The Collaboration Compass

229 Pages·2017·3.33 MB·English

Northumbria Research Link
Citation: Turnbull, Lindy (2017) The collaboration compass: Using grounded theory to map interactive
navigation. Doctoral thesis, Northumbria University.
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The Collaboration Compass: Using
Grounded Theory to Map Interactive
Navigation

L. L. Turnbull

D Nursing
2017
The Collaboration Compass: Using
Grounded Theory to Map Interactive
Navigation

L. L. Turnbull

A thesis submitted in partial fulfilment
of the requirements of the University
of Northumbria at Newcastle for the
degree of Professional Doctorate

September 2017

2
Abstract

Collaboration is central in the transformation and sustainability of future healthcare
with a clear place in integrated models of care, but the operationalisation of
collaborative working presents challenges in practice. There is a lack of evidence
about how collaboration is sustained in the delivery of healthcare, and a deficiency
of studies which include patients as part of collaboration. This thesis investigates
the meaning and manifestation of collaboration, including the experience of patients
and professionals in practice.
A social constructionist approach to grounded theory is used to investigate
collaboration in an Outpatient Parenteral Antimicrobial Therapy (OPAT) service. The
sample consists of staff and patients who have experience of OPAT. Interviews and
focus groups are used to generate data, and grounded theory methods are used to
progress the study through constant comparative analysis and theoretical sampling
to a point of data saturation. Coding, categorising and techniques of situational
analysis are used to analyse data and develop theory.
The theory of Interactive Navigation conceptualises collaboration as a device used
to navigate complex care situations and to direct collaboration with differing
consequences for patients and professionals. The factors which influence
collaboration are found to be a range of Situational Co-ordinates (Certainty,
Uncertainty, Limits, Goals and Power) and interaction takes place through
Interactive Mechanisms (Rehearsing, Coordination, Communication and Trust). The
Collaboration Compass model is presented as a tool to inform understanding of
Developing, Maintaining, Limiting and Disrupting collaboration.
Collaboration is differentiated into four distinct areas and is revealed as a social
device integral to the situation in which it takes place. This complexity requires
recognition if collaborative health and social care developments are to succeed. The
theory of Interactive Navigation presents a new way to view collaboration, and the
Collaboration Compass offers a tool to navigate situations and map collaboration in
practice.

