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Qualitative data is information you can describe with words rather than numbers.
Quantitative data is information represented in a measurable way using numbers.
One type of data isn’t better than the other.
To conduct thorough research, you need both. But knowing the difference between them is important if you want to harness the full power of both qualitative and quantitative data.
In this post, we’ll explore seven key differences between these two types of data.
The single biggest difference between quantitative and qualitative data is that one deals with numbers, and the other deals with concepts and ideas.
The words “qualitative” and “quantitative” are really similar, which can make it hard to keep track of which one is which. I like to think of them this way:
Qualitative data—the descriptive one—usually involves written or spoken words, images, or even objects. It’s collected in all sorts of ways: video recordings, interviews, open-ended survey responses, and field notes, for example.
I like how researcher James W. Crick defines qualitative research in a 2021 issue of the Journal of Strategic Marketing : “Qualitative research is designed to generate in-depth and subjective findings to build theory.”
In other words, qualitative research helps you learn more about a topic—usually from a primary, or firsthand, source—so you can form ideas about what it means. This type of data is often rich in detail, and its interpretation can vary depending on who’s analyzing it.
Here’s what I mean: if you ask five different people to observe how 60 kittens behave when presented with a hamster wheel, you’ll get five different versions of the same event.
Quantitative data, on the other hand, is all about numbers and statistics. There’s no wiggle room when it comes to interpretation. In our kitten scenario, quantitative data might show us that of the 60 kittens presented with a hamster wheel, 40 pawed at it, 5 jumped inside and started spinning, and 15 ignored it completely.
There’s no ifs, ands, or buts about the numbers. They just are.
You should use both quantitative and quantitative data to make decisions for your business.
Quantitative data helps you get to the what . Qualitative data unearths the why .
Quantitative data collects surface information, like numbers. Qualitative data dives deep beneath these same numbers and fleshes out the nuances there.
Research projects can often benefit from both types of data, which is why you’ll see the term “mixed-method” research in peer-reviewed journals. The term “mixed-method” refers to using both quantitative and qualitative methods in a study.
So, maybe you’re diving into original research. Or maybe you’re looking at other peoples’ studies to make an important business decision. In either case, you can use both quantitative and qualitative data to guide you.
Imagine you want to start a company that makes hamster wheels for cats. You run that kitten experiment, only to learn that most kittens aren’t all that interested in the hamster wheel. That’s what your quantitative data seems to say. Of the 60 kittens who participated in the study, only 5 hopped into the wheel.
But 40 of the kittens pawed at the wheel. According to your quantitative data, these 40 kittens touched the wheel but did not get inside.
This is where your qualitative data comes into play. Why did these 40 kittens touch the wheel but stop exploring it? You turn to the researchers’ observations. Since there were five different researchers, you have five sets of detailed notes to study.
From these observations, you learn that many of the kittens seemed frightened when the wheel moved after they pawed it. They grew suspicious of the structure, meowing and circling it, agitated.
One researcher noted that the kittens seemed desperate to enjoy the wheel, but they didn’t seem to feel it was safe.
So your idea isn’t a flop, exactly.
It just needs tweaking.
According to your quantitative data, 75% of the kittens studied either touched or actively participated in the hamster wheel. Your qualitative data suggests more kittens would have jumped into the wheel if it hadn’t moved so easily when they pawed at it.
You decide to make your kitten wheel sturdier and try the whole test again with a new set of kittens. Hopefully, this time a higher percentage of your feline participants will hop in and enjoy the fun.
This is a very simplistic and fictional example of how a mixed-method approach can help you make important choices for your business.
When you can swing it, you should look at both qualitative and quantitative data before you make any big decisions.
But this is where we come to another big difference between quantitative vs. qualitative data: it’s a lot easier to source qualitative data than quantitative data.
Why? Because it’s easy to run a survey, host a focus group, or conduct a round of interviews. All you have to do is hop on SurveyMonkey or Zoom and you’re on your way to gathering original qualitative data.
And yes, you can get some quantitative data here. If you run a survey and 45 customers respond, you can collect demographic data and yes/no answers for that pool of 45 respondents.
But this is a relatively small sample size. (More on why this matters in a moment.)
To tell you anything meaningful, quantitative data must achieve statistical significance.
If it’s been a while since your college statistics class, here’s a refresh: statistical significance is a measuring stick. It tells you whether the results you get are due to a specific cause or if they can be attributed to random chance.
To achieve statistical significance in a study, you have to be really careful to set the study up the right way and with a meaningful sample size.
This doesn’t mean it’s impossible to get quantitative data. But unless you have someone on your team who knows all about null hypotheses and p-values and statistical analysis, you might need to outsource quantitative research.
Plenty of businesses do this, but it’s pricey.
When you’re just starting out or you’re strapped for cash, qualitative data can get you valuable information—quickly and without gouging your wallet.
Another reason qualitative data is more accessible? It requires a smaller sample size to achieve meaningful results.
Even one person’s perspective brings value to a research project—ever heard of a case study?
The sweet spot depends on the purpose of the study, but for qualitative market research, somewhere between 10-40 respondents is a good number.
Any more than that and you risk reaching saturation. That’s when you keep getting results that echo each other and add nothing new to the research.
Quantitative data needs enough respondents to reach statistical significance without veering into saturation territory.
The ideal sample size number is usually higher than it is for qualitative data. But as with qualitative data, there’s no single, magic number. It all depends on statistical values like confidence level, population size, and margin of error.
Because it often requires a larger sample size, quantitative research can be more difficult for the average person to do on their own.
Running a study is just the first part of conducting qualitative and quantitative research.
After you’ve collected data, you have to study it. Find themes, patterns, consistencies, inconsistencies. Interpret and organize the numbers or survey responses or interview recordings. Tidy it all up into something you can draw conclusions from and apply to various situations.
This is called data analysis, and it’s done in completely different ways for qualitative vs. quantitative data.
For qualitative data, analysis includes:
You can often do qualitative data analysis manually or with tools like NVivo and ATLAS.ti. These tools help you organize, code, and analyze your subjective qualitative data.
Quantitative data analysis is a lot less subjective. Here’s how it generally goes:
Researchers generally use sophisticated data analysis tools like RapidMiner and Tableau to help them do this work.
Quantitative research tends to be less flexible than qualitative research. It relies on structured data collection methods, which researchers must set up well before the study begins.
This rigid structure is part of what makes quantitative data so reliable. But the downside here is that once you start the study, it’s hard to change anything without negatively affecting the results. If something unexpected comes up—or if new questions arise—researchers can’t easily change the scope of the study.
Qualitative research is a lot more flexible. This is why qualitative data can go deeper than quantitative data. If you’re interviewing someone and an interesting, unexpected topic comes up, you can immediately explore it.
Other qualitative research methods offer flexibility, too. Most big survey software brands allow you to build flexible surveys using branching and skip logic. These features let you customize which questions respondents see based on the answers they give.
This flexibility is unheard of in quantitative research. But even though it’s as flexible as an Olympic gymnast, qualitative data can be less reliable—and harder to validate.
Quantitative data is more reliable than qualitative data. Numbers can’t be massaged to fit a certain bias. If you replicate the study—in other words, run the exact same quantitative study two or more times—you should get nearly identical results each time. The same goes if another set of researchers runs the same study using the same methods.
This is what gives quantitative data that reliability factor.
There are a few key benefits here. First, reliable data means you can confidently make generalizations that apply to a larger population. It also means the data is valid and accurately measures whatever it is you’re trying to measure.
And finally, reliable data is trustworthy. Big industries like healthcare, marketing, and education frequently use quantitative data to make life-or-death decisions. The more reliable and trustworthy the data, the more confident these decision-makers can be when it’s time to make critical choices.
Unlike quantitative data, qualitative data isn’t overtly reliable. It’s not easy to replicate. If you send out the same qualitative survey on two separate occasions, you’ll get a new mix of responses. Your interpretations of the data might look different, too.
There’s still incredible value in qualitative data, of course—and there are ways to make sure the data is valid. These include:
Whether you’re dealing with qualitative or quantitative data, transparency, accuracy, and validity are crucial. Focus on sourcing (or conducting) quantitative research that’s easy to replicate and qualitative research that’s been peer-reviewed.
With rock-solid data like this, you can make critical business decisions with confidence.
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The aim of this paper is to analyze and to compare quantitative and qualitative research methods. The analysis will begin with the definition and description of the two methods. This will be followed by a discussion on the various aspects of the two research methods.
The similarities and differences between quantitative and qualitative research methods can be seen in their characteristics, data collection methods, data analysis methods, and the validity issues associated with them, as well as, their strengths and weaknesses.
Qualitative research method is a technique of “studying phenomena by collecting and analyzing data in non-numeric form”. It focuses on exploring the topic of the study by finding as much detail as possible. The characteristics of qualitative research include the following.
First, it focuses on studying the behavior of individuals in their natural settings. Thus, it does not use artificial experiments. This helps researchers to avoid interfering with the participants’ normal way of life.
Second, qualitative research focuses on meanings, perspectives, and understandings. It aims at finding out the meanings that the subjects of the study “attach to their behavior, how they interpret situations, and what their perspectives are on particular issues”.
Concisely, it is concerned with the processes that explain why and how things happen.
Quantitative research is “explaining phenomena by collecting numerical data that are analyzed using mathematical techniques such as statistics”.
It normally uses experiments to answer research questions. Control is an important aspect of the experiments because it enables the researcher to find unambiguous answers to research questions.
Quantitative research also uses operational definitions. Concisely, the terms used in a quantitative study must be defined according to the operations employed to measure them in order to avoid confusion in meaning or communication.
Moreover, the results of quantitative research are considered to be reliable only if they are replicable. This means that the same results must be produced if the research is repeated using the same techniques.
Hypothesis testing is also an integral part of quantitative research. Concisely, hypotheses enable the researcher to concentrate on a specific aspect of a problem, and to identify the methods for solving it.
The similarities and differences between quantitative and qualitative research methods can be seen in their characteristics
Quantitative and qualitative studies are similar in the following ways. To begin with, qualitative research is normally used to generate theory. Similarly, quantitative studies can be used to explore new areas, thereby creating a new theory.
Even though qualitative research focuses on generating theory, it can also be used to test hypotheses and existing theories. In this regard, it is similar to quantitative studies that mainly focus on testing theories and hypotheses.
Both qualitative and quantitative studies use numeric and non-numeric data. For instance, the use of statements such as less than normally involves the use of quantitative data in qualitative studies.
Similarly, quantitative studies can use questionnaires with open-ended questions to collect qualitative data.
Despite these similarities, quantitative and qualitative studies differ in the following ways. To begin with, the purpose of qualitative research is to facilitate understanding of fundamental meanings, reasons, and motives.
It also aims at providing valuable insights concerning a problem through determination of common trends in thought and generation of ideas.
On the other hand, the purpose of quantitative research is to quantify data and to use the results obtained from a sample to make generalizations on a particular population.
The sample used in qualitative research is often small and non-representative of the population. On the contrary, quantitative research uses large samples that represent the population. In this regard, it uses random sampling techniques to select a representative sample.
Qualitative research uses unstructured or semi-structured data collection techniques such as focus group discussions, whereas quantitative research uses structured techniques such as questionnaires.
Moreover, qualitative research uses non-statistical data analysis techniques, whereas quantitative uses statistical methods to analyze data. Finally, the results of qualitative research are normally exploratory and inconclusive, whereas the results of quantitative research are usually conclusive.
The similarities and differences between quantitative and qualitative research methods can be seen in their data collection methods
The main data collection methods in qualitative research include observations, interviews, content review, and questionnaires. The researcher can use participant or systematic observation to collect data.
In participant observation, the researcher engages actively in the activities of the subjects of the study. Researchers prefer this technique because it enables them to avoid disturbing the natural settings of the study.
In systematic observation, schedules are used to observe the behaviors of the participants at regular intervals. This technique enhances objectivity and reduces bias during data collection.
Most qualitative studies use unstructured interviews in which the interviewer uses general ideas to guide the interview and prompts to solicit more information.
Content review involves reading official documents such as diaries, journals, and minutes of meetings in order to obtain data. The importance of this technique is that it enables the researcher to reconstruct events and to describe social relationships.
Questionnaires are often used when the sample size is too large to be reached through face-to-face interviews. However, its use is discouraged in qualitative research because it normally influences the way participants respond, rather than allowing them to act naturally during data collection.
Quantitative research mainly uses surveys for data collection. This involves the use of questionnaires and interviews with closed-ended questions to enable the researcher to obtain data that can be analyzed with the aid of statistical techniques.
The questionnaires can be mailed or they can be administered directly to the respondents.
Observations are also used to collect data in quantitative studies. For example, the researcher can count the number of customers queuing at a point of sale in a retail shop.
Finally, quantitative researchers use management information systems to collect data. This involves reviewing documents such as financial reports to obtain quantitative data.
Qualitative researchers often start the analysis process during the data collection and preparation stage in order to discover emerging themes and patterns. This involves continuous examination of data in order to identify important points, contradictions, inconsistencies, and common themes.
After this preliminary analysis, qualitative data is usually organized through systematic categorization and concept formation. This involves summarizing data under major categories that appear in the data set.
Data can also be summarized through tabulation in order to reveal its underlying features. The summaries usually provide descriptions that are used to generate theories. Concisely, the data is used to develop theories that explain the causes of the participants’ behavior.
Theories are also developed through comparative analysis. This involves comparing observations “across a range of situations over a period of time among different participants through a variety of techniques”.
Continuous comparisons provide clues on why participants behave in a particular manner, thereby facilitating theory formulation.
Quantitative analysis begins with the identification of the level of measurement that is appropriate for the collected data. After identifying the measurement level, data is usually summarized under different categories in tables by calculating frequencies and percentage distributions.
A frequency distribution indicates the number of observations or scores in each category of data, whereas a percentage distribution indicates the proportion of the subjects of the study who are represented in each category.
Descriptive statistics help the researcher to describe quantitative data. It involves calculating the mean and median, as well as, minimum and maximum values. Other analytical tools include correlation, regression, and analysis of variance.
Correlation analysis reveals the direction and strength of the relationship associated with two variables. Analysis of variance tests the statistical significance of the independent variables. Regression analysis helps the researcher to determine whether the independent variables are predictors of the dependent variables.
Validity refers to the “degree to which the evidence proves that the interpretations of the data are correct and appropriate”. Validity is achieved if the measurement instrument is reliable. Replicability is the most important aspect of reliability in quantitative research.
This is because the results of quantitative research can only be approved if they are replicable. In quantitative research, validity is established through experiment review, data triangulation, and participant feedback, as well as, regression and statistical analyses.
In qualitative research, validity depends on unobtrusive measures, respondent validation, and triangulation. The validity of the results is likely to improve if the researcher is unobtrusive. This is because the presence of the researcher will not influence the responses of the participants.
Respondent validation involves obtaining feedback from the respondents concerning the accuracy of the data in order to ensure reliability. Triangulation involves collecting data using different methods at different periods from different people in order to ensure reliability.
The strengths of qualitative research include the following. First, it enables the researcher to pay attention to detail, as well as, to understand meanings and complexities of phenomena.
Second, it enables respondents to convey their views, feelings, and experiences without the influence of the researcher.
Third, qualitative research involves contextualization of behavior within situations and time. This improves the researcher’s understanding, thereby enhancing the reliability of the conclusions made from the findings.
Finally, the findings of qualitative research are generalizable through the theory developed in the study.
Qualitative research has the following weaknesses. Participant observation can lead to interpretation of phenomena based only on particular situations, while ignoring external factors that may influence the behavior of participants.
This is likely to undermine the validity of the research. Additionally, conducting a qualitative research is usually difficult due to the amount of time and resources required to negotiate access, to build trust, and to collect data from the respondents.
Finally, qualitative research is associated with high levels of subjectivity and bias.
Quantitative research has the following strengths. First, it has high levels of precision, which is achieved through reliable measures.
Second, it uses controlled experiments, which enable the researcher to determine cause and effect relationships.
Third, the use of advanced statistical techniques such as regression analysis facilitates accurate and sophisticated analysis of data.
Despite these strengths, quantitative research is criticized because it ignores the fact that individuals are able to interpret their experiences, as well as, to develop their own meanings.
Furthermore, control of variables often leads to trivial findings, which may not explain the phenomena that are being studied. Finally, quantitative research cannot be used to study phenomena that are not quantifiable.
The aim of this paper was to analyze quantitative and qualitative research methods by comparing and contrasting them. The main difference between qualitative and quantitative research is that the former uses non-numeric data, whereas the later mainly uses numeric data.
The main similarity between them is that they can be used to test existing theories and hypothesis. Qualitative and quantitative research methods have strengths and weaknesses. The results obtained through these methods can be improved if the researcher addresses their weaknesses.
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IvyPanda. (2019, July 2). Quantitative and Qualitative Research Methods: Similarities and Differences. https://ivypanda.com/essays/qualitative-and-quantitative-research-methods/
"Quantitative and Qualitative Research Methods: Similarities and Differences." IvyPanda , 2 July 2019, ivypanda.com/essays/qualitative-and-quantitative-research-methods/.
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BMC Health Services Research volume 24 , Article number: 855 ( 2024 ) Cite this article
The implementation of intervention programs in Emergency Departments (EDs) is often fraught with complications due to the inherent complexity of the environment. Hence, the exploration and identification of barriers and facilitators prior to an implementation is imperative to formulate context-specific strategies to ensure the tenability of the intervention.
In assessing the context of four EDs prior to the implementation of SurgeCon, a quality improvement program for ED efficiency and patient satisfaction, this study identifies and explores the barriers and facilitators to successful implementation from the perspective of the healthcare providers, patients, researchers, and decision-makers involved in the implementation.
Two rural and two urban Canadian EDs with 24/7 on-site physician support.
Data were collected prior to the implementation of SurgeCon, by means of qualitative and quantitative methods consisting of semi-structured interviews with 31 clinicians (e.g., physicians, nurses, and managers), telephone surveys with 341 patients, and structured observations from four EDs. The interpretive description approach was utilized to analyze the data gathered from interviews, open-ended questions of the survey, and structured observations.
A set of five facilitator-barrier pairs were extracted. These key facilitator-barrier pairs were: (1) management and leadership, (2) available resources, (3) communications and networks across the organization, (4) previous intervention experiences, and (5) need for change.
Improving our understanding of the barriers and facilitators that may impact the implementation of a healthcare quality improvement intervention is of paramount importance. This study underscores the significance of identifing the barriers and facilitators of implementating an ED quality improvement program and developing strategies to overcome the barriers and enhance the facilitators for a successful implementations. We propose a set of strategies for hospitals when implementing such interventions, these include: staff training, champion selection, communicating the value of the intervention, promoting active engagement of ED staff, assigning data recording responsibilities, and requiring capacity analysis.
ClinicalTrials.gov. NCT04789902. 10/03/2021.
Peer Review reports
Research motivation.
Wait times and overcrowding in emergency departments pose a severe national challenge for Canada as it has one of the highest wait times as compared to similarly industrialized countries [ 1 ]. This issue has persistently worsened as the number of emergency department (ED) visits in Canada has been increasing steadily over the past decade. From 2010–2011 to 2019–2020, the number of ED visits increased from approximately 6.7 million to 7.6 million, representing an average annual increase of 1.2%. Furthermore, the number of reported ED visits rose to almost 14.9 million in 2021–2022 from 11.7 million in 2020–2021[ 2 ]. The typical duration of a visit to an ED is around 3.5 h, which poses a risk to patients since prolonged waiting times in EDs have been associated with sub-optimal patient outcomes [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ], and to the increased likelihood of adverse events [ 10 ]. To address this issue, SurgeCon, a quality improvement program, was devised to address the lack of integration, sustainability and logistical issues which negatively impact wait times in EDs [ 11 , 12 , 13 ]. SurgeCon delivers its quality improvement program through a department level management platform that encompasses three key elements: the installation and configuration of a tailored eHealth system, organizational restructuring, and the establishment of a patient-centric environment. SurgeCon aims to go beyond simply improving wait times; it seeks to optimize ED efficiency while providing a high standard of care for patients and promoting communication among clinicians.
