview is “a conversation, whose purpose is to gather descriptions of the [life-world] of the interviewee” with respect to interpretation of the meanings of the ‘described phenomena’. According to Berg (2007) there are three main types of interviews; The first is the structured interview, whose key feature is that it is mostly organized around a set of predetermined direct questions that require immediate, mostly responses. Thus, in such an interview, the interviewer and interviewees would have very little freedom. The second type of interviews is the open-ended (unstructured) interview. Gubrium & Holstein (2002) point out that, unlike the structured interview, this kind of interviewing is an open situation through which greater flexibility and freedom are offered to both sides. Third, is the semi-structured interview, which is a more flexible version of the structured interview as “it allows depth to be achieved by providing the opportunity on the part of the interviewer to probe and expand the interviewee’s responses” (Rubin & Rubin, 2005: 88). When undertaking such interviews, researchers recommend using a basic checklist (Berg, 2007) that would help to cover all relevant areas; the main advantage is that it “allows for in-depth probing while permitting the interviewer to keep the interview within the parameters traced out by the aim of the study” (Berg 2007).
For this research, semi-structured interviews were chosen and implemented; since the researches aimed to have a deeper understating of the social (real-life) context, but still get some big data. In order to avoid any kind of a possible influence in the way of answering the questionnaire, questions were tackled with rate scale, but open questions were included aiming to understand the context of the doctor, the hospital and the HR.
These questions aimed not to provide information about the patients’ health state but the quality of the data that was provided in each section of the HR. The sections of analysis from the HR were: Laboratory Information, Radiology Information and Picture Archive, Prescription area/system, Personal Patient Health Record (Personal Data). Added to this, at the end of every questionnaire, a section regarding the nomenclatures and scientific language was asked aiming to show how the standardization of these clinical terms might or might not affect the way the HR is used.

1. Introduction
1.1 Background
1.2 Problem Discussion
1.3 Purpose
2. Literature Review
3. Theoretical Framework 
4. Methodology and Method
4.1 Research Philosophy
4.2 Research nature:
4.3 Research Approach:
4.4 Research design & strategy:
4.5 Case Design
4.6 Data Collection
4.7 Interview Design
4.8 Interview selection:
4.9 Data analysis.
5. Interview Results / Empirical Findings 
5.1 The Mexican Health Record
5.2 File Standardization
5.3 Standardization Implementation
6. Analysis 
6.1 File Standardization
6.2 Standardization Implementation.
7. Conclusion 
7.1 Discussion and Future research
7.2 Trustworthiness
7.3 Credibility
7.4 Transferability
7.5 Dependability
7.6 Confirmability:
7.7 Limitations
8. Ethics and Confidentiality
9. Reference list 
10. Appendix
Health Records in the Mexican Health System

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