3
Contents
Abstract ................................................................................................................................. 3
List of Figures and Tables .................................................................................................. 8
Figures .......................................................................................................................... 8
Tables ........................................................................................................................... 8
Acknowledgements ............................................................................................................. 9
Authors Declaration........................................................................................................... 10
Chapter One – Introduction and Background ................................................................ 11
Introduction ................................................................................................................. 11
Experiences in Professional Practice ..................................................................... 12
Outpatient Parenteral Antimicrobial Therapy ......................................................... 13
Reflection on Practice ............................................................................................... 14
Collaboration as a Concept ...................................................................................... 15
Collaboration in Healthcare ...................................................................................... 16
Policy and Drivers...................................................................................................... 17
Unanswered Questions from Practice .................................................................... 20
Overview of the Study ............................................................................................... 21
Research Questions .................................................................................................. 21
Study Design .............................................................................................................. 22
Personal Influences and a Change of Role ........................................................... 23
Overview of Thesis .................................................................................................... 23
Conclusion .................................................................................................................. 24
Chapter Two - Literature Review .................................................................................... 25
Introduction ................................................................................................................. 25
Approach to Reviewing Literature (Initial Interactions) ......................................... 25
Initial Scoping of the Literature ................................................................................ 27
Learning from the Literature ..................................................................................... 39
Establishing an On-going Relationship with the Literature .................................. 40
Approach to Reviewing Literature (Ongoing Interactions) ................................... 42
Conclusion .................................................................................................................. 43
Chapter Three - Theoretical Orientation ........................................................................ 44
Introduction ................................................................................................................. 44
Ontology and Epistemology ..................................................................................... 44
The Plurality of Practice ............................................................................................ 44
4
Social Constructionism ............................................................................................. 45
Theoretical Orientation to Paradigm and Methodology ........................................ 47
Paradigm and Practice ............................................................................................. 50
Twenty First Century Grounded Theory Methodology ......................................... 51
Situational Analysis ................................................................................................... 52
Developing and Expanding the Theoretical Orientation ....................................... 54
Symbolic Interactionism ............................................................................................ 55
Evaluating Symbolic Interactionism ........................................................................ 57
Action, Agency and Structure .................................................................................. 60
The Iowa and Indiana School of Symbolic interactionism.................................... 61
Structuration Theory .................................................................................................. 62
Conclusion .................................................................................................................. 63
Chapter Four - Research Design .................................................................................... 64
Introduction ................................................................................................................. 64
Study Design .............................................................................................................. 64
Consideration of the Research Situation ................................................................ 64
Reflexive Methods ..................................................................................................... 65
Tools of Reflexivity .................................................................................................... 67
Accessing the Research Situation: the Role of the Gatekeeper ......................... 68
Sampling ..................................................................................................................... 69
Sampling Strategy ..................................................................................................... 70
Data generation ......................................................................................................... 75
Methods of Data Analysis ......................................................................................... 80
Theoretical Sensitivity ............................................................................................... 84
Ethical Issues ............................................................................................................. 85
Conclusion .................................................................................................................. 87
Chapter Five - Data Analysis ........................................................................................... 89
Introduction ................................................................................................................. 89
Stages of Analysis ..................................................................................................... 89
Coding ......................................................................................................................... 90
Relational Maps ......................................................................................................... 91
Categorising ............................................................................................................... 93
Constant Comparison and Reflexivity..................................................................... 95
Situational Analysis ................................................................................................... 97
5
Abductive Reasoning, Agency and Structure ...................................................... 102
Social World Mapping ............................................................................................. 104
Integrating Categories............................................................................................. 107
Positional Mapping .................................................................................................. 109
Developing Theoretical Concepts and Abstracting Theory ................................ 111
Conclusion ................................................................................................................ 113
Chapter Six - Findings .................................................................................................... 115
The Collaboration Compass and Interactive Navigation ........................................ 115
Introduction ............................................................................................................... 115
The Collaboration Compass: A Conceptual Model ............................................. 115
Orientation using Situational Co-ordinates .......................................................... 117
Interactive Mechanisms .......................................................................................... 122
Interactive Navigation using the Collaboration Compass .................................. 125
Silences in the Data ................................................................................................ 140
Conclusion ................................................................................................................ 141
Chapter Seven – Discussion ......................................................................................... 142
Introduction ............................................................................................................... 142
The Challenge of Representing Complex Collaboration .................................... 142
The Complexity of Collaboration in Practice Situations ..................................... 143
The Role of Structure and Agency in Collaboration ............................................ 144
Navigating the Situation .......................................................................................... 146
Finding Collaborative Direction .............................................................................. 150
Interactive Navigation and Power.......................................................................... 156
The Collaboration Compass and Interactive Navigation in Theoretical Context
................................................................................................................................... 162
Conclusion ................................................................................................................ 166
Chapter Eight – Summary and Implications for Future Collaborative Practice ....... 168
Introduction ............................................................................................................... 168
Summary of Key Findings ...................................................................................... 168
Implications for National and Local Policy............................................................ 170
Implications for Collaborative Practice ................................................................. 174
Implications for Research ....................................................................................... 177
From Reflection to Reflexivity and Back Again ................................................... 179
Conclusion ................................................................................................................ 182
6
References ....................................................................................................................... 184
Appendix A ....................................................................................................................... 211
University Ethics Committee Letter ....................................................................... 211
Appendix B ....................................................................................................................... 212
NHS Ethics Committee Letter ................................................................................ 212
Appendix C ....................................................................................................................... 216
NHS Trust Research and Development Department Letter .............................. 216
Appendix D ....................................................................................................................... 218
Letter of Invitation to Participants .......................................................................... 218
Appendix E ....................................................................................................................... 219
Patient Participant Information Sheet Appendix .................................................. 219
Appendix F ....................................................................................................................... 221
Staff Participant Information Sheet ....................................................................... 221
Appendix G....................................................................................................................... 223
Consent Form .......................................................................................................... 223
Appendix H ....................................................................................................................... 224
Semi-structured Interview Protocol ....................................................................... 224
Appendix I ........................................................................................................................ 226
Focus Group Protocol ............................................................................................. 226
Appendix J ........................................................................................................................ 229
Coordinating Category Map ................................................................................... 229