Implementation of such a multidimensional quality improvement program in the dynamic and complex organizational structure of EDs, requires exploring barriers and facilitators prior to the respective implementation to formulate a set of strategies to enhance facilitators and overcome barriers, which may lead to a redesign of the program itself. Previous research in this area either lack the inclusion of strategies to overcome barriers or solely concentrate on eHealth adoption and implementation while neglecting considerations towards restructuring the organization of EDs and improving communication among clinicians. Barriers are factors that inhibit the implementation of practice change [ 14 ], while facilitators are factors that make the implementation easier [ 15 ]. Schreiweis et al. (2019) identified 76 barriers and 268 facilitators of implementation of eHealth services in health care out of 38 articles published between 2007 to 2018 from 12 different countries [ 16 ]. The most frequent barriers were categorized in three categories: individuals (e.g., poor digital health literacy), environmental and organizational (e.g., problems with financing eHealth solutions), and technical (e.g., lack of necessary devices). Also, some of the most stated facilitators were as follows: individuals (e.g., improvement in communication), environmental and organizational (e.g., involvement of all relevant stakeholders), and technical (e.g., ease of use). A limited number of studies have been conducted in an ED setting. For instance, Gyamfi et al., (2017) along with Kirk et al. (2016) and MacWilliams et al. (2017) explored relevant facilitators (e.g., capacity building, involvement and moral support of management and implementers, training and motivation, and environmental context and resources) and barriers (e.g., financial resources, data entry errors, shortage of human resources, and logistical constraints) that influence the implementation of eHealth services (e.g., Electronic Medical Records and screening tools) in EDs in Denmark, Ghana, and Canada (Ontario and Nova Scotia) [ 17 , 18 , 19 ]. Gyamfi et al. (2017) and Kirk et al. (2016) utilized semi-structured interviews, while MacWilliams et al. (2017) utilized focus groups for their data collection (these findings were then thematically analyzed) [ 17 , 18 , 19 ]. MacWilliams et al. (2017) also proposed suggestions to overcome barriers to implementation of Electronic Medical Records in EDs such as providing sufficient logistics (e.g., computers and accessories, reliable internet), rewarding staff, and regular staff training [ 19 ].
The aforementioned literature, along with other related literature, does not encompass the exploration of barriers and facilitators prior to the implementation of a large-scale quality improvement program that targets not only technical (i.e., eHealth system), but also structural (i.e., restructuring the ED organization and fostering patient-centric environment) and human (i.e., promoting communication across clinicians) aspects of the healthcare system. In fact, the objective of the quality improvement program in this study is not only to improve wait time, but also patient satisfaction, provider satisfaction, and the quality of care provided in EDs. As such, the SurgeCon program is connected to multiple dimensions related to patient outcomes within EDs. This study aims to explore barriers and facilitators prior to the implementation of SurgeCon in two rural and two urban Canadian EDs and formulate a set of strategies to overcome barriers and enhance facilitators. The findings identify areas of change for practitioners and policymakers [ 20 ]. This study is based on in-depth semi-structured interviews with clinicians, telephone interviews with patients, and structured observations in four EDs.
SurgeCon includes three components: implementing an eHealth system to automate an action-based surge capacity plan, restructuring the ED organization and workflow, and fostering a more patient-centric environment. SurgeCon’s eHealth system predicts surge levels which sets appropriate automated workflows in motion to enact proactive measures to improve patient flow and associated outcomes. Crucially, eHealth interventions are generally reported to have a positive impact on patient care [ 21 ] wherein its impact ranges from an increase in the availability of patient information, enhanced communication between healthcare workers, improved healthcare accessibility, and reduced patient wait times [ 13 , 22 , 23 ]. The evolution of eHealth services can be attributed to solving critical challenges faced by healthcare institutions around the world, such as wait times and overcrowding which are significant challenges for EDs globally [ 24 , 25 ]. In addition to SurgeCon's eHealth system, a comprehensive approach to improving ED efficiency is also provided by including a patient flow course for frontline nurses and physicians. This course focuses on patient-centeredness and introduces process improvement strategies such as enhancing collaboration between physicians and mid-level providers like nurse practitioners, prioritizing stable patients based on factors beyond just acuity, and aiming to decrease the duration between a patient's arrival and their first assessment by a physician. Furthermore, SurgeCon's implementation process aims to improve the patient experience while in the department. This involves identifying problem areas that could negatively impact a patient's physical and mental well-being, such as their comfort level, ease of navigation, cleanliness of the department, clutter in the ED, and other related factors.
We employed a mixed-method approach at the technique level, incorporating semi-structured interviews, a structured questionnaire, and structured observation to collect data. To analyze the data, we adopted an interpretive description approach, as outlined by Thorne et al. (1997) [ 26 ]. This approach entails situating the findings within the current body of knowledge and drawing upon the contributions of other scholars, as highlighted by Mitchell and Cody (1993) [ 27 ]. This study aims to provide rich descriptive information on the key barriers and facilitators based on the language of the people involved, which inherently requires some degree of interpretation. The existing knowledge is not an organizing structure, rather, it serves as a foundational framework, providing a starting point and acts as an appropriate platform “upon which the design logic and the inductive reasoning in interpreting meanings within the data can be judged” [ 26 ].
The implementation of SurgeCon in this study follows a stepped-wedge cluster trial design, specifically focusing on EDs within Category A hospitals. These hospitals offer round-the-clock physician coverage in their EDs. All the hospitals involved in the study are located within the same jurisdiction, operating under the same governance and management structure. The two rural intervention sites in this trial are similar in size, each with a capacity of 8 ED beds. They have a staff roster consisting of approximately 6–10 physicians and 12 nurses, divided into two teams that work on rotating schedules.
One of the urban sites is an acute care facility that provides services to the entire province. The other urban site has 15 beds and shares a physician roster of approximately 40 physicians with the other urban site. Each ED at the urban sites is staffed with 55 and 70 nurses, respectively. Both urban sites offer a wide range of inpatient and outpatient services, including several tertiary services (Table 1 ).
Prior to the implementation of the SurgeCon intervention we conducted semi-structured, in-depth interviews with a total of 31 clinicians. This cohort comprised of 20 clinicians from rural EDs and 11 from urban EDs. This included 12 nurses, 9 physicians, 7 managers, 2 patient care facilitators, and 1 program coordinator with 1 to 32 years of work experience in EDs with 69% of participants identifying as female. The interview questions were informed by the Consolidated Framework for Implementation Research (CFIR), Organization Readiness for Knowledge Translation (OR4KT) domains, and the clinical/content expertise of the team. The recruitment continued until data saturation was achieved [ 28 ].
Data on patient satisfaction and patient-reported experiences with ED wait times were collected through telephone surveys that took place from March 1, 2021, to August 31, 2021. In total, 341 patients who visited one of the four selected EDs were interviewed, with 136 coming from rural EDs and 205 from urban EDs. The mean age was 55.7 (SD = 16.8) with 66% of participants identifying as female. We analyzed open-ended questions that specifically targeted patients' experiences while receiving care at the selected EDs and gathered their suggestions for improving the ED environment. Patients' insights confirmed our findings regarding resources, communication, and the necessity for change. The interview guide adapted questions from previously validated questionnaires which include the Ontario Emergency Department Patient Experience of Care Survey , the CIHI Canadian Patient Experiences Survey , the Press Ganey Emergency Department Survey , and the NHS Accident and Emergency Department Questionnaire .
Structured observations were conducted by research team members who were also healthcare staff and had special permission to visit each of the sites which were locked-down and only accessible to authorized ED personnel and patients due to COVID-19 pandemic restrictions. A ‘Site Assessment Checklist’ was used to assess each of the four EDs in terms of the ED’s available resources (e.g., medical, human, and technological), staff communication, pervious experiences of intervention, staff readiness and tension for change. The checklist was developed through a Delphi approach which included the input of research team members, ED staff, and patients who selected key criteria to assess the EDs.
The data collected and referenced in this analysis stems from an innovative pragmatic cluster randomized trial designed to evaluate the effects of SurgeCon, an ED management platform, on wait times and patient satisfaction. The subset of data that was considered relevant to our analysis was collected from March 2021 to December 2022. All data used in this study were collected prior to the implementation of SurgeCon at the four EDs selected for the cluster randomized trial. Even though each dataset was gathered and analyzed independently, they were considered complementary to each other instead of being mutually exclusive.
Data from in-depth interviews, surveys, and structured observations was analyzed according to an interpretative description approach, while utilizing constant comparative analysis. Each set of data was repeatedly read by a qualitative researcher to comprehend the overall phenomena with questions such as “what is happening here? and “what am I learning about this?”, to become familiar with the data, to identify the potential themes or patterns and to achieve a broader insight about the phenomena [ 26 , 28 , 29 , 30 ]. The data was then coded in a broad manner and continually compared and examined for similarities, differences, and relationships to help formulate major themes. A set of five facilitator-barrier pairs was extracted in this study.
All stages in the coding process were conducted by a qualitative researcher and were then categorically reviewed by members of the team to reach a consensus. The data analysis process started with the exploration of semi-structured interview data, which then progressed to include structured observation, and ended with the comprehensive analysis of the data gathered through surveys. Data extracted from semi-structured, in-depth interviews with clinicians served as the primary source for exploring barriers and facilitators before implementation. However, structured observations and survey data were integrated to offer additional clarity and act as auxiliary and confirmatory sources. Data collected from different stakeholders produced complementary results that captured multidimensional interpretations of the topic. The integrated blend of findings collected from various stakeholders through disparate methods not only explains multiple dimensions of the phenomena but also targets different audiences. In this study, data triangulation (gathering data at different times from various sources), investigator triangulation (multiple researchers study the topic of interest), and methodological triangulation (utilizing multiple methods) were utilized as cross-validation checks [ 31 , 32 ].
The barriers and facilitators to the implementation of SurgeCon fell into five themes, each of which plays a dual role of a barrier and facilitator (see Fig. 1 ). These key pairings were: (1) management and leadership, (2) available resources, (3) communications and networks across the organization, (4) previous intervention experiences, and (5) need for change. No significant differences were observed in terms of barriers and facilitators between the groups (i.e., rural and urban EDs) or among providers, patients, and observer inputs. While observer inputs provided insight on all categories, the patients’ input had the most influence on the following categories; available resources, communications and networks, and the need for change. In the following sections, we discuss each of these barrier and facilitator pairs.
Process of Identifying Barriers and Facilitators toward Formulating Strategies
The overarching management and leadership EDs was anticipated to be one of the most important facilitators of the SurgeCon implementation. Having a receptive, accessible, and supportive senior manager who is continually engaged with all aspects of the transition phase paired with an effective management system where the staff are involved in the decision-making process, was perceived to stimulate positive managerial-clinical communications along with an increasing likelihood for the positive reception of an implementation program. Active early involvement, support, and engagement of managers in two EDs were deemed crucial facilitators to fostering a nurturing and motivating environment that encourages physicians and nurses to proactively engage in the implementation process. Data from the observations served as confirmation of the involvement of both management and staff as well.
“I can converse openly and there is an open-door policy. Furthermore, just in terms of communication, there is always a timely response and the manager is very proactive” [Healthcare provider] “The site manager, the direct manager of the staff, comes every morning to the department to see what was happening last night. If there is any new issue, [the manager offers assistance and any logistical resolutions] that can be done or offered immediately. Additionally, they have free access to the director and to the manager through email. The manager’s office is just a few meters away from them, so they can just reach them at any time. For the doctors, the situation is also the same” [Healthcare provider]
However, management and leadership could also pose barriers to a successful implementation. Barriers such as low manager participation and contribution, unreceptive and inaccessible managers, low staff autonomy and involvement in decision-making, and the lack of staff consultation all emerged in the analysis.
“You know a couple of years ago with the previous manager, everything was unilaterally implemented. As in, it was put forward and we had to strictly abide by it irrespective of what we felt the outcome was going to be. There were several instances where you had to accept what was told to you and consequently, there was very little room for discussion or negotiation.” [Healthcare provider]
When working in a small ED with limited staff turnover and a long-standing team who are familiar with daily routines and operations, it was deemed integral for managers to involve and engage frontline ED staff in the decision-making process while also managing strategies for running the department. Failure to give staff autonomy in their roles was anticipated to be a barrier to a successful implementation within this framework.
“The emergency department was say anywhere from 98-99% senior. So, when you got a small department that is pretty much occupied by senior staff, it runs itself. Most of us have been nursing for 30 plus years. So, we know how the system works; we know what we have to do; we know how to solve problems; we are familiar with critical thinking to get issues resolved. However, this other manager was always critiquing us, and certainly not in a constructive manner”. [Healthcare provider]
Amplifying these issues was the fact that there was a history of struggling with unapproachable, autocratic and unavailable managers in the ED. It left the clinicians with sentiments of neglect and varying overdue demands and expectations. This in-turn caused a “toxic environment” which was percived as a critical barrier to the successfull implementation:
“But it really was like I said before, a toxic environment which placed everybody in on a defensive stance at all times and people did not want to go to work and more crucially, people did not like to work. If they did statistics on it, I am sure there was a huge spike in sick leave as people were just not wanting to go to work. That's the bottom line.” [Healthcare provider]
Availability of resources was considered as a critical facet for the implementation of SurgeCon. As such, disparate resources, that crossed human and medical resources and several other silos (e.g., space constraint), were anticipated to be necessary considerations to ensure the long-term tenability of the SurgeCon intervention. Participants at all four EDs unanimously identified excess workload, and staff shortages, and absence of opportunities to ease workloads as the most significant anticipated barriers to implementation. To incorporate the new implementation system, not only was it asserted that all clinicians need to be available and have sufficient time to attend a staff training program, but they also need to regularly entering and updating SurgeCon data. Virtually all participants anticipated that the lack of human resources (i.e., insufficient medical staff) would be a crucial barrier.
“Human resources can be a bit harder to come by because nurses are often treated as a commodity. There is so much overtime at the current time and requires increased staff.” [Healthcare provider] “I think more family doctors are needed to lower the congestion in the ED.” [Patient] “Need more staff. Patient asked multiple times to be taken to the bathroom after being left alone in a wheelchair... She asked again hours later and received no help so she peed in her wheelchair fully clothed and left without seeing a doctor due to embarrassment and such a lack of help.” [Patient] “if we don't have enough staff or if we don't have enough beds. To me it don't matter what you're doing, it’s not going to work. It's going to be harder for it to work if you don't have the resources.” [Healthcare provider]
Other than staff shortages, high staff turnover rates were cited as another anticipated barrier to implementation. The high level of staff turnover adversely impacted the level of communication among staff, and was also perceived as a significant challenge with regards to training and accommodating necessary implementation activities.
“We have a lot of new nurses that are just coming out of program. So, helping mentor them with an overwhelmed emergency department is difficult as they are also trying to get their footing within the emergency department, and learn new skills and tasks. I find communications a bit lacking right now because we have so much new staff and they're just trying to get their footing and learn. In doing so, it is hard to have that communication. Like everyone helps wherever they can but you're also trying to, within that time, train your new staff as well. It's kind of a bit hectic.” [Healthcare provider] “Rapid turnover of staff at HSC. So some of the staff have been through process improvement while many others have not.” [Observer]
Insufficient admission space (e.g., inadequate number of beds) and the lack of physical space and rooms in EDs were often identified by clinicians as the primary cause of backlogs and overcrowding in EDs. These factors were anticipated to be barriers to the implementation process as they affect patient admissions, transfers, discharges, as well as the restructuring of the ED organization and workflow.
“Some of the barriers would certainly be the inability to have free or vacant beds to transfer patients out of or transporting patients out of our department to a tertiary care facility.” [Healthcare provider] “There needs to be more beds and seating arrangements.” [Patient] “There is no current space adequate enough to run the flow center model.” [Observer] “Rooms are sticky at times; space is small and overpopulated.” [Observer]
In order to ensure the successful adoption of SurgeCon, intra and inter-departmental communication was deemed to be a critical factor. Consistent and frequent communication between clinicians, particularly among physicians and nurses, is necessary to execute implementation activities successfully. However, this theme received mixed evaluations by participants. Poor communication and fragmented relationships between nurses and physicians, and lack of teamwork among staff emerged as significant barriers to the implementation of SurgeCon. In all four EDs, it was observed that physicians and nurses do not have any formal joint meetings and there was scarce communication between different units within EDs. The lack of shared multidisciplinary meetings in EDs decreased the chance of developing mutual understanding and commitment, building empathy and awareness toward each other’s challenges, and enhancing unity and teamwork.
“There seems to be a huge miscommunication between staff, mainly to do with rules surrounding COVID.” [Patient] “We do not sit down at the same table. There are family practice meetings, there are student emergency doc meetings and then, there are nursing meetings; you are not set at the same table. So, I cannot realistically know, feel nor empathize with anybody else’s needs if I am not even aware of them. We are never really made aware of that stuff.” [Healthcare provider] “More communication between staff and patients would be very useful as most people will be more patient and understanding.” [Patient]
Even in the case of personal conflicts and tensions arising between nurses and physicians, formal meetings of managers were considered as a predominate strategy to resolve the respective issues rather than directly involving staff. While the lack of intergroup (i.e., nurses and physicians) communication was evaluated as a barrier, participants positively evaluated intragroup communication, citing regular weekly formal meetings and informal daily meetings when necessary. Furthermore, nurses at one of the sites participated in a Facebook group to share their concerns.
“There is a Facebook group… it was outlined that they are short a nurse, and they are looking for an extra nurse to come in. So, they posted that on the Facebook group in hopes that somebody will see it and come to their rescue.” [Healthcare provider]
In general, a collaborative, supportive, receptive and cooperative environment were considered as a facilitator to implementation. The staff valued a culture of support, transparency, and availability. Also, it was assessed that working in a small ED, where the clinicians are familiar with one another more intimately and for a prolonged duration of time, positively fostered teamwork and supportive communication.
“One main ED unit and there seemed to be good communication and in the smaller sites its quite easy to communicate” [Observer]
Another barrier under this construct was identified as the lack of communication and dialogue between staff in two different units within the EDs. As these units operated independently, the minimal contact and communication between them became routine. Communication between the two units was restricted to the end of the shift and pertained primarily to handing-over patients. When problems arose, the most common means of communication to resolve or discuss the issue was conducted via email.
“We’re taking care of the patients in unit one or unit two, and someone else is taking care of the patients in the other unit. So, I don't really talk to the other person. So, the only time when we communicate is around handover. So that's often sort of one we're saying, “Well, I am leaving, so you take over this patient.” [Healthcare provider] “When we asked staff if they felt the areas of the departments communicated well together they said yes but while we watched it certainly seemed like all the areas functioned independently of each other. NO situational awareness.” [Observer]
A common concern among participants pertained to the lack of engagement and involvement of other departments in the hospital in the implementation process of the intervention. The participants seemed to believe that the implementation could not be successful if other departments and stakeholders in the hospital have no intention to participate. Given the interconnectedness of a hospital’s departments, an intervention aimed to improve ED patient flow must also comprise meaningful engagement from external departments and must be prioritized at all levels of the organization rather than having the ED treated as an individual entity.
“We've done a lot of improvements. For instance, our stroke process or STEMI process, those are things that we've implemented within our department to help streamline that category of patient, that were more focused on just the ED which were more successful. We haven't been able to be successful because of the barriers that lie outside of our department which are a little bit more systems or like, organizational wide. It becomes harder because maybe there's been an unwillingness to participate or not seeing the value because a lot of people don't see what it is like in our department all the time. So, they think that it's just value for us as opposed to value for them as well.” [Healthcare provider]
Another potential barrier to implementation was the anticipated lack of physician participation in the implementation process. Nurses constantly emphasized the crucial role of physicians in the uptake of the intervention and furthermore desired assurance that the physicians will be well-informed about the implementation and will not be disengaged during the process.
“I think physicians are older, more experienced positions or maybe just set in their ways and are less open to change. Some of the physician group will be more resistant.” [Healthcare provider]
Despite the busy clinical environments, the success in the development and undertaking of the implementation hinged on constant and regular communication, including routine informal and formal meetings, that took place between the research team and clinicians. Although in-person meetings were preferable, due to COVID-19 pandemic related restrictions, videoconferencing was replaced to facilitate communication. Scheduling and arranging a meeting with clinicians because of the heavy workload, busy clinical schedule and demands was deemed as extremely challenging and proposed a critical barrier to implementation. Additionally, some of the research members do not have a direct line of communication with clinicians if not through internal facilitators or champions– i.e., nurse practitioners. Although a champion or facilitator demonstrated knowledge about the workload of clinicians which facilitated the scheduling of meetings, the lack of direct communication and in-person meetings seemed to be a critical barrier to implementation as the level of social engagement and connectedness between research staff and medical staff was adversely impacted.
The previous experiences of staff members in implementing other interventions were evaluated as mostly positive by clinicians and researchers who conducted structured observations. However, some barriers were reported as well. The prior positive experiences of interventions were reported by the study participants, such as with X32 Healthcare’s Online Staffing Optimization project. In general, participants reported that the X32 project resulted in improved workflow efficiency, simplified and organized patient assessments, prioritized triage, and reduced wait times. These positive experiences with past interventions seemed to positively shape the participants perceptions of the SurgeCon implementation.
“The X32 program was overall an effective program in my opinion. We did implement a lot of changes, overall infrastructure changes- the way that we introduce patients into our department and get them through the department to finally get them discharged. After the X32 program, we've seen dramatic improvements and changes versus the way that we were doing it.” [Healthcare provider]
However, there were also negative perceptions of past intervenstions, for example, a lack of communication between researchers and staff, and the lack of follow-up evaluations to meet the contextually specific needs of the EDs.
“Initially, there was a fair bit of communication between staff, the researchers and the end users but after it was implemented, I don't think there was any follow-up or any review of the X32.” [Healthcare provider]
The perception of inadequacies or unsuccessful outcomes from prior intervention efforts appeared to influence the study participants' perceptions of the implementation of SurgeCon and was seen to be a potential barrier to future implementations. This historical context of past initiatives not meeting their intended goals created scepticism and resistance towards embracing the new SurgeCon program.
“SurgeCon is new to us, but we've tried lots of different things over the years, and they've all failed. We've all put work into it… we'll try something, and we'll get all motivated to do it- we'll try it for six months, and everything that we've done falls apart inevitably.” [Healthcare provider] “Many previous wait time related interventions over the past number of years and front line staff report mostly failures with staff reverting to old ways.” [Observer]
Tension for change is considerd as an important concept for leaders seeking to improve performance in their organizations. It is a mechanism that created the energy and motivation needed to mobilize human beings into action. Although dissatisfaction with the current approach was the most common perspective as described from patients and providers in four EDs; this was considered concurrently as a strong motivation and potential barrier for clinicians to actively engage in the implementation process. Dissatisfaction with long wait-times and poor workflow was perceived as a major aspect of motivation; the most endorsed facilitator was found to be the perception of necessity of the intervention to rectify deficiencies in wait-time and workflow efficiency. Clinicians valued the change and deemed it as urgently necessary and beneficial. They valued the intervention and possessed an intrinsic inclination towards change as they had long-lasting concerns about the wait-time and workflow; they anticipated that SurgeCon might help to resolve the issues faced in EDs. Thus, clinicians in these EDs collectively valued the intervention and demonstrated an appreciation for the actions taken, which was seen to be one of the more crucial facilitators and implementation drivers.
“I had to wait for 7 and a half hours which felt ridiculously long, even though there were not a lot of other people waiting.” [Patient] “We have been waiting for 2 days because there were no in-patient beds available.” [Patient] “The most important motivation is improving the quality of management for the patients and then, that will be reflected to the wellbeing of the patient as well as the smooth flow of the patient within the department. So, if there is any new idea that can facilitate this- they usually are very eager to adapt and undertake it.” [Healthcare provider]
The participants frequently felt that the staff struggled to deal with the confusion arising from technological limitations in communicating information about wait times and the availability of medical resources. Several complaints were made regarding complications in scheduling appointments, inconsistent wait times, and misallocation of scarce resources which diminished the overall efficiency of the ED. These issue was considered motivating factors for the implementation of SurgeCon.
“The sites lacked a digital patient tracking system that resulted in communication lapses between units.” [Observer] “[Our province] is far behind in technology compared to other provinces.” [Patient]
Participants expressed some dissatisfaction with the planned implementation as a result of not having enough time to participate, staff shortages, and heavy workloads. Two of the selected EDs were found to be particularly affected by this issue, which posed a significant obstacle even before the implementation which involved conducting pre-implementation in-depth interviews. The implementation of the quality improvement program would go ahead as planned, albeit with poor engagement and support from ED staff. Consequently, this lack of involvement might hinder the intervention from reaching their full potential.
“I think that's going to be the biggest challenge is just getting them on board. Just the word “change” or “implementation” right now is a bit challenging.” [Healthcare provider] “I mean morale in the past few years… it’s not in a good place and I think it's because of the increased business, and staff feel like they're burning out, so it's not that they don't do a good job. We need more resources.” [Healthcare provider]
Two of the EDs chosen for this study had rejected previous intervention attempts, (e.g., X32 Healthcare’s Online Staffing Optimalization), which implies that the organizational climate might not be change-oriented. This phenomenon, other than dissatisfaction, was rooted in being resistant to changes (including technological changes) while conforming to the existing status-quo and being reluctant to adopt the consulted changes suggested from outside of the organization. To the participants, interventions meant novel systems, processes and skills which inherently implied altering the quondam workplace routine to adopt a newer system. While ED staff constantly struggled with the internal forces for change (e.g., heavy workload, staffing issues, and long wait time), they were not receptive to the external research team’s attempts at initiating change through the implementation of the intervention. This extended to not only external stimuli for change, but also propositions for change initiated by insiders which were not mobilized in either of the urban sites.
Repeated resistance to technological changes expressed by staff in general. [Observer] “It was unknown- you hear this company from outside is going to come in and fix your emergency department. A lot of people felt like, ‘Well, why do we need an outside company? Why don’t they just speak to the staff that actually works there to see how they could fix it?’ We knew what needed to be fixed but I kind of felt amused as to why did an external entity do it when they didn't ask the people that worked in a department first.” [Healthcare provider] “I feel like change is a big thing for people personally and professionally. So, it is just going to take a while for people to get used to it and, it's something new that’s breaking our old routine of how we did things. I feel those will be some barriers. Technology is going to be a challenge and like I said, it’s a big change.” [Healthcare provider]
During the pandemic, it became evident that engaging ED staff in implementation activities across all four EDs will create a challenging environment. Frontline staff had to manage exhaustion, frustration, burnout, isolation, and a higher volume of sick patients, making change initiation difficult. Clinicians often lacked the energy to participate in pre-implementation interviews, despite compensation and other offered incentives. In describing their experiences, one participant states:
“We're just basically keeping our heads above water at this point.” [Healthcare provider]
Low motivation to participate was caused due to feeling burdened by a heavy workload, COVID-19 regulations and subsequent procedure alterations. Thus, these dismayed clinicians struggled with the pandemic and thereby, served as another major barrier to the intervention.
“With this pandemic, there's constant policy changes, procedure changes, and they're frustrated with it. So, if you want to bring in something else, even though it's going to help them a lot of times- they're resistant because it's just something else on their ‘To Do List’ and they don't want to be bothered with having to learn something else.” [Healthcare provider].
Given the high rate of failure in translating evidence into practice in health care services and the challenges of implementing eHealth interventions [ 33 , 34 ], it is necessary to assess barriers and facilitators prior to implementation to attain a successful implementation. This study found five facilitator-barrier pairs that were perceived to influence the successful implementation of SurgeCon in the four EDs in our study.
Management and leadership structures were the first facilitator-barrier pair. Such structures play a critical role in the integration and maintenance of innovative implementations in hospital settings[ 35 ]. The findings of Bonawitz et al. (2020) suggest that ineffective management and leadership serve as barriers to change in healthcare institutions [ 36 ]. Management systems that effectively encourage the involvement of health care providers in making ED-related decisions and support proactive managers are perceived to be crucial facilitators, as evidenced by the findings of this study, while disengaged managers and lack of staff autonomy are perceived as critical barriers. The findings observed in this study parallel those observed by Manca et al. (2018) [ 37 ], who found that participative leadership, which seeps into control-oriented management, poses a significant barrier to the dynamics presented by the organizational culture toward change. Furthermore, the lack of top-management sponsorship and presence-based culture presented a recurring barrier to the adoption of innovation in healthcare institutions. Our data suggest that early engagement of managers in implementation procedures and applying a participative leadership style that promotes active engagement of staff may facilitate successful implementation. This is supported by Bonawitz et al. (2020) who found a participative leadership style to be a critical component in successfully implementing change in a healthcare setting [ 36 ].
Available resources is the second facilitator-barrier pair. According to de Wit et al. (2018), implementing system-wide changes requires substantial prerequisite committed hospital resources [ 38 ]. However, tailoring a strategy may permit circumventing change management projects that require committing substantial additional resources [ 39 ]. Furthermore, Barnett et al. (2011) express that the influence of human-based resources is integral in the process of developing, establishing, and diffusing innovations in healthcare institutions [ 40 ]. However, the Canadian Institute for Health Information (2021) points out the stark shortages and increasing staff turnover rates in medical staff within the Canadian healthcare system [ 24 ]. With a perpetually changing and constrained workforce, any pursuit to adopt an implementation will intrinsically face initial challenges. Additionally, de Wit et al. (2018) provide a comprehensive overview of the critical resources prior to initiating change: depending on the idiosyncratic details of implementation, educational resources need to be made available (with minimal barriers to accessing them), along with committed hospital resources in the form of financial, staffing, and other resources [ 38 ]. Furthermore, a lack of medical resources negatively impacts patient admissions, patient transfer delays, cancellation of surgeries, or early discharges [ 41 ]. Inadequate financial, technological, human, and medical resources were consistently identified as anticipated barriers across all four ED sites. Although implementing SurgeCon does not require substantial additional resources and the ED sites are provided with the technological equipment and educational requirements prior to the intervention, the shortage of medical staff and lack of medical resources remain potentially significant barriers, as found by this study.
The third facilitator-barrier pair is communications and networks across the organization. Considering the insights gained from previous studies on leadership structures in healthcare institutions, communication is a critical symptom of a participative leadership structure [ 35 , 36 , 42 , 43 ]. It is repeatedly established that teamwork, trust and other parameters of the respective organizational climate are founded by the principles of the underlying leadership structure. According to our study however, even in the participative leadership structure which embraces engagement and involvement of staff, ED environments suffer a lack of communication between nurses and physicians and between different ED units. While the minimal formal and informal discussions that occur between physicians and nurses may meet the basic requirements for professional standards, they are not fully cognisant of each other’s concerns and challenges. To fully engage and participate in the implementation of an intervention, collaboration between all ED staff is required. Lack of communication, dialogue, and teamwork among staff is recognized as an anticipated barrier to successful implementation. Conversely, constant communication and dialogue between the research staff and healthcare provider is considered as a practice that would facilitate the intervention’s implementation. However, in our case, due to COVID-19 restrictions, almost all communications were transferred from in-person to a virtual medium. Being overwhelmed by COVID-19 regulatory demands, staff shortages and burdensome workloads, clinicians were not left with enough energy and time to participate in pre-implementation on-line interviews.
The fourth facilitator-barrier pair, previous intervention experiences, were also anticipated to impact the SurgeCon implementation. Hamilton et al. (2010) found that prior experience with change efforts contributed to readiness for change in healthcare institutions [ 44 ]. As such, it is expressed that previous experience with interventions contributes to calibrating an appropriate organizational climate that is conducive to change. Previous experience greatly assists in establishing the appropriate steps and instilling confidence to create a ripe organizational climate for the implementation [ 45 ]. Zapka et al. (2013) express the need for reviews of past experiences of change as a necessary element to sustain the implementation [ 46 ]. The findings of this study with regard to previous experience of interventions and its potential to make a positive or negative impact on future interventions parallel those observed by previous scholars. Our data reveals that the negative perceptions of past intervenstions (e.g., lack of follow-up evaluations), was considered a notable obstacle to the implementation of SurgeCon.
The fifth facilitator-barrier pair was the need for change. Grol (2013) illustrates the importance of the perception of necessity in successfully adopting an intervention, particularly in a healthcare environment. Institutions with a positive perception of the necessity of an intervention are more likely to adopt and sustain an implementation [ 47 ]. Tension for change in implementation science is defined as the proclivity for shareholders to perceive the current situation as requiring a change or intolerable [ 48 , 49 , 50 ]. Our findings illustrated that dissatisfaction with the current system, with long wait times and poor workflow in EDs, was perceived as a necessity for urgent change and intervention. However, the perception of the necessity of the intervention does not necessarily imply valuing or practicing the change requirements. Our study supports findings of the inverse relationship between staff burnout and motivation to support an intervention [ 51 , 52 ]. When considering the drastic national rise in burnout experienced by healthcare workers in Canada [ 53 ], the current healthcare environment is not conducive to change. Lack of time, staff shortages, and heavy workload coupled with COVID-19 fatigue and burnout did not leave clinicians with sufficient energy to even participate in pre-implementation interviews, let alone in interest in being actively involved in the intervention. Additionally, this study found that using new technology and altering the workplace routines were perceived as barriers to change among clinicians. Regardless of the high level of dissatisfaction and staff workload, clinicians were still resistant to the interventions proposed by external sources.
Identifying and evaluating barriers and facilitators alone is only the first step in enhancing the probability of successful implementations of eHealth interventions such as SurgeCon. It is also important to formulate a set of strategies for hospitals to overcome the identified barriers and enhance the facilitators (Fig. 1 ). The recommended strategies—staff training, frontline champions, performance data review, communicating the value of the intervention, encouraging active engagement of ED staff, assigning an individual to regularly record data, and requiring capacity analysis—aim to address and overcome barriers while capitalizing on facilitators. These multi-faceted strategies were identified through discussions with decision makers, clinicians, patients, and research team members as well as lessons learned from SurgeCon’s implementation at the pilot site.
To elaborate on the specific components: It is crucial that a majority of ED staff attend a training on paitient flow and have ED leadership participate in software configuration to adjust and tailor SurgeCon’s the digital eHealth platform to their ED. Attending training sessions facilitates the adoption of quality improvement initiatives and patient flow strategies included within the SurgeCon platform and encourages ED staff to become actively engaged with the implementation process. This process is essential to foster an active participation and discussion between all tiers of staff which may not routinely transpire. The training course needs to actively engage frontline staff and must include the following modules: Interactive Simulation, SurgeCon eHealth Platform, and Patient Centeredness modules. The aim of the Interactive Simulation module is to provide insights into the rationale of connecting the software to process improvement and elucidate its procedure in a practical setting using ED-based scenarios. Since the module will be interactive, it allows for greater clarity to ensure that learning outcomes are achieved. The SurgeCon eHealth Platform module will assist ED staff in becoming familiar with the digital whiteboard application. This includes learning how the system collects and reports information, how to interpret and respond to system notices and warnings, and how to customize the dashboard to create a site-specific, adaptive version of SurgeCon that addresses the unique needs of their ED. The Patient Centeredness module comprises an educational session which reinforces the core importance of values pertaining to patient care across the following topics: providing quality ED care to all patients regardless of urgency; treating patients with respect; and considering the patient’s visit to an ED as always of vital necessity.
Having a dedicated frontline champion who is selected by ED management and trained by the implementation team can help ensure effective communication and facilitate the implementation process. These individuals can act as a liaison between ED staff and the research team, providing ongoing support and addressing any questions or concerns that may arise. In addition, they can provide valuable feedback to the research team regarding technical issues or challenges encountered during implementation which can help inform adjustments and improvements to the intervention. Ultimately, having frontline champions who are invested in the success of the intervention can contribute to a more seamless and effective implementation process.
Continuous performance reporting plays a crucial role in enhancing the operational efficiency and effectiveness of EDs and contributes to the development of improved operational strategies by providing meaningful data. In this study, the research protocol involves prominently displaying department-level data in the ED, such as at nursing stations, and providing individual-level performance reports to physicians at the participating sites. However, in the post-COVID era, EDs have been experiencing staffing shortages, which have necessitated changes in the reporting protocols of this study, particularly regarding key performance indicator (KPI) data. The KPIs examined in this study include the time to physician initial assessment (PIA), the length of stay in the ED (LOS), and the rate of patients leaving the ED without being seen by a physician (LWBS). These KPIs are widely recognized as the gold standard for evaluating ED performance. However, these indicators assume consistent operating conditions, and the reliability of using them as the primary method for assessing department efficiency diminishes in the presence of staff shortages. Providing individual physicians with performance reports may serve as a reminder of the operational challenges they have faced rather than providing a fair assessment of their ability to efficiently manage patient flow in their department. As a result, the research team decided to recommend aggregated department-level performance reports. Ultimately, the primary goal is to increase physician motivation to utilize SurgeCon by demonstrating its capacity to reduce door-to-doctor time, which is a critical metric for assessing standards of emergency care and efficiency.
It is important to the research team to communicate the importance and value of SurgeCon by presenting a successful implementation in the pilot site to raise awareness about the prospective results and enhance motivation for the adoption of the intervention. Additionally, implementing interventions is a “collective action” which necessitates a commitment to the process by all members. As Weiner (2009, p. 2) [ 54 ] states “implementing complex organizational changes involves collective action by many people, each of whom contributes something to the implementation effort […] problems arise when some feel committed to implementation, but others do not.” To stimulate engagement, compensation (i.e., full payment for attendance including travel and meals) offers for participating in training sessions and interviews; refreshments, in the form of snacks and beverages, were also provided at every training session. Furthermore, assigning an individual whose primary role is to manually enter data that cannot be automated into SurgeCon’s eHealth system, and using demand and capacity analysis to determine staffing models that will benefit the department are among the suggested strategies to overcome several of the encountered barriers to implementation.
Successfully implementing eHealth systems goes beyond addressing technological aspects alone. It requires a thorough exploration of potential barriers and facilitators and the development of strategies to overcome barriers and enhance the facilitators. SurgeCon aims to enhance quality standards, improve efficiency, and increase satisfaction among both patients and providers in EDs. However, implementing such a quality improvement initiative in EDs presents challenges. Therefore, identifying these barriers and facilitators is crucial for developing tailored implementation strategies that are contextually relevant. This approach helps to ensure a smooth and sustainable transition, leading to long-term success and optimal performance. This study extends the findings in relevant literature by indentifying these facilitator-barrier pairs and providing a set of strategies to overcome the barriers and enhance the facilitators in the implementation of a large-scale quality improvement program. In investigating the factors associated with the successful adoption of SurgeCon, a broader consideration of the barriers and facilitators can be derived. Understanding these factors can assist in identifying obstacles and motivators that enable the sustainability and effectiveness of interventions at other EDs; this is critical given the high failure rate of ED quality improvement programs.
Effective management and leadership structures and participative leadership styles that encourage staff involvement and proactive management may facilitate ED implementations. Emphasis on the allocation of sufficient hospital resources (i.e., technological, human, and medical) and effective communication and collaboration are essential for fostering a supportive and cohesive work environment, thus facilitating such interventions. Those with positive perceptions of the need for the intervention are more likely to adopt and sustain implementation efforts, and previous experiences with interventions and the perception of the need for an intervention emerged as influential factors in the readiness for change.
This study strategically incorporates triangulation. By doing so, it addresses inherent blind spots and biases in each method, enhances the validation of data, and offers diverse perspectives on the topic. This triangulation not only validates findings but also contributes to a more comprehensive and calibrated understanding of the phenomena under investigation. Furthermore, this study involves a multi-disciplinary planning and implementation team to comprehensively study the various facilitators and barriers prior to implementation.
This study, like any rigorous research endeavor, is not exempt from limitations, and it is essential to openly acknowledge these factors to provide a transparent understanding of the study's scope. While our study gains insights from four diverse EDs, it is crucial to note a limitation in its context-specific nature. Our primary focus revolves around understanding barriers and facilitators before implementing the SurgeCon quality improvement program in Canadian EDs. Findings may lack broad generalizability. However, our emphasis on transferability urges researchers to assess the applicability of insights in similar settings, fostering a nuanced understanding. In this study, the data collector observed potential social desirability tendencies among participants. To address this, we made efforts to assure participants of anonymity and confidentiality, provided clear communication about the study's purpose and data use, and incorporated strategies like follow-up questions. Additionally, we encouraged participants to share examples to illustrate their responses, aiming to mitigate potential response bias [ 55 ]. Finally, the study, conducted within a specific timeframe, must consider the dynamic healthcare landscape. The advent of COVID-19 brought rapid changes to healthcare policies, ED protocols, and overall healthcare delivery. Acknowledging this evolving context during and after data collection is crucial for interpreting the study's findings in the broader context of a changing healthcare system.
The findings of this study will guide future initiatives for the implementation of quality improvement programs within the complex environment of EDs by identifying facilitators and barriers prior to implementation to ensure they are continually considered during the design phase of an intervention. We propose that it is important to examine these factors before implementing such systems so that the implementation can be designed and managed to address the multivariate impact they may impose.
The datasets generated and/or analysed during the current study are not publicly available to protect the confidentiality of participants’ data but are available from the corresponding author upon reasonable request.
Consolidated Framework for Implementation Research
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Organization Readiness for Knowledge Translation
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Physician initial assessment
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Leaving the ED without being seen
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Funding agencies providing financial support for the SurgeCon study include:
-Canadian Institutes of Health Research.
-Newfoundland and Labrador Provincial Government (Department of Industry, Energy and Technology).
-Eastern Health (NL Eastern Regional Health Authority).
-Trinity Conception Placentia Health Foundation.
Among the funding agencies providing financial support, only Eastern Health is assisting with the collection of data. The design of the study, analysis, interpretation of data and manuscript preparation is/will be completed independently by the research team.
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Nahid Rahimipour Anaraki, Meghraj Mukhopadhyay, Oliver Hurley & Shabnam Asghari
Faculty of Business Administration, Memorial University of Newfoundland, St. John’s, NL, A1B 3V6, Canada
Jennifer Jewer
Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, A1B 3V6, Canada
Christopher Patey
Eastern Health, Carbonear Institute for Rural Reach and Innovation By the Sea, Carbonear General Hospital, Carbonear, NL, A1Y 1A4, Canada
Paul Norman
Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, A1B 3V6, Canada
Holly Etchegary
Discipline of Family Medicine, Faculty of Medicine, Faculty of Medicine Building, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John’s, Newfoundland, A1B 3V6, Canada
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NRA, MM, JJ, CP, PN, OH, HE, and SA have made substantial contributions to writing the main manuscript text and revising it. All authors reviewed the manuscript.
Correspondence to Shabnam Asghari .
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Ethical approval for the SurgeCon study was granted on March 19, 2020 by the Newfoundland and Labrador Health Research Ethics Board. Ethics approval will be renewed annually until the end of the study. All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all the participants. HREB Reference #: 2019.264.
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35% of startups fail because there is no market need. This is because they haven’t conducted any customer research to determine whether the product they are building is actually what customers want.
To gather the information needed to avoid this, quantitative data is a valuable tool for all startups. This article will examine quantitative data, the difference between quantitative and qualitative data, and how to collect the former.
Quantitative data is information that can be measured and expressed numerically. It is essential for making data-driven decisions, as it provides a concrete foundation for analysis and evaluation.
In various fields, such as market research , quantitative data helps businesses understand consumer behavior, market trends, and overall performance. Companies can gain insights that drive strategic decisions and improve their products or services by collecting and analyzing numerical data.
Whether conducting a survey, running experiments , or gathering information from other sources, quantitative data analysis is key to uncovering patterns, testing hypotheses, and making informed decisions based on solid evidence.
Quantitative data comes in many forms and is used across various industries to provide measurable and numerical insights. Here are some examples of quantitative data:
Quantitative data and qualitative data are two fundamental types of information used in research and analysis, each serving distinct purposes and represented in different forms.
Quantitative data is numeric and measurable. It allows you to quantify variables and identify patterns or trends that can be generalized. For example, tracking product trends or analyzing charts to understand market movements. Some quantitative data examples include:
On the other hand, qualitative data is descriptive and subjective, often represented in words and visuals. It aims to explore deeper insights, understand data , and provide context to behaviors and experiences.
Examples of qualitative data include:
Understanding the different types of quantitative data is essential for effective data analysis . These types help categorize and analyze data accurately to derive meaningful insights and make informed decisions.
Nominal data categorizes information without a specific order or ranking. It is used to label variables that do not have a quantitative value.
For instance, in a SaaS platform , user roles can be categorized as ‘admin,’ ‘editor,’ or ‘viewer.’ Subscription types might be classified as ‘free,’ ‘basic,’ ‘premium,’ or ‘enterprise.’
This data type is typically represented using bar charts or pie charts to show the frequency or proportion of each category.
Ordinal data categorizes information with a specific order or ranking. It is used to label variables that follow a particular sequence.
Examples include:
This type of data is typically represented using bar charts or stacked bar charts to illustrate the order and frequency of each category.
Discrete data is numerical values that can only take on specific values and cannot be subdivided meaningfully.
Examples include the number of new sign-ups daily, the count of support tickets received, and the number of active users at a given time.
This type of numerical data is often represented using bar charts or column charts to display the frequency of each value.
Continuous data is numerical information that can take on any numerical value within a range.
In a SaaS context, examples include measuring the amount of time users spend on a platform, the bandwidth usage of an application, and the revenue generated over a specific period. Continuous data, along with interval data, helps identify patterns and trends over time.
Analyzing quantitative data offers several advantages, making it a valuable approach in various fields, especially in SaaS. Here are some key benefits:
Quantitative data is numeric and objective, allowing for precise measurement and verification. This reduces the influence of personal biases and subjectivity in analysis, leading to more reliable and consistent results.
Analyzing customer data using quantitative methods can provide clear insights into user behavior and preferences, helping businesses make data-driven decisions.
Quantitative data analysis can handle large datasets efficiently, enabling the identification of patterns and trends across extensive samples.
This capability makes it possible to draw broad, generalized conclusions that can be applied to larger populations. For example, a company might analyze usage data from thousands of users to understand overall engagement trends and identify areas for improvement .
Quantitative data allows straightforward comparisons across various groups, time periods, and variables. This facilitates the evaluation of changes over time, differences between demographics, and the impact of different factors on outcomes.
For instance, comparing customer satisfaction scores before and after a product update can help assess the effectiveness of the changes and guide future improvements.
While quantitative data analysis offers many benefits, it also has some drawbacks:
Quantitative data can miss the deeper context and nuances of human behavior, focusing solely on numbers without explaining the reasons behind actions. For example, tracking user behavior may show usage patterns but not the motivations or feelings behind them.
Accurate analysis and interpretation of quantitative data require specialized skills . Without proper expertise, there is a risk of misinterpretation and incorrect conclusions, which can negatively impact decision-making.
The reliability of quantitative analysis depends on the data collection methods and the quality of measurement tools. Poor data collection can lead to data discrepancies , affecting the validity of the results. Ensuring consistent, high-quality data collection is essential for accurate analysis.
Collecting data for quantitative research involves using systematic and structured methods to gather numerical information. Let’s look at a few methods in detail.
Customer feedback surveys are a key method for collecting quantitative data. Tools like Userpilot can trigger in-app surveys with closed-ended questions to ensure consistent data collection.
Conducting these surveys quarterly or after a specific period helps track changes in customer satisfaction and other important metrics. This approach provides reliable, numerical insights into customer opinions and experiences.
Product analytics tools are essential for tracking user interactions and feature usage. Utilizing these tools allows you to monitor metrics such as user sessions, feature adoption , and user engagement regularly.
This quantitative data provides valuable insights into how users interact with your product, helping you understand their behavior and improve the overall user experience.
Tracking customer support data is crucial for quantitative research. You can record details such as ticket number, issue type, resolution time, and customer feedback by monitoring support tickets.
Organize these tickets into categories, such as feature requests , to identify common problems and areas needing product improvement . This approach helps understand customer needs and enhance overall service quality.
Implementing experiments, such as A/B tests , is a powerful method for collecting quantitative data. By comparing the performance of different features or designs, you can gain valuable insights into what works best for your users.
Use the insights gained from these A/B tests and other product experimentation methods to make informed decisions that enhance your product and user experience.
Searching for datasets on platforms like Kaggle or Statista can provide valuable information relevant to your research. However, to avoid issues with data discrepancy , ensure these datasets are accurate and reliable before incorporating them into your analysis.
Utilizing accurate open-source datasets can significantly enhance your product analysis by providing a broader context and more robust quantitative data for comparison and insights.
Analyzing quantitative data involves using various methods to extract meaningful and actionable insights. These techniques help understand the data’s patterns, trends, and relationships, enabling informed decision-making and strategic planning .
Statistical analysis involves using mathematical techniques to summarize, describe, and infer patterns from data. This method helps validate hypotheses and make data-driven decisions .
For SaaS companies, statistical analysis can be crucial in understanding user behavior , evaluating the effectiveness of new features, and identifying trends in user engagement.
By leveraging statistical techniques, SaaS businesses can derive meaningful insights from their data, allowing them to optimize their products and services based on empirical evidence.
Trend analysis involves tracking quantitative data points and metrics to identify consistent patterns. Using a tool like Userpilot, SaaS companies can generate detailed trend analysis reports that provide valuable insights into how various metrics evolve.
This method enables SaaS companies to forecast future outcomes, understand seasonal variations, and plan strategic initiatives accordingly. By identifying trends, businesses can anticipate changes, adapt their strategies, and stay ahead of market dynamics.
Funnel analysis defines key stages in the user journey and tracks the number of users progressing through each stage.
This method helps SaaS companies identify friction and drop-off points within the funnel. By understanding where users are dropping off, businesses can implement targeted improvements to enhance user experience and increase conversions.
Cohort analysis groups users into cohorts based on attributes such as the month of sign-up or acquisition channel and tracks their behavior over time.
This method allows SaaS companies to understand user retention and engagement patterns by comparing how cohorts perform over various periods. By analyzing these patterns, businesses can identify successful strategies and improvement areas.
Path analysis maps user journeys and analyzes the actions taken by users. This method helps SaaS companies identify the “ happy path ” or the optimal route users take to achieve their goals.
By understanding these paths , businesses can streamline the user experience, making it more intuitive and efficient.
Feedback analysis involves using questionnaires and examining responses to close-ended questions to identify patterns in customer feedback . This quantitative data helps you to understand common user sentiments, preferences, and areas needing improvement.
Businesses can make informed decisions to enhance their products and services by systematically analyzing feedback.
Collecting quantitative data is important if you want a product that will succeed. Your customers are the only people who can signal your success, so speaking to them and analyzing the quantitative data you collect will help you to produce the best product you can.
If you want help collecting quantitative data and analyzing it, Userpilot can help. Book a demo now to see exactly how it can help.
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What’s the difference between quantitative and qualitative methods.
Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.
Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.
Attrition refers to participants leaving a study. It always happens to some extent—for example, in randomized controlled trials for medical research.
Differential attrition occurs when attrition or dropout rates differ systematically between the intervention and the control group . As a result, the characteristics of the participants who drop out differ from the characteristics of those who stay in the study. Because of this, study results may be biased .
Action research is conducted in order to solve a particular issue immediately, while case studies are often conducted over a longer period of time and focus more on observing and analyzing a particular ongoing phenomenon.
Action research is focused on solving a problem or informing individual and community-based knowledge in a way that impacts teaching, learning, and other related processes. It is less focused on contributing theoretical input, instead producing actionable input.
Action research is particularly popular with educators as a form of systematic inquiry because it prioritizes reflection and bridges the gap between theory and practice. Educators are able to simultaneously investigate an issue as they solve it, and the method is very iterative and flexible.
A cycle of inquiry is another name for action research . It is usually visualized in a spiral shape following a series of steps, such as “planning → acting → observing → reflecting.”
To make quantitative observations , you need to use instruments that are capable of measuring the quantity you want to observe. For example, you might use a ruler to measure the length of an object or a thermometer to measure its temperature.
Criterion validity and construct validity are both types of measurement validity . In other words, they both show you how accurately a method measures something.
While construct validity is the degree to which a test or other measurement method measures what it claims to measure, criterion validity is the degree to which a test can predictively (in the future) or concurrently (in the present) measure something.
Construct validity is often considered the overarching type of measurement validity . You need to have face validity , content validity , and criterion validity in order to achieve construct validity.
Convergent validity and discriminant validity are both subtypes of construct validity . Together, they help you evaluate whether a test measures the concept it was designed to measure.
You need to assess both in order to demonstrate construct validity. Neither one alone is sufficient for establishing construct validity.
Content validity shows you how accurately a test or other measurement method taps into the various aspects of the specific construct you are researching.
In other words, it helps you answer the question: “does the test measure all aspects of the construct I want to measure?” If it does, then the test has high content validity.
The higher the content validity, the more accurate the measurement of the construct.
If the test fails to include parts of the construct, or irrelevant parts are included, the validity of the instrument is threatened, which brings your results into question.
Face validity and content validity are similar in that they both evaluate how suitable the content of a test is. The difference is that face validity is subjective, and assesses content at surface level.
When a test has strong face validity, anyone would agree that the test’s questions appear to measure what they are intended to measure.
For example, looking at a 4th grade math test consisting of problems in which students have to add and multiply, most people would agree that it has strong face validity (i.e., it looks like a math test).
On the other hand, content validity evaluates how well a test represents all the aspects of a topic. Assessing content validity is more systematic and relies on expert evaluation. of each question, analyzing whether each one covers the aspects that the test was designed to cover.
A 4th grade math test would have high content validity if it covered all the skills taught in that grade. Experts(in this case, math teachers), would have to evaluate the content validity by comparing the test to the learning objectives.
Snowball sampling is a non-probability sampling method . Unlike probability sampling (which involves some form of random selection ), the initial individuals selected to be studied are the ones who recruit new participants.
Because not every member of the target population has an equal chance of being recruited into the sample, selection in snowball sampling is non-random.
Snowball sampling is a non-probability sampling method , where there is not an equal chance for every member of the population to be included in the sample .
This means that you cannot use inferential statistics and make generalizations —often the goal of quantitative research . As such, a snowball sample is not representative of the target population and is usually a better fit for qualitative research .
Snowball sampling relies on the use of referrals. Here, the researcher recruits one or more initial participants, who then recruit the next ones.
Participants share similar characteristics and/or know each other. Because of this, not every member of the population has an equal chance of being included in the sample, giving rise to sampling bias .
Snowball sampling is best used in the following cases:
The reproducibility and replicability of a study can be ensured by writing a transparent, detailed method section and using clear, unambiguous language.
Reproducibility and replicability are related terms.
Stratified sampling and quota sampling both involve dividing the population into subgroups and selecting units from each subgroup. The purpose in both cases is to select a representative sample and/or to allow comparisons between subgroups.
The main difference is that in stratified sampling, you draw a random sample from each subgroup ( probability sampling ). In quota sampling you select a predetermined number or proportion of units, in a non-random manner ( non-probability sampling ).
Purposive and convenience sampling are both sampling methods that are typically used in qualitative data collection.
A convenience sample is drawn from a source that is conveniently accessible to the researcher. Convenience sampling does not distinguish characteristics among the participants. On the other hand, purposive sampling focuses on selecting participants possessing characteristics associated with the research study.
The findings of studies based on either convenience or purposive sampling can only be generalized to the (sub)population from which the sample is drawn, and not to the entire population.
Random sampling or probability sampling is based on random selection. This means that each unit has an equal chance (i.e., equal probability) of being included in the sample.
On the other hand, convenience sampling involves stopping people at random, which means that not everyone has an equal chance of being selected depending on the place, time, or day you are collecting your data.
Convenience sampling and quota sampling are both non-probability sampling methods. They both use non-random criteria like availability, geographical proximity, or expert knowledge to recruit study participants.
However, in convenience sampling, you continue to sample units or cases until you reach the required sample size.
In quota sampling, you first need to divide your population of interest into subgroups (strata) and estimate their proportions (quota) in the population. Then you can start your data collection, using convenience sampling to recruit participants, until the proportions in each subgroup coincide with the estimated proportions in the population.
A sampling frame is a list of every member in the entire population . It is important that the sampling frame is as complete as possible, so that your sample accurately reflects your population.
Stratified and cluster sampling may look similar, but bear in mind that groups created in cluster sampling are heterogeneous , so the individual characteristics in the cluster vary. In contrast, groups created in stratified sampling are homogeneous , as units share characteristics.
Relatedly, in cluster sampling you randomly select entire groups and include all units of each group in your sample. However, in stratified sampling, you select some units of all groups and include them in your sample. In this way, both methods can ensure that your sample is representative of the target population .
A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.
The key difference between observational studies and experimental designs is that a well-done observational study does not influence the responses of participants, while experiments do have some sort of treatment condition applied to at least some participants by random assignment .
An observational study is a great choice for you if your research question is based purely on observations. If there are ethical, logistical, or practical concerns that prevent you from conducting a traditional experiment , an observational study may be a good choice. In an observational study, there is no interference or manipulation of the research subjects, as well as no control or treatment groups .
It’s often best to ask a variety of people to review your measurements. You can ask experts, such as other researchers, or laypeople, such as potential participants, to judge the face validity of tests.
While experts have a deep understanding of research methods , the people you’re studying can provide you with valuable insights you may have missed otherwise.
Face validity is important because it’s a simple first step to measuring the overall validity of a test or technique. It’s a relatively intuitive, quick, and easy way to start checking whether a new measure seems useful at first glance.
Good face validity means that anyone who reviews your measure says that it seems to be measuring what it’s supposed to. With poor face validity, someone reviewing your measure may be left confused about what you’re measuring and why you’re using this method.
Face validity is about whether a test appears to measure what it’s supposed to measure. This type of validity is concerned with whether a measure seems relevant and appropriate for what it’s assessing only on the surface.
Statistical analyses are often applied to test validity with data from your measures. You test convergent validity and discriminant validity with correlations to see if results from your test are positively or negatively related to those of other established tests.
You can also use regression analyses to assess whether your measure is actually predictive of outcomes that you expect it to predict theoretically. A regression analysis that supports your expectations strengthens your claim of construct validity .
When designing or evaluating a measure, construct validity helps you ensure you’re actually measuring the construct you’re interested in. If you don’t have construct validity, you may inadvertently measure unrelated or distinct constructs and lose precision in your research.
Construct validity is often considered the overarching type of measurement validity , because it covers all of the other types. You need to have face validity , content validity , and criterion validity to achieve construct validity.
Construct validity is about how well a test measures the concept it was designed to evaluate. It’s one of four types of measurement validity , which includes construct validity, face validity , and criterion validity.
There are two subtypes of construct validity.
Naturalistic observation is a valuable tool because of its flexibility, external validity , and suitability for topics that can’t be studied in a lab setting.
The downsides of naturalistic observation include its lack of scientific control , ethical considerations , and potential for bias from observers and subjects.
Naturalistic observation is a qualitative research method where you record the behaviors of your research subjects in real world settings. You avoid interfering or influencing anything in a naturalistic observation.
You can think of naturalistic observation as “people watching” with a purpose.
A dependent variable is what changes as a result of the independent variable manipulation in experiments . It’s what you’re interested in measuring, and it “depends” on your independent variable.
In statistics, dependent variables are also called:
An independent variable is the variable you manipulate, control, or vary in an experimental study to explore its effects. It’s called “independent” because it’s not influenced by any other variables in the study.
Independent variables are also called:
As a rule of thumb, questions related to thoughts, beliefs, and feelings work well in focus groups. Take your time formulating strong questions, paying special attention to phrasing. Be careful to avoid leading questions , which can bias your responses.
Overall, your focus group questions should be:
A structured interview is a data collection method that relies on asking questions in a set order to collect data on a topic. They are often quantitative in nature. Structured interviews are best used when:
More flexible interview options include semi-structured interviews , unstructured interviews , and focus groups .
Social desirability bias is the tendency for interview participants to give responses that will be viewed favorably by the interviewer or other participants. It occurs in all types of interviews and surveys , but is most common in semi-structured interviews , unstructured interviews , and focus groups .
Social desirability bias can be mitigated by ensuring participants feel at ease and comfortable sharing their views. Make sure to pay attention to your own body language and any physical or verbal cues, such as nodding or widening your eyes.
This type of bias can also occur in observations if the participants know they’re being observed. They might alter their behavior accordingly.
The interviewer effect is a type of bias that emerges when a characteristic of an interviewer (race, age, gender identity, etc.) influences the responses given by the interviewee.
There is a risk of an interviewer effect in all types of interviews , but it can be mitigated by writing really high-quality interview questions.
A semi-structured interview is a blend of structured and unstructured types of interviews. Semi-structured interviews are best used when:
An unstructured interview is the most flexible type of interview, but it is not always the best fit for your research topic.
Unstructured interviews are best used when:
The four most common types of interviews are:
Deductive reasoning is commonly used in scientific research, and it’s especially associated with quantitative research .
In research, you might have come across something called the hypothetico-deductive method . It’s the scientific method of testing hypotheses to check whether your predictions are substantiated by real-world data.
Deductive reasoning is a logical approach where you progress from general ideas to specific conclusions. It’s often contrasted with inductive reasoning , where you start with specific observations and form general conclusions.
Deductive reasoning is also called deductive logic.
There are many different types of inductive reasoning that people use formally or informally.
Here are a few common types:
Inductive reasoning is a bottom-up approach, while deductive reasoning is top-down.
Inductive reasoning takes you from the specific to the general, while in deductive reasoning, you make inferences by going from general premises to specific conclusions.
In inductive research , you start by making observations or gathering data. Then, you take a broad scan of your data and search for patterns. Finally, you make general conclusions that you might incorporate into theories.
Inductive reasoning is a method of drawing conclusions by going from the specific to the general. It’s usually contrasted with deductive reasoning, where you proceed from general information to specific conclusions.
Inductive reasoning is also called inductive logic or bottom-up reasoning.
A hypothesis states your predictions about what your research will find. It is a tentative answer to your research question that has not yet been tested. For some research projects, you might have to write several hypotheses that address different aspects of your research question.
A hypothesis is not just a guess — it should be based on existing theories and knowledge. It also has to be testable, which means you can support or refute it through scientific research methods (such as experiments, observations and statistical analysis of data).
Triangulation can help:
But triangulation can also pose problems:
There are four main types of triangulation :
Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.
However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.
Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.
Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.
Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.
In general, the peer review process follows the following steps:
Exploratory research is often used when the issue you’re studying is new or when the data collection process is challenging for some reason.
You can use exploratory research if you have a general idea or a specific question that you want to study but there is no preexisting knowledge or paradigm with which to study it.
Exploratory research is a methodology approach that explores research questions that have not previously been studied in depth. It is often used when the issue you’re studying is new, or the data collection process is challenging in some way.
Explanatory research is used to investigate how or why a phenomenon occurs. Therefore, this type of research is often one of the first stages in the research process , serving as a jumping-off point for future research.
Exploratory research aims to explore the main aspects of an under-researched problem, while explanatory research aims to explain the causes and consequences of a well-defined problem.
Explanatory research is a research method used to investigate how or why something occurs when only a small amount of information is available pertaining to that topic. It can help you increase your understanding of a given topic.
Clean data are valid, accurate, complete, consistent, unique, and uniform. Dirty data include inconsistencies and errors.
Dirty data can come from any part of the research process, including poor research design , inappropriate measurement materials, or flawed data entry.
Data cleaning takes place between data collection and data analyses. But you can use some methods even before collecting data.
For clean data, you should start by designing measures that collect valid data. Data validation at the time of data entry or collection helps you minimize the amount of data cleaning you’ll need to do.
After data collection, you can use data standardization and data transformation to clean your data. You’ll also deal with any missing values, outliers, and duplicate values.
Every dataset requires different techniques to clean dirty data , but you need to address these issues in a systematic way. You focus on finding and resolving data points that don’t agree or fit with the rest of your dataset.
These data might be missing values, outliers, duplicate values, incorrectly formatted, or irrelevant. You’ll start with screening and diagnosing your data. Then, you’ll often standardize and accept or remove data to make your dataset consistent and valid.
Data cleaning is necessary for valid and appropriate analyses. Dirty data contain inconsistencies or errors , but cleaning your data helps you minimize or resolve these.
Without data cleaning, you could end up with a Type I or II error in your conclusion. These types of erroneous conclusions can be practically significant with important consequences, because they lead to misplaced investments or missed opportunities.
Data cleaning involves spotting and resolving potential data inconsistencies or errors to improve your data quality. An error is any value (e.g., recorded weight) that doesn’t reflect the true value (e.g., actual weight) of something that’s being measured.
In this process, you review, analyze, detect, modify, or remove “dirty” data to make your dataset “clean.” Data cleaning is also called data cleansing or data scrubbing.
Research misconduct means making up or falsifying data, manipulating data analyses, or misrepresenting results in research reports. It’s a form of academic fraud.
These actions are committed intentionally and can have serious consequences; research misconduct is not a simple mistake or a point of disagreement but a serious ethical failure.
Anonymity means you don’t know who the participants are, while confidentiality means you know who they are but remove identifying information from your research report. Both are important ethical considerations .
You can only guarantee anonymity by not collecting any personally identifying information—for example, names, phone numbers, email addresses, IP addresses, physical characteristics, photos, or videos.
You can keep data confidential by using aggregate information in your research report, so that you only refer to groups of participants rather than individuals.
Research ethics matter for scientific integrity, human rights and dignity, and collaboration between science and society. These principles make sure that participation in studies is voluntary, informed, and safe.
Ethical considerations in research are a set of principles that guide your research designs and practices. These principles include voluntary participation, informed consent, anonymity, confidentiality, potential for harm, and results communication.
Scientists and researchers must always adhere to a certain code of conduct when collecting data from others .
These considerations protect the rights of research participants, enhance research validity , and maintain scientific integrity.
In multistage sampling , you can use probability or non-probability sampling methods .
For a probability sample, you have to conduct probability sampling at every stage.
You can mix it up by using simple random sampling , systematic sampling , or stratified sampling to select units at different stages, depending on what is applicable and relevant to your study.
Multistage sampling can simplify data collection when you have large, geographically spread samples, and you can obtain a probability sample without a complete sampling frame.
But multistage sampling may not lead to a representative sample, and larger samples are needed for multistage samples to achieve the statistical properties of simple random samples .
These are four of the most common mixed methods designs :
Triangulation in research means using multiple datasets, methods, theories and/or investigators to address a research question. It’s a research strategy that can help you enhance the validity and credibility of your findings.
Triangulation is mainly used in qualitative research , but it’s also commonly applied in quantitative research . Mixed methods research always uses triangulation.
In multistage sampling , or multistage cluster sampling, you draw a sample from a population using smaller and smaller groups at each stage.
This method is often used to collect data from a large, geographically spread group of people in national surveys, for example. You take advantage of hierarchical groupings (e.g., from state to city to neighborhood) to create a sample that’s less expensive and time-consuming to collect data from.
No, the steepness or slope of the line isn’t related to the correlation coefficient value. The correlation coefficient only tells you how closely your data fit on a line, so two datasets with the same correlation coefficient can have very different slopes.
To find the slope of the line, you’ll need to perform a regression analysis .
Correlation coefficients always range between -1 and 1.
The sign of the coefficient tells you the direction of the relationship: a positive value means the variables change together in the same direction, while a negative value means they change together in opposite directions.
The absolute value of a number is equal to the number without its sign. The absolute value of a correlation coefficient tells you the magnitude of the correlation: the greater the absolute value, the stronger the correlation.
These are the assumptions your data must meet if you want to use Pearson’s r :
Quantitative research designs can be divided into two main categories:
Qualitative research designs tend to be more flexible. Common types of qualitative design include case study , ethnography , and grounded theory designs.
A well-planned research design helps ensure that your methods match your research aims, that you collect high-quality data, and that you use the right kind of analysis to answer your questions, utilizing credible sources . This allows you to draw valid , trustworthy conclusions.
The priorities of a research design can vary depending on the field, but you usually have to specify:
A research design is a strategy for answering your research question . It defines your overall approach and determines how you will collect and analyze data.
Questionnaires can be self-administered or researcher-administered.
Self-administered questionnaires can be delivered online or in paper-and-pen formats, in person or through mail. All questions are standardized so that all respondents receive the same questions with identical wording.
Researcher-administered questionnaires are interviews that take place by phone, in-person, or online between researchers and respondents. You can gain deeper insights by clarifying questions for respondents or asking follow-up questions.
You can organize the questions logically, with a clear progression from simple to complex, or randomly between respondents. A logical flow helps respondents process the questionnaire easier and quicker, but it may lead to bias. Randomization can minimize the bias from order effects.
Closed-ended, or restricted-choice, questions offer respondents a fixed set of choices to select from. These questions are easier to answer quickly.
Open-ended or long-form questions allow respondents to answer in their own words. Because there are no restrictions on their choices, respondents can answer in ways that researchers may not have otherwise considered.
A questionnaire is a data collection tool or instrument, while a survey is an overarching research method that involves collecting and analyzing data from people using questionnaires.
The third variable and directionality problems are two main reasons why correlation isn’t causation .
The third variable problem means that a confounding variable affects both variables to make them seem causally related when they are not.
The directionality problem is when two variables correlate and might actually have a causal relationship, but it’s impossible to conclude which variable causes changes in the other.
Correlation describes an association between variables : when one variable changes, so does the other. A correlation is a statistical indicator of the relationship between variables.
Causation means that changes in one variable brings about changes in the other (i.e., there is a cause-and-effect relationship between variables). The two variables are correlated with each other, and there’s also a causal link between them.
While causation and correlation can exist simultaneously, correlation does not imply causation. In other words, correlation is simply a relationship where A relates to B—but A doesn’t necessarily cause B to happen (or vice versa). Mistaking correlation for causation is a common error and can lead to false cause fallacy .
Controlled experiments establish causality, whereas correlational studies only show associations between variables.
In general, correlational research is high in external validity while experimental research is high in internal validity .
A correlation is usually tested for two variables at a time, but you can test correlations between three or more variables.
A correlation coefficient is a single number that describes the strength and direction of the relationship between your variables.
Different types of correlation coefficients might be appropriate for your data based on their levels of measurement and distributions . The Pearson product-moment correlation coefficient (Pearson’s r ) is commonly used to assess a linear relationship between two quantitative variables.
A correlational research design investigates relationships between two variables (or more) without the researcher controlling or manipulating any of them. It’s a non-experimental type of quantitative research .
A correlation reflects the strength and/or direction of the association between two or more variables.
Random error is almost always present in scientific studies, even in highly controlled settings. While you can’t eradicate it completely, you can reduce random error by taking repeated measurements, using a large sample, and controlling extraneous variables .
You can avoid systematic error through careful design of your sampling , data collection , and analysis procedures. For example, use triangulation to measure your variables using multiple methods; regularly calibrate instruments or procedures; use random sampling and random assignment ; and apply masking (blinding) where possible.
Systematic error is generally a bigger problem in research.
With random error, multiple measurements will tend to cluster around the true value. When you’re collecting data from a large sample , the errors in different directions will cancel each other out.
Systematic errors are much more problematic because they can skew your data away from the true value. This can lead you to false conclusions ( Type I and II errors ) about the relationship between the variables you’re studying.
Random and systematic error are two types of measurement error.
Random error is a chance difference between the observed and true values of something (e.g., a researcher misreading a weighing scale records an incorrect measurement).
Systematic error is a consistent or proportional difference between the observed and true values of something (e.g., a miscalibrated scale consistently records weights as higher than they actually are).
On graphs, the explanatory variable is conventionally placed on the x-axis, while the response variable is placed on the y-axis.
The term “ explanatory variable ” is sometimes preferred over “ independent variable ” because, in real world contexts, independent variables are often influenced by other variables. This means they aren’t totally independent.
Multiple independent variables may also be correlated with each other, so “explanatory variables” is a more appropriate term.
The difference between explanatory and response variables is simple:
In a controlled experiment , all extraneous variables are held constant so that they can’t influence the results. Controlled experiments require:
Depending on your study topic, there are various other methods of controlling variables .
There are 4 main types of extraneous variables :
An extraneous variable is any variable that you’re not investigating that can potentially affect the dependent variable of your research study.
A confounding variable is a type of extraneous variable that not only affects the dependent variable, but is also related to the independent variable.
In a factorial design, multiple independent variables are tested.
If you test two variables, each level of one independent variable is combined with each level of the other independent variable to create different conditions.
Within-subjects designs have many potential threats to internal validity , but they are also very statistically powerful .
Advantages:
Disadvantages:
While a between-subjects design has fewer threats to internal validity , it also requires more participants for high statistical power than a within-subjects design .
Yes. Between-subjects and within-subjects designs can be combined in a single study when you have two or more independent variables (a factorial design). In a mixed factorial design, one variable is altered between subjects and another is altered within subjects.
In a between-subjects design , every participant experiences only one condition, and researchers assess group differences between participants in various conditions.
In a within-subjects design , each participant experiences all conditions, and researchers test the same participants repeatedly for differences between conditions.
The word “between” means that you’re comparing different conditions between groups, while the word “within” means you’re comparing different conditions within the same group.
Random assignment is used in experiments with a between-groups or independent measures design. In this research design, there’s usually a control group and one or more experimental groups. Random assignment helps ensure that the groups are comparable.
In general, you should always use random assignment in this type of experimental design when it is ethically possible and makes sense for your study topic.
To implement random assignment , assign a unique number to every member of your study’s sample .
Then, you can use a random number generator or a lottery method to randomly assign each number to a control or experimental group. You can also do so manually, by flipping a coin or rolling a dice to randomly assign participants to groups.
Random selection, or random sampling , is a way of selecting members of a population for your study’s sample.
In contrast, random assignment is a way of sorting the sample into control and experimental groups.
Random sampling enhances the external validity or generalizability of your results, while random assignment improves the internal validity of your study.
In experimental research, random assignment is a way of placing participants from your sample into different groups using randomization. With this method, every member of the sample has a known or equal chance of being placed in a control group or an experimental group.
“Controlling for a variable” means measuring extraneous variables and accounting for them statistically to remove their effects on other variables.
Researchers often model control variable data along with independent and dependent variable data in regression analyses and ANCOVAs . That way, you can isolate the control variable’s effects from the relationship between the variables of interest.
Control variables help you establish a correlational or causal relationship between variables by enhancing internal validity .
If you don’t control relevant extraneous variables , they may influence the outcomes of your study, and you may not be able to demonstrate that your results are really an effect of your independent variable .
A control variable is any variable that’s held constant in a research study. It’s not a variable of interest in the study, but it’s controlled because it could influence the outcomes.
Including mediators and moderators in your research helps you go beyond studying a simple relationship between two variables for a fuller picture of the real world. They are important to consider when studying complex correlational or causal relationships.
Mediators are part of the causal pathway of an effect, and they tell you how or why an effect takes place. Moderators usually help you judge the external validity of your study by identifying the limitations of when the relationship between variables holds.
If something is a mediating variable :
A confounder is a third variable that affects variables of interest and makes them seem related when they are not. In contrast, a mediator is the mechanism of a relationship between two variables: it explains the process by which they are related.
A mediator variable explains the process through which two variables are related, while a moderator variable affects the strength and direction of that relationship.
There are three key steps in systematic sampling :
Systematic sampling is a probability sampling method where researchers select members of the population at a regular interval – for example, by selecting every 15th person on a list of the population. If the population is in a random order, this can imitate the benefits of simple random sampling .
Yes, you can create a stratified sample using multiple characteristics, but you must ensure that every participant in your study belongs to one and only one subgroup. In this case, you multiply the numbers of subgroups for each characteristic to get the total number of groups.
For example, if you were stratifying by location with three subgroups (urban, rural, or suburban) and marital status with five subgroups (single, divorced, widowed, married, or partnered), you would have 3 x 5 = 15 subgroups.
You should use stratified sampling when your sample can be divided into mutually exclusive and exhaustive subgroups that you believe will take on different mean values for the variable that you’re studying.
Using stratified sampling will allow you to obtain more precise (with lower variance ) statistical estimates of whatever you are trying to measure.
For example, say you want to investigate how income differs based on educational attainment, but you know that this relationship can vary based on race. Using stratified sampling, you can ensure you obtain a large enough sample from each racial group, allowing you to draw more precise conclusions.
In stratified sampling , researchers divide subjects into subgroups called strata based on characteristics that they share (e.g., race, gender, educational attainment).
Once divided, each subgroup is randomly sampled using another probability sampling method.
Cluster sampling is more time- and cost-efficient than other probability sampling methods , particularly when it comes to large samples spread across a wide geographical area.
However, it provides less statistical certainty than other methods, such as simple random sampling , because it is difficult to ensure that your clusters properly represent the population as a whole.
There are three types of cluster sampling : single-stage, double-stage and multi-stage clustering. In all three types, you first divide the population into clusters, then randomly select clusters for use in your sample.
Cluster sampling is a probability sampling method in which you divide a population into clusters, such as districts or schools, and then randomly select some of these clusters as your sample.
The clusters should ideally each be mini-representations of the population as a whole.
If properly implemented, simple random sampling is usually the best sampling method for ensuring both internal and external validity . However, it can sometimes be impractical and expensive to implement, depending on the size of the population to be studied,
If you have a list of every member of the population and the ability to reach whichever members are selected, you can use simple random sampling.
The American Community Survey is an example of simple random sampling . In order to collect detailed data on the population of the US, the Census Bureau officials randomly select 3.5 million households per year and use a variety of methods to convince them to fill out the survey.
Simple random sampling is a type of probability sampling in which the researcher randomly selects a subset of participants from a population . Each member of the population has an equal chance of being selected. Data is then collected from as large a percentage as possible of this random subset.
Quasi-experimental design is most useful in situations where it would be unethical or impractical to run a true experiment .
Quasi-experiments have lower internal validity than true experiments, but they often have higher external validity as they can use real-world interventions instead of artificial laboratory settings.
A quasi-experiment is a type of research design that attempts to establish a cause-and-effect relationship. The main difference with a true experiment is that the groups are not randomly assigned.
Blinding is important to reduce research bias (e.g., observer bias , demand characteristics ) and ensure a study’s internal validity .
If participants know whether they are in a control or treatment group , they may adjust their behavior in ways that affect the outcome that researchers are trying to measure. If the people administering the treatment are aware of group assignment, they may treat participants differently and thus directly or indirectly influence the final results.
Blinding means hiding who is assigned to the treatment group and who is assigned to the control group in an experiment .
A true experiment (a.k.a. a controlled experiment) always includes at least one control group that doesn’t receive the experimental treatment.
However, some experiments use a within-subjects design to test treatments without a control group. In these designs, you usually compare one group’s outcomes before and after a treatment (instead of comparing outcomes between different groups).
For strong internal validity , it’s usually best to include a control group if possible. Without a control group, it’s harder to be certain that the outcome was caused by the experimental treatment and not by other variables.
An experimental group, also known as a treatment group, receives the treatment whose effect researchers wish to study, whereas a control group does not. They should be identical in all other ways.
Individual Likert-type questions are generally considered ordinal data , because the items have clear rank order, but don’t have an even distribution.
Overall Likert scale scores are sometimes treated as interval data. These scores are considered to have directionality and even spacing between them.
The type of data determines what statistical tests you should use to analyze your data.
A Likert scale is a rating scale that quantitatively assesses opinions, attitudes, or behaviors. It is made up of 4 or more questions that measure a single attitude or trait when response scores are combined.
To use a Likert scale in a survey , you present participants with Likert-type questions or statements, and a continuum of items, usually with 5 or 7 possible responses, to capture their degree of agreement.
In scientific research, concepts are the abstract ideas or phenomena that are being studied (e.g., educational achievement). Variables are properties or characteristics of the concept (e.g., performance at school), while indicators are ways of measuring or quantifying variables (e.g., yearly grade reports).
The process of turning abstract concepts into measurable variables and indicators is called operationalization .
There are various approaches to qualitative data analysis , but they all share five steps in common:
The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .
There are five common approaches to qualitative research :
Hypothesis testing is a formal procedure for investigating our ideas about the world using statistics. It is used by scientists to test specific predictions, called hypotheses , by calculating how likely it is that a pattern or relationship between variables could have arisen by chance.
Operationalization means turning abstract conceptual ideas into measurable observations.
For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioral avoidance of crowded places, or physical anxiety symptoms in social situations.
Before collecting data , it’s important to consider how you will operationalize the variables that you want to measure.
When conducting research, collecting original data has significant advantages:
However, there are also some drawbacks: data collection can be time-consuming, labor-intensive and expensive. In some cases, it’s more efficient to use secondary data that has already been collected by someone else, but the data might be less reliable.
Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organizations.
There are several methods you can use to decrease the impact of confounding variables on your research: restriction, matching, statistical control and randomization.
In restriction , you restrict your sample by only including certain subjects that have the same values of potential confounding variables.
In matching , you match each of the subjects in your treatment group with a counterpart in the comparison group. The matched subjects have the same values on any potential confounding variables, and only differ in the independent variable .
In statistical control , you include potential confounders as variables in your regression .
In randomization , you randomly assign the treatment (or independent variable) in your study to a sufficiently large number of subjects, which allows you to control for all potential confounding variables.
A confounding variable is closely related to both the independent and dependent variables in a study. An independent variable represents the supposed cause , while the dependent variable is the supposed effect . A confounding variable is a third variable that influences both the independent and dependent variables.
Failing to account for confounding variables can cause you to wrongly estimate the relationship between your independent and dependent variables.
To ensure the internal validity of your research, you must consider the impact of confounding variables. If you fail to account for them, you might over- or underestimate the causal relationship between your independent and dependent variables , or even find a causal relationship where none exists.
Yes, but including more than one of either type requires multiple research questions .
For example, if you are interested in the effect of a diet on health, you can use multiple measures of health: blood sugar, blood pressure, weight, pulse, and many more. Each of these is its own dependent variable with its own research question.
You could also choose to look at the effect of exercise levels as well as diet, or even the additional effect of the two combined. Each of these is a separate independent variable .
To ensure the internal validity of an experiment , you should only change one independent variable at a time.
No. The value of a dependent variable depends on an independent variable, so a variable cannot be both independent and dependent at the same time. It must be either the cause or the effect, not both!
You want to find out how blood sugar levels are affected by drinking diet soda and regular soda, so you conduct an experiment .
Determining cause and effect is one of the most important parts of scientific research. It’s essential to know which is the cause – the independent variable – and which is the effect – the dependent variable.
In non-probability sampling , the sample is selected based on non-random criteria, and not every member of the population has a chance of being included.
Common non-probability sampling methods include convenience sampling , voluntary response sampling, purposive sampling , snowball sampling, and quota sampling .
Probability sampling means that every member of the target population has a known chance of being included in the sample.
Probability sampling methods include simple random sampling , systematic sampling , stratified sampling , and cluster sampling .
Using careful research design and sampling procedures can help you avoid sampling bias . Oversampling can be used to correct undercoverage bias .
Some common types of sampling bias include self-selection bias , nonresponse bias , undercoverage bias , survivorship bias , pre-screening or advertising bias, and healthy user bias.
Sampling bias is a threat to external validity – it limits the generalizability of your findings to a broader group of people.
A sampling error is the difference between a population parameter and a sample statistic .
A statistic refers to measures about the sample , while a parameter refers to measures about the population .
Populations are used when a research question requires data from every member of the population. This is usually only feasible when the population is small and easily accessible.
Samples are used to make inferences about populations . Samples are easier to collect data from because they are practical, cost-effective, convenient, and manageable.
There are seven threats to external validity : selection bias , history, experimenter effect, Hawthorne effect , testing effect, aptitude-treatment and situation effect.
The two types of external validity are population validity (whether you can generalize to other groups of people) and ecological validity (whether you can generalize to other situations and settings).
The external validity of a study is the extent to which you can generalize your findings to different groups of people, situations, and measures.
Cross-sectional studies cannot establish a cause-and-effect relationship or analyze behavior over a period of time. To investigate cause and effect, you need to do a longitudinal study or an experimental study .
Cross-sectional studies are less expensive and time-consuming than many other types of study. They can provide useful insights into a population’s characteristics and identify correlations for further research.
Sometimes only cross-sectional data is available for analysis; other times your research question may only require a cross-sectional study to answer it.
Longitudinal studies can last anywhere from weeks to decades, although they tend to be at least a year long.
The 1970 British Cohort Study , which has collected data on the lives of 17,000 Brits since their births in 1970, is one well-known example of a longitudinal study .
Longitudinal studies are better to establish the correct sequence of events, identify changes over time, and provide insight into cause-and-effect relationships, but they also tend to be more expensive and time-consuming than other types of studies.
Longitudinal studies and cross-sectional studies are two different types of research design . In a cross-sectional study you collect data from a population at a specific point in time; in a longitudinal study you repeatedly collect data from the same sample over an extended period of time.
Longitudinal study | Cross-sectional study |
---|---|
observations | Observations at a in time |
Observes the multiple times | Observes (a “cross-section”) in the population |
Follows in participants over time | Provides of society at a given point |
There are eight threats to internal validity : history, maturation, instrumentation, testing, selection bias , regression to the mean, social interaction and attrition .
Internal validity is the extent to which you can be confident that a cause-and-effect relationship established in a study cannot be explained by other factors.
In mixed methods research , you use both qualitative and quantitative data collection and analysis methods to answer your research question .
The research methods you use depend on the type of data you need to answer your research question .
A confounding variable , also called a confounder or confounding factor, is a third variable in a study examining a potential cause-and-effect relationship.
A confounding variable is related to both the supposed cause and the supposed effect of the study. It can be difficult to separate the true effect of the independent variable from the effect of the confounding variable.
In your research design , it’s important to identify potential confounding variables and plan how you will reduce their impact.
Discrete and continuous variables are two types of quantitative variables :
Quantitative variables are any variables where the data represent amounts (e.g. height, weight, or age).
Categorical variables are any variables where the data represent groups. This includes rankings (e.g. finishing places in a race), classifications (e.g. brands of cereal), and binary outcomes (e.g. coin flips).
You need to know what type of variables you are working with to choose the right statistical test for your data and interpret your results .
You can think of independent and dependent variables in terms of cause and effect: an independent variable is the variable you think is the cause , while a dependent variable is the effect .
In an experiment, you manipulate the independent variable and measure the outcome in the dependent variable. For example, in an experiment about the effect of nutrients on crop growth:
Defining your variables, and deciding how you will manipulate and measure them, is an important part of experimental design .
Experimental design means planning a set of procedures to investigate a relationship between variables . To design a controlled experiment, you need:
When designing the experiment, you decide:
Experimental design is essential to the internal and external validity of your experiment.
I nternal validity is the degree of confidence that the causal relationship you are testing is not influenced by other factors or variables .
External validity is the extent to which your results can be generalized to other contexts.
The validity of your experiment depends on your experimental design .
Reliability and validity are both about how well a method measures something:
If you are doing experimental research, you also have to consider the internal and external validity of your experiment.
A sample is a subset of individuals from a larger population . Sampling means selecting the group that you will actually collect data from in your research. For example, if you are researching the opinions of students in your university, you could survey a sample of 100 students.
In statistics, sampling allows you to test a hypothesis about the characteristics of a population.
Methodology refers to the overarching strategy and rationale of your research project . It involves studying the methods used in your field and the theories or principles behind them, in order to develop an approach that matches your objectives.
Methods are the specific tools and procedures you use to collect and analyze data (for example, experiments, surveys , and statistical tests ).
In shorter scientific papers, where the aim is to report the findings of a specific study, you might simply describe what you did in a methods section .
In a longer or more complex research project, such as a thesis or dissertation , you will probably include a methodology section , where you explain your approach to answering the research questions and cite relevant sources to support your choice of methods.
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BMC Public Health volume 24 , Article number: 2075 ( 2024 ) Cite this article
In view of the importance of managers’ wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers’ wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers’ wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth.
The study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied.
The findings indicate that a manager’s working environment evolves from its initial stages and through the company’s growth, leading to variations over time in the manager’s experiences of wellbeing and work–life balance as well as changes in job demands and resources. Managers’ working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work–life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers’ increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers’ wellbeing.
This study shows that, in the context of small business, managers’ working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers’ working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.
Peer Review reports
Small businesses play a significant role in global economies [ 1 , 2 ] and growing businesses are especially important in creating jobs and contributing to economic growth [ 3 , 4 , 5 ]. Previous research has shown the importance of managers’ wellbeing for leadership behaviours [ 6 ], employee health [ 7 ] and business survival and effectiveness [ 8 , 9 ]. Managers’ working conditions influence their wellbeing, which is important for their practiced leadership [ 6 , 10 ], which in its turn has effect on employees’ wellbeing [ 7 , 11 , 12 , 13 ]. Therefore, a better understanding of managers’ wellbeing and working conditions in the context of small businesses is important for creating healthy and sustainable businesses. Yet too few studies have focused on managers’ health and working conditions in the context of small companies.
Previous research has provided a largely static picture of wellbeing and work in small businesses, missing the variability and dynamism characteristic of this context [ 14 ]. One aspect of the dynamic context of small businesses is growth and the changes that growth causes in the companies. Hessels et al. [ 9 ] report that increasing firm age and size may have implications for managers’ working situation and wellbeing. More research is needed to examine how business growth can impact managers’ working conditions and wellbeing as this has implications for employees’ wellbeing and company performance. The purpose of this study is to explore perceived changes in working conditions and wellbeing among managers in the context of growing small businesses.
Prior to discussing the methodology of the study, the section below provides a short exposé over the conceptual and theoretical framework of this study as well as an overview of the previous research.
Through the lens of the Job Demands–Resources (JD–R) model [ 15 , 16 , 17 ] this paper explores the wellbeing and working conditions of managers of small businesses. The JD–R model, differentiates between two types of factors in the work environment: job demands and job resources [ 17 ]. The term “job demands” refers to job characteristics and circumstances requiring physical and psychological efforts and having physiological and psychological costs [ 17 ], e.g. workload and work pace. Resources, e.g. control, autonomy and support, on the other hand, contribute to achieving work goals, personal growth and development, and counterbalance the job demands and related physiological and psychological costs [ 18 ]. It has been suggested that working conditions characterized by high demands and low resources lead to increased strain and decreased work engagement [ 18 ] while work situations with high job demands and high resources are regarded as active and stimulating [ 19 ]. Research has shown that wellbeing, in general, is positively influenced by high job resources and negatively by increased job demands [ 20 , 21 , 22 ].
The JD-R model is among the most influential in connecting working conditions to well-being beside the demand–control–support model [ 23 , 24 ] and the effort–reward imbalance model [ 25 , 26 ]. This model was chosen since it is flexible, enabling among others the inclusion of working conditions and factors relevant to specific occupational settings [ 27 ]. Moreover, it has received empirical support across various contexts [ 28 , 29 , 30 , 31 ].
Since well-being encompasses several dimensions [ 32 , 33 ], such as physical, emotional, mental, and social [ 34 , 35 ], there have emerged quite a few ways of defining this concept. This paper adopts a broad conceptualization of well-being to capture the dimensions and reflecting managers’ evaluation of their lives, feeling well and daily functioning based on their unique perspectives [ 36 , 37 , 38 ]. This concept includes individuals’ subjective judgement of their life, work, health, relationships, and sense of purpose, including both positive (such as feeling of job satisfaction and happiness) and negative (such as feelings of distress, health problems impairing individuals’ daily functioning and quality of life) aspects of wellbeing [ 39 ].
There have been two strands of research applied to small business, one focusing on the general population of managers and the other focusing on entrepreneurs. However, among these studies, very few to date have specifically addressed managers’ wellbeing and working conditions in the context of small and growing companies. For instance, the published research has not sufficiently distinguished between different types of entrepreneurs, i.e. those with and those without employees [ 9 , 14 ]. There are differences in the nature of managerial work between that of small and large companies; and there are differences even between smaller firms depending on their size [ 40 ]. In addition, in small businesses, manager–owners have the combined responsibilities of entrepreneurs, managers, and operative employees, which may impact their work and wellbeing.
Research shows that both entrepreneurs and managers in general experience stressful working situations and high levels of demands, in terms of long working hours, a high workload and fast work pace, poor work–life balance, role conflicts and low support [ 8 , 14 , 41 , 42 , 43 , 44 , 45 , 46 ]. Entrepreneurs also work under uncertainty and amidst financial problems [ 8 , 14 ]. On the other hand, both managers and entrepreneurs experience high levels of control, autonomy and decision latitude [ 14 , 41 , 47 ]. Entrepreneurs enjoy flexibility and meaningfulness in work and report high job satisfaction and optimism [ 8 , 14 ].
Despite the intense demands and stressful work, managers and entrepreneurs generally report good wellbeing, better wellbeing compared with employees and other non-managers [ 9 , 14 , 19 , 48 ]. However, several studies have pointed to risks of decreased wellbeing associated with managerial position [ 49 , 50 , 51 , 52 ]. Similarly, entrepreneurs may run high risk of burnout [ 8 ] and ill health in the long term because of continuous exposure to high levels of stressors [ 14 ]. A few studies have reported entrepreneurs’ poor wellbeing [ 53 , 54 ].
Research also highlights differences in the wellbeing of managers based on their hierarchical level, where top managers enjoy better wellbeing, and first-line managers experience worse wellbeing and working conditions [ 55 , 56 ]. Buttner [ 4 ] suggests that entrepreneurs experience more problems with wellbeing, as well as higher stress and lower job satisfaction compared with managers and points to differences in entrepreneurial and managerial work demands.
Regarding business growth, this is known to be a complex and multifaceted phenomenon [ 57 ]. Despite a large volume of research, the area still suffers from insufficient theoretical development and a limited understanding [ 58 , 59 ]. In business studies, one of the approaches to describing business growth can be found in a rich plethora of life cycle models illustrating growth trajectories of firms as passing through a number of stages [ 60 , 61 ]. However, although the life cycle approach has been challenged for its determinism and linearity [ 61 ], researchers agree on the common features in the growth process, which include a series of stable periods, accompanied by crises points, as well as changes in the companies’ basic structure, activities and key challenges over time. In other words, when companies grow there are certain transformations beyond change in size and age.
According to a model by Churchill and Lewis [ 62 ], which was specifically developed for small growing companies, businesses move through five growth stages, namely, existence, survival, take-off, success, and resource maturity. Each stage involves an increase in diversity and complexity of five management factors: managerial style and management decision making (including the extent to which decision making authority is delegated by the owner); organizational structure (involving layers of management in the company); operational systems (referring to the development of financial, marketing, and production systems in the company); strategic planning (the degree to which a company develops both short- and long-range goals as well as major strategic planning); and owner involvement (the extent to which the owner is active in the business operations and decisions). The set of core problems and challenges that managers face also changes through the stages [ 62 , 63 ]. According to Churchill and Lewis [ 62 ], as a business moves through the growth stages, the owner’s style of decision making changes and becomes less controlling and more delegating. This means that owner involvement in the firm and daily work decreases and a new layer of management is created, with new managers coming in, as well as there being an increase in the complexity of organizational structure, operational systems, and strategic planning.
Torrès and Julien’s [ 64 ] discussion on the denaturing of small businesses (i.e. when the businesses no longer have the typical features of small businesses and adopt attributes that belong to larger companies) can help understand change related to growth. According to Torrrès and Julien [ 64 ], the denaturing of small business management practices can be marked by a higher degree of management decentralization, higher levels of labour specialization, the development of more formal, long-term strategies, a growing complexity, and formalization of information systems, as well as expanded markets. Denaturing is also followed by decreasing proximity in relations and contacts, growing formality and procedures, and a more structured and long-term approach [ 64 ].
Thus, growth (in size and complexity) introduces changes in a company’s structural and contextual dimension [ 61 ] that have consequences for the nature of the manager’s role [ 63 ] and, supposedly, for managers’ working conditions, resources and demands. However, little attention has been paid to business growth from an occupational health perspective.
Therefore, as stated above, this study explores how managers in small companies perceive their working conditions and wellbeing in the context of business growth. Following the theoretical foundation, the next section sets the stage for discussing the methodology that was used in this study.
Study design and sample.
This study used a qualitative methodology based on interviews with managers of small companies. The company selection was linked to a regional project, Successful Companies in Gästrikland (SCiG), which annually credits successful businesses (ranked highest in terms of profitable growth) in a region in mid-Sweden. The selection procedure is fully described elsewhere [ 40 ].
For this study, we selected small companies (max 50 employees) that were nominated for the award between 2008 and 2019 and had been in operation since 2008 at least. Interviews were performed with 20 managers from twelve companies. The heterogeneity of the sample was increased by purposefully selecting companies on the top and at the bottom of the nomination list for the period 2008–2019. Nine companies had more than seven nominations during the period (indicating sustained profitable growth); three companies had only one nomination (indicating a short growth period).
The chief executive officers (CEOs) of the selected companies were invited by letter and subsequent phone calls to participate in the study. They were provided with information about the study’s purpose, methodology, and treatment of the collected data. The companies were in sales ( n = 5), manufacturing ( n = 4), technical consultancy ( n = 2), and transportation ( n = 1), employed between four and 46 persons and had been in operation for 12–51 years.
Twelve CEOs, nine of whom were owner–managers, and eight managers at lower level made up the group of participants. Managers of different levels were included to increase the variation in the material as the situation of low-level managers can differ from that of top managers. The participants included 18 male and two female managers between the ages of 29 and 66. Their managerial experience ranged from 3 to 29 years. Four managers were university-educated; 16 had secondary education or similar. Table 1 illustrates an overview of the characteristics of the managers participating in the study.
The qualitative interviews were performed in 2020. A semi-structured interview guide [ 65 ] was employed and included such themes as experiences of managers’ wellbeing, working conditions, and work-related factors influencing their wellbeing. Examples of questions were: “How do you perceive your own health and wellbeing?”, “Did your wellbeing change during your work as manager? – If yes, in what way, and what did it depend on?”, “How do you perceive your work–life balance?” and “How do you perceive your working situation?” The open-ended questions were followed by probing questions to follow up and get clarifications and examples. This procedure enabled a natural conversation where interviewees could freely describe their perspectives. The participants were not provided with a definition of “wellbeing”.
The interviews were carried out by the first author either at the companies ( n = 18) or remotely using the video conferencing service Zoom ( n = 2). The interviews lasted 60–90 min. With the participants’ permission, all interviews were audio-recorded. A professional transcriber ( n = 17) and the first author ( n = 3) transcribed the interviews verbatim.
Data analysis was performed in two complementary stages. In the first stage, the data were analysed using qualitative content analysis [ 66 , 67 , 68 ]. Following the guidelines of Elo & Kyngäs [ 66 ] and Graneheim & Lundman [ 67 ] the content analysis followed such steps as preparation (selecting the unit of analysis and familiarizing with the data), organization (open coding, grouping, categorization, and abstraction) and reporting. The interview transcripts in their entirety were regarded as units of analysis [ 67 ]. They were read several times to achieve immersion in the data. The texts were thereafter uploaded to ATLAS.ti for Windows, version 9 (Microsoft, Seattle, WA, USA) for subsequent analysis.
All information in the interview transcripts, that was judged as relevant for the objective of the study, was thoroughly coded. The coding was done by selecting meaning units (ranging from a few words to several sentences) and assigning a heading that reflected their meaning and content. These headings became the initial codes. For instance, the phrase “My health was quite poor. Poor sleep. … Notepad on the bedside table so when you woke up at night and thought of things you had to write them down…. It wears you out a lot. You get old, you know, inside you age quickly… (IP1)” was coded as “Felt unwell previously”.
These initial codes were then compared with each other for similarities and differences, sorted, and abstracted into broader categories. The coding scheme was revised and refined several times through the iterative processes of sorting and abstraction, comparing meaning units, codes, categories, and subcategories. Thus, the content analysis in the first stage resulted in a list of categories, subcategories and codes describing managers’ perception of changes in their wellbeing and working conditions. These are presented in a category matrix (Table 2 ), elaborated, and supported by participants’ quotes in the Results section.
In the second stage, thematic analysis was employed to identify trajectories in the participants’ perceptions of their wellbeing, demands and resources (which are the categories identified in the first stage of analysis). This was done based on their descriptions of their working situation, currently and previously, as manager of the business. All the transcripts were reread several times and individual trajectories of the perceived changes in the factors were summarized for each case. These individual trajectories were aggregated in groups showing commonalities and differences in the participants’ experiences in how their perceived wellbeing, demands and resources had changed from previous periods to the time of data collection. The pattern grouping showed more salient trajectories where individuals could be a part of several groups. As a result, the analysis in the second stage suggested themes illustrating common patterns in participants’ individual trajectories of perceived wellbeing, demands and resources.
The main analysis was done by the first author (E.A.). Sorting and abstraction of data was then discussed with the second author (D.L.). Finally, the categories and themes were reviewed by all authors. The analysis presented in the results section is performed close to the manifest content [ 67 ] reflecting the perceptions and experiences of managers as expressed by them, and with low degree of interpretation by the authors. Further interpretation, analysis of connections between the categories and theorizing is done in the discussion section.
The study was approved by the Swedish Ethical Review Authority (approval No. 2019 − 00314). Furthermore, the study was carried out in line with the principles of the Declaration of Helsinki. All participants were informed about the study’s objective, the voluntariness of participation, anonymity, and confidentiality principles as well as their right to decline an interview at any moment without having to provide a justification. Before each interview, informed consent was gained from each participant.
Following the discussion of the methodology, the next section offers the reader an overview of the results of the empirical study.
The results are presented in two sections corresponding to the two stages of the analysis. In the first section we present findings showing that there has been change in managers’ experience of their wellbeing and working conditions from previously to today, and what factors were affected (see Table 2 ). The second section presents the findings of a trajectory analysis, individually investigating each manager’s journey and illustrating different ways in which these changes occurred.
A. managers’ wellbeing and work-life balance currently and previously.
The managers stated that they were satisfied with their job, and that they thrived at work. Several participants maintained that it was fun to go to work and that work gave them energy. Most of the managers assessed themselves as feeling well. Some said that their physical health could be better, e.g. they referred to problems of overweight or problems due to having a prolonged sitting time at work.
I feel great in many ways. Physically, it’s so-so considering that I’m overweight! Occupational health is great when I don’t work 100% and I’m in charge of my own free time. (Interview participant (IP) 1, CEO) Certainly it has been up and down, but I perceive my health as good. It makes me feel good when I come here [to work]; I enjoy it a lot. And that gives me a lot of energy. (IP 16, lower manager)
Several managers expressed that they were down-prioritizing their physical health in favour of spending time with family and of doing managerial work. Some maintained that they had not done what they should have done for their health to be better. Several participants wished that they could do more exercise.
Managers referred to feeling stressed during certain periods because of high workload and work pace; however, the stress was not constant. They described that it “goes in waves” and that work had “ups and downs.” Most managers stated that they were rarely badly stressed and when they were, it was for shorter time periods. Also, the managers felt they had a good balance between work and private life currently.
Several owner–managers expressed that the sheer fact that they had the opportunity to carry out what made them thrive compensated for the heavy burden of having to work long hours. Some noted that they felt calm when there was a lot of work and a high tempo because it meant that the company had a lot of orders and it was going well for the business.
You enjoy your job, but you may work a little more, but you get a good life situation yourself. … I like to work … I like to have many “irons in the fire”. That’s when I’m at my calmest … as long as it’s full speed and challenges like that … (IP 4, CEO).
Several managers, however, stated that they had felt unwell in earlier periods of their managerial career. They reported having felt tired, worn out and stressed constantly over longer periods of time. Some felt that they had prioritized away their health, had not had time to take care of themselves, to have lunch or take breaks, and had overconsumed coffee and tobacco. Several participants had since had problems with physical and mental health, including problems with the heart and stomach, burnout, and stress-induced shingles.
From the beginning … when I started … I worked very, very hard and then my stomach took a beating … and I’ve always been a bit stingy [which is why this CEO did not hire staff to do some of the work]. So I worked evenings and nights … until 3 in the morning … well, I probably did it for about 5 years …. So that’s when I realized I can’t go on like this. (IP 3, CEO) The first year I got gastritis and I started to feel dizzy, because I worked extremely hard. I went to the doctor and I used a pack of snus a day, drank twelve cups of coffee a day. I guess I didn’t realize my situation, that I have a big family plus a job. (IP 19, CEO)
Several managers stated that it had been a problem when they had worked more in the past. They described that a high workload and long working hours made it difficult to combine running a business and having a family life. They discussed that it is usual for small business owners to have difficulties with a relationship and family because of a large workload. Many managers felt that, previously, they had had no control over their own time and no time for family or relationships.
It’s hard to have your own business. But … if you have your own business and you feel that you’re managing your free time, then you’ve come to the right place. However, if you have to work 100 h a week because you have a bad conscience about things, then you’re not in control of your own time. You won’t exactly be a nice person. Because you’re never at home, you’re never free … It doesn’t work with a relationship … from a family’s point of view, it’s probably really hard to be together with a self-employed person. (IP 1, CEO ) The man I bought the company from … ran it for 4 years; then his wife said, You have to choose between me and the job. So then I was alone [in running the business]. I didn’t have a holiday. I had two small children, I worked every day of the week, between 7am and 9pm every day except weekends when I worked a little less but basically I worked all the time. Then my wife said, Now you have to choose, between the company and the family. (IP 8, CEO)
Most of the managers described their current workload as quite high, but manageable. They estimated that they worked between 40 and 60 h a week, and generally did not see that as problematic. They knew the workload went up and down, in waves, and intense periods were followed by calmer periods during which they could recover. Some managers when talking about small business owners in general said that it is inevitable to work long hours – it is a common situation. They described that, when running an own business, one can never feel that the work is finished as there is always something to solve or improve.
When you run a business, you’re never done. There are always improvements to be made. You can never sit down and feel that now things are good. We want to improve our production, routines. At the same time, the most important thing is to be able to deliver, both products and services. That’s what we live on, so to speak. If we can’t do that, we don’t make any money. Then we’ll be out of business soon. (IP 20, CEO)
Some managers also reported that company growth brought about new challenges for them to handle. They expressed that there was a constant need for adjustments in the organization to match the growing size and complexity of the tasks performed by the company. In addition, some participants talked about the challenges in the organization related to clarity of structure, roles, policies, routines and information as companies expanded. Some managers mentioned conflicts and staff turnover in some periods as well as difficulties to maintain the family climate and close relationships.
Talking about previous periods of their managerial career in the current company, many managers described having worked much more compared with their present work situation. They estimated having worked between 50 and 100 h a week, including evenings and holidays.
Before, I worked a lot more. Maybe 100 h a week. I have done that for many years. Probably 20 years I would think … Lots of night work. Came home at 2, 3 and then up again at … (IP 1, CEO).
At the same time, the managers said that it was fun and they enjoyed working in this period of heavy workload and long working hours. Several managers explained that they were very engaged and ambitious, and wanted to achieve much more. Some described that they just worked and worked. One mentioned that he kept going as if he was a superman, another as if she was immortal; both meant that they felt they could manage anything and did not realize their limits.
I think you have a great overconfidence in yourself; in the beginning you want to do everything, you want to change yourself, you want to change the company, you have made an investment. Then after a while you realize that life is more than just work, life is more than money. (IP 8, CEO)
c1. Change in organizational resources
In the managers’ descriptions of their current and previous working conditions, they often referred to changes in the available organizational resources due to the growth of the company. They described that previously, when the company had been small, they had had multiple roles and had done almost everything in the company, operative work, administration, and management. All activities in the business had been theirs. They had felt they needed to be present all the time to ensure that everything ran smoothly and had done as much as they could themselves to save costs and build a stronger financial base for the company.
When the company had expanded, they had acquired financial and personnel resources. A new group of managers (at a lower level) had been hired, who had taken over some of the responsibility for staff and daily operative leadership. Extra staff had been hired to take care of finance and administration, relieving the managers from these tasks.
The acquisition of additional job resources was particularly prominent in CEOs’ perceptions of wellbeing. They felt that their workload decreased as they could delegate responsibility and tasks to lower-level managers, technical–administrative staff, and other employees. The CEOs could work more purposefully on overall leadership, and more proactively with development and seeking new clients, which, in their eyes, meant a purer leadership role, focusing on managerial tasks.
A few years ago, you were more of a salesperson and then you would get into a new suit and then you would go in and manage people. It was completely new … You do not do everything, you do [only] your thing. (IP 1, CEO) I had more to do and then it simply took longer. Now I have less to do. My work tasks are now shared by more people. (IP 4, CEO)
Some companies assigned both lower-level managers and other staff to take care of improvements in certain key areas, such as optimization of organization and processes, the work environment and safety, quality, certification, documenting routines, etc. The CEOs reported that they had not had the time to take care of these issues before. Finally, the process of growth required changes in the organization. The managers described that when the company expanded, there was an increase in specialization and division into departments or groups. The companies developed a clearer organization, roles and routines, which, according to the managers, contributed to a smoother processes and more effective problem solving.
We’ve made a lot of changes over the years, from chaos to organized chaos to order. Now that we have an organization, I work much less. (IP 1, CEO)
While most companies in the study showed continuous growth, three companies did not. The managers of these companies did not mention gaining organizational resources, but instead described the vulnerability of being a small business that was related to lack of financial and personnel resources.
c2. Change in individual resources
Many managers said that they had come to the insight that their work situation was not sustainable in the long run and needed to be changed.
To have that pace forever, then you give up in the end … but if you enjoy it and want to continue working then you have to try to find a sustainable work situation that works both at work and at home. … because otherwise you end up as a human being that you won’t be able to bear. You have nothing more to give … and it’s certain that you will burn yourself and others out. (IP 16, lower manager)
Two factors had led to this insight: ill health and the family situation. Some managers realized the importance of wellbeing and a sustainable work situation after having problems with their health and work–life balance. Those who developed health problems described how this had become a strong warning signal.
I got burned out 10 years ago. … And there it stopped. So I learned then. It was absolutely the most useful lesson I could have received. (IP 13, CEO)
Several managers expressed that they now prioritized health more and strove for a better work–life balance and a more sustainable work situation. Some worked intently on changing their situation and reducing their own working time. Some also maintained that they kept the balance over a long period of time, meaning that they worked overtime some days but compensated for it by working less on other days.
Some managers also mentioned a change in their family situation and their relationship with their partner and children as factors that had made them aware of the importance of wellbeing and work–life balance and had convinced them to make changes in the working situation. One participant talked about age as playing a role in this context. He emphasized that now, closer to retirement age, he did not want to work too much. He wanted more free time.
I work less now. I worked a lot more in the past! I don’t want to work as much. I’ve handed over things like administration, preparation of orders, and so on to the deputy manager. (IP 20, CEO)
Several managers specially highlighted the importance of accumulated managerial experience. They described that they had become more secure in their role and had reached a better understanding of the situation and the yearly work cycle. Based on this they made quicker decisions and did not spend so much time on seeking information. They also described that they had learned to cope better with the work situation, e.g. through planning, prioritizing, working in a more structured way, accomplishing work bit by bit, not promising too much and accepting that stress and a high workload are part of a manager’s job.
The trajectory analysis showed that the changes in the managers’ wellbeing and working conditions occurred in different ways. Despite large variation in experiences, individual and firm-level characteristics and circumstances, several groups of trajectories of participants’ wellbeing and working conditions were identified.
This group consisted of owner–managers of growing companies who experienced changes in wellbeing as well as in organizational and individual factors. The managers in this group reported that, initially, when their companies had been smaller, they had experienced a deterioration in wellbeing because of a high workload, fast work pace and long working hours. However, enhanced organizational and individual resources had led to an improved work situation and wellbeing for this group. As companies had grown, managers had been able to hire more staff who could relieve them or take over some of their tasks. According to the managers in this group, their wellbeing had improved over time, from having been stressed to a new experience of feeling good. Challenges to wellbeing and disruption of the work–life balance had provided them with increased awareness of the importance of a sustainable working life and their own wellbeing. Several managers described that they had specifically worked on changing both their own work environment and the organization to make the company less dependent on the owner–manager’s availability all the time.
The managers in this group had a stable wellbeing and had not experienced any significant changes in their wellbeing due to their work. Some managers noted that owing to their coping strategies (positive personality and taking things as they come without judging them as tough, and seeing all problems as challenges and tasks to be solved) they were not affected by high workload and stress.
The managers in this group mentioned their high resilience, positive personality, and active coping strategies. We also observed that some of the companies had several owner–managers, meaning managers’ tasks were shared by several persons.
Findings showed that managers in this group described that from the beginning they had had high awareness of the importance of sustainability at work and of maintaining a work–life balance. They intentionally strived to keep working hours to a moderate level, set clear boundaries between work and free time, and not work overtime. They described their health as stable and good and did not experience any change in wellbeing. Some managers mentioned that they had experienced work-related ill health, stress, and poor balance between their job and private life in previous jobs. They felt that this experience had helped them realize the importance of health. One manager learned from the example of his entrepreneur parents who had worked long hours. From the beginning, managers in this group had a high awareness of the importance of sustainable work life (and a high level of individual resources), which protected them from overworking and helped them maintain good levels of wellbeing.
The common feature of managers in this group is that their work situation was constrained by vulnerability characteristic of small businesses due to insufficient personnel and financial resources. These managers needed to work overtime to fill the personnel gaps and work operatively to earn their salary. They had to do administrative work, were unable to delegate tasks to others and could not invest time in the company’s development. These smaller companies also described some organizational adjustments; however, to a lesser extent. For example, they might hire a lower manager, or get help with finance, or with support systems, and developing improved routines. The managers also talked about trying to keep working hours at a moderate level. The managers in this group had low organizational resources but still felt well. Their working situation was constrained by the small size of their companies, but this did not translate into low wellbeing.
This group consisted of managers who were new in their role of owner–manager or lower manager. Some had experienced heavy work demands when they had filled their role of manager, especially during the first period. After having problems with health these managers had acquired insight into the importance of wellbeing and had started to work intently on attaining and preserving a balance between work and life. They had also become more secure in their role after acquiring experience of working in a managerial position, and learned to delegate responsibilities to others, create better routines, prioritize actions, and not dwell too long on decisions. At the time of the interviews, the managers reported a clear improvement of their wellbeing compared with the first years of being in management.
Some of the newly promoted lower-level managers felt that their wellbeing had improved in their new position. They linked this to increased resources related to achieving larger responsibility, greater possibility to influence company development, more control over work and time, additional variation in work, and stimulating work.
The purpose of this study was to explore perceived changes in working conditions and wellbeing among managers of growing small businesses. To show how the results lead to conclusions regarding the purpose of the study, we first give a brief summary of the main findings and then discuss the observed changes in the managers’ wellbeing, their demands and resources, as well as changes in the context of small businesses itself in the process of growth. This is done by interpreting the findings and setting them in relation to the theoretical framework of the study.
The results indicate that managers’ working conditions in small companies evolve during periods of company growth. This leads to variations over time in managers’ experiences of wellbeing and work–life balance as well as to changes in job demands and resources. Managers’ working situation becomes less demanding and more manageable with a reduction in workload and working hours and a better work–life balance. The findings suggest that this perceived improvement may be due to changes in organizational factors, such as increased company resources, but also to managers’ personal insight based on their experiences, and to increasing awareness of the importance of a sustainable work situation. However, the analysis also showed that there were different trajectories in the way the perceived working conditions and wellbeing changed over time and how organizational and individual resources mattered for the managers’ wellbeing.
As mentioned previously, the basic assumption of the JD–R model is that specific job demands, and also resources, are rooted in specific occupational settings, i.e. they vary depending on the work settings and the context of the organization [ 27 ]. The present study, building on the JD–R model’s assumptions, shows further that the specific context of small companies is itself subject to changes when a company expands and evolves. In other words, the results of this study illustrate that change occurs in a company over time because of the growth, which refers to an aspect of dynamism that occurs in the small business context. Changes in managers’ wellbeing, job demands, and resources in the context of small business growth are explicated below.
Concerning wellbeing, previous research reported good health and job satisfaction with regard to both managers [ 45 , 48 ] and entrepreneurs [ 9 , 14 , 69 , 70 , 71 ], although some few studies showed the opposite (e.g. [ 49 , 51 , 53 , 54 ]). This study provides a more nuanced understanding of managers’ wellbeing in the context of small businesses. Like previous research, the findings in this study point out that managers felt well and experienced job satisfaction and good work–life balance despite the high demands they faced. Although they felt well at the time of the interview, many owner–managers had also experienced impaired wellbeing in previous periods when their company had been smaller and weaker, as shown in the description of the first trajectory group. Thus, the findings suggest that owner–managers in small businesses risk impaired wellbeing due to high workload, long working hours, and work–life conflict when the company is particularly small and when managers lead the growing company mostly by themselves. Also, new managers at low and higher levels, as demonstrated by trajectory group 5, seem to be at risk of diminished wellbeing due to increased job demands, especially during the first years of their managerial career. Increased demands due to transition to a managerial position have also been shown in previous studies [ 47 , 72 ].
Moreover, our results indicate that companies’ increased resources due to growth had implications for managers’ working conditions and wellbeing. First, the managers’ workload decreased because of increased possibilities to delegate a part of their tasks to lower-level managers and because of the increased number of personnel. Second, larger resources, better organization and routines reduced the degree of uncertainty and increased the preparedness and capacity to tackle arising problems, and thus increased the sense of manageability and reduced the intensity of the demands. The study shows that the decreased demands and increased organizational resources led to improved wellbeing for managers, as illustrated in the first trajectory group. Therefore, growth may have a positive effect on managers’ working conditions, primarily for higher managers in small growing companies. However, results from the study also indicate that growth can itself be a stressor, requiring constant adjustments and changes in the organization. If not well handled, growth can result in problems and tensions. Company growth, therefore, creates a changed situation that requires new strategies, new ways of working, and adjustments in an organization.
In relation to the organizational context, the present study distinctly points to the changing nature of the organization undergoing growth. More specifically, the study suggests that, during the process of growth, there is an increase in the degree to which an owner delegates their responsibilities as well as in the complexity of organizational structure (such as management levels) and operational systems (such as financial and production management systems). There also is a decrease in an owner’s involvement in business activities and daily decisions. Increased labour specialization, formalization, standardization (e.g. work with routines), planning and control as well as reduced proximity in relations with employees were some of the transformations that companies went through. Transformations may mean changes in the content of managers’ work, demands (e.g. decreased demands related to managers’ daily work, lower involvement in operational activities and lower working hours) and resources (e.g. in the form of a larger staff, personnel with special competence, higher use of operational systems, formalization and routines, and greater financial security due to larger resources). The described transformations could be traced to all the companies in the study that were growing, and thus represent a background characteristic of all the trajectory groups except for the fourth group (companies that did not continue to grow). The changes are generally in line with the transformations described in Churchill and Lewis’ [ 62 ] model, but also with Torrès and Julien’s [ 64 ] discussion on the denaturing of small business, as presented above.
According to the findings in the present study, even the features of small companies that give specificity to the management modes in this context are subject to change when a company expands. Applying Torrès and Julien’s [ 64 ] view, the current findings may indicate that companies in the process of growth “denature” and lose their small businesses specificity. Thus, businesses transition from simpler, more intuitive, and informal approaches to management, which are characterized by close relationships, to more complex, structured, and formalized modes that focus on long-term planning and less personal interaction [ 64 ]. This may even apply to managers’ work. As mentioned previously, managers in the smallest of small companies have a special position combining the managerial roles of several different levels: being the owner, the entrepreneur, the operative worker, the administrator, etc. (referring to the fourth trajectory group and the initial situation for the first, second and third groups). When a company expands the owner–manager’s work and role transform and become more like those of managers in larger companies (as described for the first trajectory group). The findings thus point to the special working conditions of owner–managers of small companies (characterized by a combination of different roles, resource constraints and the changing nature of their work in the process of business growth) while middle managers’ working conditions and wellbeing in these companies are more in line with what previous research has shown about managers in general.
In the current study, the smallest companies were vulnerable because of poor financial and personnel resources, while the larger small companies did not experience this vulnerability. The growing companies were able to enhance their personnel, financial and organizational resources thanks to growth, which allowed them to overcome the vulnerability related to small business size. This means that these companies built up a stronger reserve pool, which led to higher resilience, allowing them to endure acute and chronic stressors, prevent resource loss and ensure future resource gain [ 73 , 74 , 75 ]. The companies in the study that continued to grow seemed to have a resource surplus; and developed in positive spirals in relation to economic growth as they continued to grow steadily. Having a resource surplus or strong resource reservoirs can obviously be a protection and resource factor for managers’ wellbeing.
Interestingly, the results showed that managers in the smallest companies (companies that had had a short period of growth and did not continue to grow, as shown in the fourth trajectory group) experienced good wellbeing despite high demands. Two possible explanations might help understand these findings. First, as described above, it seems that the available personal resources had a protective effect. Second, it is possible that these companies may have attained the size and mode of operation that allowed a manageable working situation for managers. These companies experienced small business vulnerability due to low resources but remained stable. They were able to engage in reactive coping with daily stressors (e.g. sickness among staff, or machine breakdowns) and handle the situation and keep the balance, even though they were currently not able to invest in growth. Their lack of resources did not seem to lead to negative spirals; however, vulnerability remained. In other words, in case the external environment changes, e.g. in an economic recession, they may be at risk of escalating resource depletion.
An interesting finding of the study is that managers in general seemed satisfied with their job despite high workload both previously and currently. In relation to owner–managers, an entrepreneurial dimension in their job should be noted. Entrepreneurs’ work is self-chosen and the workload is quite often self-inflicted as well. Having a lot of work and solving problems can be the source of motivation, wellbeing, and work satisfaction for an entrepreneur. Entrepreneurs choose to have a lot of work and see this as a sign that everything is going well for the business. At the same time, demands related to high workload and pace may lead to lower wellbeing in the long term [ 14 ]. There seemed to be dual experiences of workload in the owner–managers’ work.
Finally, the study indicates that individual resources may affect managers’ working conditions. Firstly, these relate to managers’ awareness of the importance of health for their own and their companies’ sustainable working life. Secondly, the findings showed the significance of acquiring managerial experience as well as learning the own profession, and the work content and specific situation in the company.
It should be noted that we observed an increase in organizational resources in all growing companies and the participants from these companies admitted that an increase in organizational resources had improved their working conditions and reduced their workload. However, it seems that this had the most pronounced effect on improvement of wellbeing of owner–managers in the first trajectory group. It appears that the first group differed from the other groups of managers in growing companies (the second and third trajectory groups] in the way that they initially lacked individual resources in terms of awareness of the importance of wellbeing and sustainable working life. Those managers who initially enjoyed large individual resources did not overwork and therefore did not experience deterioration in wellbeing. This may suggest that individual resources can have a protective effect [ 16 ]. The findings further show that several managers developed a greater understanding of the importance of sustainable working life after having had problems with wellbeing and work–life balance (e.g. in the first and third trajectory groups). Thanks to this increased understanding, managers changed their behaviours (e.g. by keeping working hours to a moderate level or taking some time off after a period of hard work), which contributed to a reduction in their workload, which in turn had a positive impact on their wellbeing. Therefore, the study’s results suggest that there is feedback from managers’ wellbeing to their personal resources. Before concluding the paper, an outline of the study’s limitations and the practical implications of the findings are highlighted in the section below.
This study responds to calls to deepen the understanding of occupational health of small business managers [ 76 , 77 ], to pay more attention to variability and temporal aspects in the work and wellbeing of small business managers [ 8 , 14 ].
The main contribution of this study is that it brings attention to the dynamic, fluid and contextually conditioned nature of managers’ work in small growing companies, and its implications for their wellbeing, as well as the interconnectedness of managers’ work, work organization and wellbeing. This clearly adds to previous research, largely offering a static view of managers’ wellbeing. Additionally, the study employed an interdisciplinary approach, integrating theoretical perspectives and empirical research from research areas of occupational health, management studies, business growth, and entrepreneurship. This and usage of qualitative approach contributes to a deeper and more nuanced understanding of managers’ working conditions and wellbeing in the particularly under-researched context of small growing firms, adding to the previous research characterised by predominantly quantitative approaches, and largely confined to a single research domain.
In terms of practical implications, the study’s results can support leaders in maintaining their own health when running small businesses and pursuing growth and economic effectiveness of the company. Thus, small business managers, particularly at the beginning of their careers, would benefit from developing an awareness of the role of wellbeing for their work and their organization. The study also delineates sources of occupational stress that may be detrimental to their wellbeing and available resources that may help to support and strengthen their wellbeing. Thus, the study draws attention to the importance of promoting a healthy work environment for both owner-managers and lower managers in small businesses. Managers should also be aware that high workload and long working hours constitute a risk to their wellbeing with potentially negative consequences for their companies. Information about factors important for the wellbeing of small business managers can be used in training programs for this group. Also, managers should be coached to participate in various professional peer networks to discuss their working situation, receive support and shared experience, learn how to create clearly defined boundaries for when they are working and not working to ensuring that they do not overwork.
The study may also inspire relevant stakeholders such as politicians, trade unions of employers and other decision makers to develop appropriate and feasible ways and structures (e.g. education kits for entrepreneurs, mentorship, shared resource pools for administrative work and human resources management etc. for several businesses) to reduce the sensitivity that start-ups and small businesses live with, to increase managers’ and companies’ resources, improving managers’ working conditions and therefore their wellbeing.
Altogether, it seems that the different pathways described in the trajectories led to higher resilience and a more sustainable working situation for managers thanks to reduced demands and increased resources. However, we are aware that the study sample, consisting of growing successful companies having survived for several years in a row, may have implications for our conclusions as companies that had not survived and where managers’ wellbeing may have led to entrepreneurial exit (i.e. when an owner–manager leaves or closes the firm) were not included. Previous research has indicated that most small businesses do not survive their first years of operation [ 78 ] and owner–managers’ wellbeing is associated with their exit intentions [ 79 ]. Future research should explore, qualitatively and quantitatively, the cases where managers’ wellbeing status led to entrepreneurial exit.
Another question that should be addressed in future studies is whether growth initially demands extra investment of resources from managers to ensure continuing growth. When managers lack the necessary resources (which is the case in many small businesses) they often need to work extra to save costs, or earn more to create the necessary surplus to ensure growth.
Assumingly, if the sample had had an even distribution of gender the results may have looked different, for instance in relation to work–life balance as women often do not have the same possibility to work extremely long hours as the men in our study did.
A possible limitation of the study is that the categories currently and previously may differ between individual managers. Currently could imply today but could also cover the last few years. Similarly, previously could mean last year but it could also mean 10 years ago. These discrepancies are due to the fact that the companies were in different stages of growth and managers had varied length of managerial experience. This has implications for the granularity of the trajectory analysis.
Furthermore, although the study results indicated changes in perceived wellbeing over time, these findings need to be interpreted with caution because of the small sample size. Additionally, the study relied on a qualitative design. Therefore, future research is warranted using other methodologies (e.g. quantitative). The trajectory analysis did not aim to identify general patterns in managers’ evolving wellbeing, demands and resources in relation to small companies’ growth; it merely was an attempt to illustrate that participants perceived those changes occurred in different ways because of an interplay between organizational and individual resources.
Finally, this study relied on managers’ subjective experiences and perceptions of their working conditions and wellbeing, which they felt reflected their current situation. Nevertheless, it is important to be aware of other perspectives which could see managers’ narratives as socially constructed. The findings of the study, for instance, show the importance of managers’ individual resources. This could be discussed in relation to the view of managers as either doers or heroes in the research streams that oppose exaggerating managers’ role in a company’s success and failures [ 80 ]. It could be argued that what managers share regarding their experiences and perceptions can be seen as an expression of their socially constructed identity of strong and action-oriented entrepreneurs whose actions are decisive for business success; and that they perhaps overemphasize their own individual contribution. Therefore, research capturing these experiences using other methods such as observations or discourse analysis is warranted.
Also, it can be assumed that those who felt satisfied with their job, wanted to share their success story, and had more time were more inclined to take part in the study. Those who could barely keep their heads above water may have been more likely to decline participation – both because of stress and because they could not live up to the narrative.
This study shows the dynamic picture of small business managers’ working conditions and wellbeing that is due to the growth-related changes in the company and the managers’ work. Managers’ experiences of own wellbeing, the posed demands, and available resources changed over time in the process of the companies’ growth. When the companies were small, there was a risk for impaired wellbeing among owner–managers because of high workload, long working hours, and work–life imbalance. In addition, the study shows a positive impact of increased organizational resources brought through the company’s growth, leading to reduced workload, improved wellbeing, and work–life balance for managers. Furthermore, the perceived improvements were due not only to the changes in organizational factors, but also to managers’ personal insights and an increased awareness of the importance of a sustainable work situation. Finally, the results showed that the perceived changes in managers’ working conditions and wellbeing followed different trajectories over time because of the interaction between organizational and personal factors.
The data presented in the study are available on reasonable request from the corresponding author. The data are not publicly available owing to restrictions in the ethical approval of this study.
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Elena Ahmadi & Gunnar Bergström
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Elena Ahmadi
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Daniel Lundqvist
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Gunnar Bergström
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Gloria Macassa
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All authors (E.A., D.L., G.B., G.M.) planned and designed the study. E.A. collected and analyzed the data and discussed the analysis with D.L. E.A. wrote the main manuscript. All authors (E.A., D.L., G.B., G.M.) reviewed the manuscript.
Correspondence to Elena Ahmadi .
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Ahmadi, E., Lundqvist, D., Bergström, G. et al. Managers in the context of small business growth: a qualitative study of working conditions and wellbeing. BMC Public Health 24 , 2075 (2024). https://doi.org/10.1186/s12889-024-19578-4
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Compressed sensitivity encoding (sense): qualitative and quantitative analysis.
2.1. population, 2.2. protocol optimisation, 2.3. mri protocol, 2.4. qualitative image analysis.
2.6. statistical analysis, 3.1. qualitative image analysis, 3.2. quantitative image analysis, 3.3. subgroup qualitative and quantitative image analysis, 4. discussion, 5. conclusions, supplementary materials, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest, abbreviations.
FLAIR | Fluid Attenuated Inversion Recovery |
C-SENSE | Compressed SENsing–Sensitivity Encoding |
C | contrast |
CNR | contrast-to-noise ratio |
SNR | signal-to-noise ratio |
MRI | magnetic resonance imaging |
CNS | central nervous system |
WM | white matter |
GM | grey matter |
CSF | cerebrospinal fluid |
TSE | Turbo Spin Echo |
SENSE | sensitivity encoding |
CS | Compressed Sensing |
ROI | Regions Of Interest |
SWI | Susceptibility Weighted Imaging-phase |
SAR | Specific Absorption Rate |
TFE | Turbo Field Echo |
Click here to enlarge figure
Compressed-SENSE | No Compressed-SENSE | |||||
---|---|---|---|---|---|---|
T1-TSE | T2-TSE | 3D T2-FLAIR | T1-TSE | T2-TSE | 3D T2-FLAIR | |
Acquisition matrix | 308 × 257 | 420 × 322 | 252 × 251 | 308 × 226 | 420 × 350 | 228 × 228 |
Field of view (cm) | 23 | 23 | 25 | 23 | 23 | 25 |
Repetition time (ms) | 2000 | 6200 | 6000 | 2000 | 3000 | 4800 |
Echo time (ms) | 20 | 90 | 340 | 20 | 80 | 280 |
Slice thickness (mm) | 3 | 1.5 | 1 | 4 | 4 | 1.1 |
Intersection gap (mm) | 1 | 1 | −0.5 | 1 | 1 | −0.55 |
Number of averages | 1 | 2 | 1 | 1 | 1 | 2 |
Bandwidth (kHz) | 165.7 | 217.2 | 318.7 | 169.8 | 195.8 | 1166.5 |
C-SENSE factor | 3 | 2 | 9 | - | - | - |
Acquisition time | 2′34″ | 3′08″ | 3′50″ | 3′00″ | 2′42″ | 4′34″ |
Sequences | Reader 1 | Reader 2 |
---|---|---|
T1-TSE Compressed-SENSE | 4.93 [4–5] | 4.78 [3–5] |
T1-TSE No Compressed-SENSE | 4.95 [4–5] | 4.84 [4–5] |
T2-TSE Compressed-SENSE | 4.93 [4–5] | 4.77 [4–5] |
T2-TSE No Compressed-SENSE | 4.82 [4–5] | 4.70 [4–5] |
3D T2 FLAIR Compressed-SENSE | 4.78 [4–5] | 3.97 [3–5] |
3D T2 FLAIR No Compressed-SENSE | 4.89 [4–5] | 4.78 [4–5] |
Compressed-SENSE | No Compressed-SENSE | |||||||
---|---|---|---|---|---|---|---|---|
Median | 25th | 75th | Median | 25th | 75th | p-Value | ||
FLAIR | GM-WM | 0.09 | 0 | 0.17 | 0.08 | 0.01 | 0.15 | 0.130 |
GM-CSF | 0.64 | 0.56 | 0.69 | 0.77 | 0.71 | 0.82 | <0.001 * | |
WM-CSF | 0.58 | 0.51 | 0.64 | 0.74 | 0.66 | 0.79 | <0.001 * | |
T1 | GM-WM | −0.17 | −0.24 | −0.13 | −0.19 | −0.25 | −0.13 | 0.009 * |
GM-CSF | 0.68 | 0.64 | 0.71 | 0.65 | 0.59 | 0.7 | <0.001 * | |
WM-CSF | 0.76 | 0.74 | 0.79 | 0.75 | 0.71 | 0.77 | <0.001 * | |
T2 | GM-WM | 0.11 | 0.05 | 0.17 | 0.1 | 0.05 | 0.16 | 0.849 |
GM-CSF | −0.52 | −0.55 | −0.47 | −0.39 | −0.43 | −0.33 | <0.001 * | |
WM-CSF | −0.59 | −0.62 | −0.56 | −0.48 | −0.51 | −0.44 | <0.001 * |
Compressed-SENSE | No Compressed-SENSE | |||||||
---|---|---|---|---|---|---|---|---|
Median | 25th | 75th | Median | 25th | 75th | p-Value | ||
FLAIR | GM-WM | 2.32 | 0.09 | 4.73 | 1.95 | 0.33 | 3.99 | 0.150 |
GM-CSF | 11.38 | 8.81 | 14.51 | 12.82 | 10.10 | 15.46 | 0.002 * | |
WM-CSF | 9.05 | 7.00 | 11.68 | 10.66 | 8.30 | 12.93 | <0.001 * | |
T1 | GM-WM | −9.03 | −11.99 | −6.38 | −8.79 | −11.94 | −6.22 | 0.633 |
GM-CSF | 17.05 | 13.85 | 20.63 | 15.03 | 12.03 | 18.65 | <0.001 * | |
WM-CSF | 25.71 | 22.37 | 31.31 | 24.69 | 19.30 | 29.24 | 0.007 * | |
T2 | GM-WM | 3.85 | 1.59 | 6.29 | 4.72 | 2.07 | 8.07 | <0.001 * |
GM-CSF | −43.52 | −52.04 | −35.44 | −33.35 | −40.00 | −27.02 | <0.001 * | |
WM-CSF | −47.30 | −57.74 | −39.84 | −38.82 | −45.99 | −31.38 | <0.001 * |
Compressed-SENSE | No Compressed-SENSE | |||||||
---|---|---|---|---|---|---|---|---|
Median | 25th | 75th | Median | 25th | 75th | p-Value | ||
FLAIR | FC | 18.45 | 15.48 | 21.70 | 18.08 | 14.91 | 20.24 | 0.207 |
Ge | 11.64 | 9.63 | 13.46 | 12.40 | 9.85 | 13.74 | 0.235 | |
CSF | 3.26 | 2.90 | 3.81 | 1.90 | 1.51 | 2.39 | <0.001 * | |
Sp | 10.73 | 9.08 | 13.65 | 11.39 | 9.26 | 13.04 | 0.797 | |
CS | 14.93 | 13.10 | 18.29 | 15.17 | 12.44 | 17.47 | 0.540 | |
OC | 14.02 | 11.95 | 16.73 | 14.62 | 12.13 | 16.43 | 0.803 | |
Th | 12.32 | 10.95 | 15.94 | 12.99 | 11.21 | 15.38 | 0.841 | |
T1 | FC | 18.83 | 14.40 | 21.91 | 16.51 | 13.63 | 19.49 | 0.025 * |
Ge | 29.91 | 23.44 | 36.06 | 28.48 | 23.01 | 33.30 | 0.269 | |
CSF | 4.00 | 3.44 | 4.87 | 4.21 | 3.62 | 5.00 | 0.331 | |
Sp | 29.91 | 25.83 | 35.78 | 29.16 | 23.77 | 34.13 | 0.232 | |
CS | 30.68 | 26.07 | 36.10 | 28.39 | 23.63 | 32.54 | 0.084 | |
OC | 21.19 | 17.73 | 25.15 | 19.48 | 16.84 | 22.67 | 0.028 * | |
Th | 23.69 | 20.56 | 28.08 | 22.27 | 18.82 | 26.44 | 0.201 | |
T2 | FC | 23.45 | 20.07 | 27.88 | 30.32 | 27.07 | 36.43 | <0.001 * |
Ge | 15.76 | 13.46 | 17.78 | 20.57 | 17.36 | 23.45 | <0.001 * | |
CSF | 64.21 | 53.73 | 77.68 | 61.58 | 51.03 | 71.94 | 0.073 | |
Sp | 15.97 | 13.12 | 18.84 | 20.29 | 16.16 | 23.71 | <0.001 * | |
CS | 18.53 | 16.22 | 21.69 | 23.59 | 20.86 | 28.34 | <0.001 * | |
OC | 18.39 | 15.42 | 21.01 | 24.05 | 19.91 | 27.95 | <0.001 * | |
Th | 20.96 | 17.25 | 23.73 | 25.53 | 22.33 | 29.46 | <0.001 * |
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Picchi, E.; Minosse, S.; Pucci, N.; Di Pietro, F.; Serio, M.L.; Ferrazzoli, V.; Da Ros, V.; Giocondo, R.; Garaci, F.; Di Giuliano, F. Compressed SENSitivity Encoding (SENSE): Qualitative and Quantitative Analysis. Diagnostics 2024 , 14 , 1693. https://doi.org/10.3390/diagnostics14151693
Picchi E, Minosse S, Pucci N, Di Pietro F, Serio ML, Ferrazzoli V, Da Ros V, Giocondo R, Garaci F, Di Giuliano F. Compressed SENSitivity Encoding (SENSE): Qualitative and Quantitative Analysis. Diagnostics . 2024; 14(15):1693. https://doi.org/10.3390/diagnostics14151693
Picchi, Eliseo, Silvia Minosse, Noemi Pucci, Francesca Di Pietro, Maria Lina Serio, Valentina Ferrazzoli, Valerio Da Ros, Raffaella Giocondo, Francesco Garaci, and Francesca Di Giuliano. 2024. "Compressed SENSitivity Encoding (SENSE): Qualitative and Quantitative Analysis" Diagnostics 14, no. 15: 1693. https://doi.org/10.3390/diagnostics14151693
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INTRODUCTION. Scientific research is usually initiated by posing evidenced-based research questions which are then explicitly restated as hypotheses.1,2 The hypotheses provide directions to guide the study, solutions, explanations, and expected results.3,4 Both research questions and hypotheses are essentially formulated based on conventional theories and real-world processes, which allow the ...
When collecting and analyzing data, quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings. Both are important for gaining different kinds of knowledge. Quantitative research. Quantitative research is expressed in numbers and graphs. It is used to test or confirm theories and assumptions.
Qualitative research aims to produce rich and detailed descriptions of the phenomenon being studied, and to uncover new insights and meanings. Quantitative data is information about quantities, and therefore numbers, and qualitative data is descriptive, and regards phenomenon which can be observed but not measured, such as language.
That said, qualitative research can help demonstrate the causal mechanisms by which something happens. Qualitative research is also helpful in exploring alternative explanations and counterfactuals. If you want to know more about qualitative research and causality, I encourage you to read chapter 10 of Rubin's text.
Step 1: Restate the problem. The first task of your conclusion is to remind the reader of your research problem. You will have discussed this problem in depth throughout the body, but now the point is to zoom back out from the details to the bigger picture. While you are restating a problem you've already introduced, you should avoid phrasing ...
Research methodology in doctoral research: Understanding the meaning of conducting qualitative research [Conference session]. Association of Researchers in Construction Management (ARCOM) Doctoral Workshop (pp. 48-57). Association of Researchers in Construction Management.
However, qualitative research can be time-consuming, and data analysis may be subjective. In contrast, quantitative research provides objective and quantifiable data, making it easier to draw conclusions and establish causation. It enables researchers to collect data from large samples, increasing the generalizability of findings.
Qualitative v s Quantitative Research . Quantitative research deals with quantity, hence, this research type is concerned with numbers and statistics to prove or disapprove theories or hypothesis. In contrast, qualitative research is all about quality - characteristics, unquantifiable features, and meanings to seek deeper understanding of behavior and phenomenon.
LEARN ABOUT: Research Process Steps. Where as, qualitative research uses conversational methods to gather relevant information on a given subject. 4. Post-research response analysis and conclusions. Quantitative research uses a variety of statistical analysis methods to derive quantifiable research conclusions.
Qualitative research is based upon data that is gathered by observation. Qualitative research articles will attempt to answer questions that cannot be measured by numbers but rather by perceived meaning. Qualitative research will likely include interviews, case studies, ethnography, or focus groups. Indicators of qualitative research include:
Abstract. In Chap. 1, the nature and scope of research were outlined and included an overview of quantitative and qualitative research and a brief description of research designs. In this chapter, both quantitative and qualitative research will be described in a little more detail with respect to essential features and characteristics.
Quantitative research is an inquiry into an identified problem, based on testing a theory, measured with numbers, and analyzed using statistical techniques. The goal of quantitative methods is to determine whether the predictive generalizations of a theory hold true. By contrast, a study based upon a qualitative process of inquiry has the goal ...
In this example, qualitative and quantitative methodologies can lead to similar conclusions, but the research will differ in intent, design, and form. Taking a look at behavioral observation, another common method used for both qualitative and quantitative research, qualitative data may consider a variety of factors, such as facial expressions ...
Revised on June 22, 2023. Quantitative research is the process of collecting and analyzing numerical data. It can be used to find patterns and averages, make predictions, test causal relationships, and generalize results to wider populations. Quantitative research is the opposite of qualitative research, which involves collecting and analyzing ...
While the qualitative research relies on verbal narrative like spoken or written data, the quantitative research uses logical or statistical observations to draw conclusions. In a qualitative research, there are only a few non-representative cases are used as a sample to develop an initial understanding.
Having said that, the conclusion of a qualitative study can at times be quite detailed. This would depend on the complexity of the study. A questionnaire about likes and dislikes is simpler to score, interpret, and infer than a focus group, interview, or case study. In the case of a simpler study, you may reiterate the key findings of the study ...
Qualitative research is a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting. It focuses on the "why" rather than the "what" of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their every day lives.
Scientific research adopts qualitati ve and quantitative methodologies in the modeling. and analysis of numerous phenomena. The qualitative methodology intends to. understand a complex reality and ...
As far as the laws of mathematics refer to reality, they are not certain; and as far as they are certain, they do not refer to reality. Albert Einstein 1. Some clinicians still believe that qualitative research is a "soft" science and of lesser value to clinical decision making, but this position is no longer tenable. 2-4 A quick search using the key word qualitative on the Canadian Family ...
The conclusions are as stated below: i. Students' use of language in the oral sessions depicted their beliefs and values. based on their intentions. The oral sessions prompted the students to be ...
Convergent parallel: Quantitative and qualitative data are collected at the same time and analysed separately. After both analyses are complete, compare your results to draw overall conclusions. Embedded: Quantitative and qualitative data are collected at the same time, but within a larger quantitative or qualitative design. One type of data is ...
Whether you're dealing with qualitative or quantitative data, transparency, accuracy, and validity are crucial. Focus on sourcing (or conducting) quantitative research that's easy to replicate and qualitative research that's been peer-reviewed. With rock-solid data like this, you can make critical business decisions with confidence.
Qualitative research uses unstructured or semi-structured data collection techniques such as focus group discussions, whereas quantitative research uses structured techniques such as questionnaires. Moreover, qualitative research uses non-statistical data analysis techniques, whereas quantitative uses statistical methods to analyze data.
Data were collected prior to the implementation of SurgeCon, by means of qualitative and quantitative methods consisting of semi-structured interviews with 31 clinicians (e.g., physicians, nurses, and managers), telephone surveys with 341 patients, and structured observations from four EDs. ... Conclusion. Improving our understanding of the ...
Quantitative data is objective, handles large datasets, and enables easy comparisons, providing clear insights and generalized conclusions in various fields. However, quantitative data analysis lacks contextual understanding, requires analytical expertise, and is influenced by data collection quality that may affect result validity.
Convergent parallel: Quantitative and qualitative data are collected at the same time and analyzed separately. After both analyses are complete, compare your results to draw overall conclusions. Embedded: Quantitative and qualitative data are collected at the same time, but within a larger quantitative or qualitative design. One type of data is ...
5. Conclusion. This systematic review has provided a quantitative and qualitative analysis of empirical research papers in quantifying drought risk using indicators of hazard, exposure, and vulnerability. Several efforts have been made to review DRA research.
Small businesses play a significant role in global economies [1, 2] and growing businesses are especially important in creating jobs and contributing to economic growth [3,4,5].Previous research has shown the importance of managers' wellbeing for leadership behaviours [], employee health [] and business survival and effectiveness [8, 9].Managers' working conditions influence their ...
Background. This study aimed to qualitatively and quantitatively evaluate T1-TSE, T2-TSE and 3D FLAIR sequences obtained with and without Compressed-SENSE technique by assessing the contrast (C), the contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR). Methods. A total of 142 MRI images were acquired: 69 with Compressed-SENSE and 73 without Compressed-SENSE. All the MRI images ...
Know what the difference is between quantitative and qualitative research 3. Know the difference between exploratory and descriptive research 4. Know the types of exploratory and descriptive (and their pros and cons) Here's the best way to solve it. 1. **Variable**: - A variable is any characteri...