7
List of Figures and Tables
Figures
Figure 1: Timeline of Research Journey ....................................................................... 21
Figure 2: Collaborative Links .......................................................................................... 74
Figure 3: Theoretical Sampling ...................................................................................... 74
Figure 4: Word Cards ....................................................................................................... 79
Figure 5: Situational Map and Relational Analysis....................................................... 81
Figure 6: Social World Map ............................................................................................. 82
Figure 7: Positional Map .................................................................................................. 83
Figure 8: Participant A Data: Messy Relational Map (Coordinating) ......................... 92
Figure 9: Participant A Map: Category (Coordinating) ................................................ 94
Figure 10: Participant D Data: Colour Coded D ........................................................... 94
Figure 11: Participant D Map: Colour Coded Categories ............................................ 95
Figure 12: First Situational Map ...................................................................................... 98
Figure 13: Situational Map: Coordinating/Facilitating Category and Sub-categories
........................................................................................................................................... 100
Figure 14: Situational Map: Trusting Category and Sub-categories ........................ 100
Figure 15: Situational Map: Rehearsing Category and Sub Categories ................. 101
Figure 16: Situational Map: Power Category and Sub-categories ........................... 101
Figure 17: Situational Map: Nine Situational Categories .......................................... 102
Figure 18: Social World Map 1 ..................................................................................... 105
Figure 19: Social World Map 2 ..................................................................................... 106
Figure 21: Conceptual Diagram 2 ................................................................................ 108
Figure 22: Positional Maps 1 ........................................................................................ 110
Figure 23: Positional Maps 2 ........................................................................................ 112
Figure 24: Final Situational Map: Theoretical Categories and Sub-categories. ..... 112
Figure 25: Conceptual Diagram 3 ................................................................................ 113
Figure 26: Interactive Navigation: Underpinning Categories and Sub-categories . 116
Figure 27: The Collaboration Compass Model ........................................................... 116
Figure 28: Situational Co-ordinates ............................................................................. 117
Figure 29: Interactive Mechanisms .............................................................................. 123
Figure 30: Positional Map for Developing Collaboration ........................................... 126
Figure 31: Positional Map for Maintaining Collaboration........................................... 132
Figure 32: Positional Map for Limiting Collaboration ................................................. 134
Figure 33: Positional Map for Disrupting Collaboration ............................................. 137
Figure 34: The Collaboration Compass Model ........................................................... 170
Tables
Table 1: Participant Details .............................................................................................. 72
Table 2: Itinerary of Interviews and Focus Groups....................................................... 76
Table 3: Stages of Analysis ............................................................................................. 90

8
Acknowledgements

Many people have helped me during my studies, and there are too many to name
individually, but I would like to acknowledge and express particular thanks to the
following:
Professor Susan Carr for her support, encouragement and excellent supervision,
and Carol Wills for her support during the early part of my doctoral journey.
I am grateful to Northumbria University and County Durham and Darlington NHS
Foundation Trust for their support.
My friends and family have been stalwart in their understanding, support and
encouragement. I’m so grateful to my husband Paul for his confidence in my ability,
and for reading every word. To my daughter Emma for sharing in the doctoral highs
and lows, my son David for his assurance that everything would get done, and to
my sister Gillian, for keeping track of my reading and for providing regular email
encouragement. Thank you also to my amazing friends Liz and Dot, who led the
way and who remained sure that I would follow.
I am particularly grateful to all the participants in my study who gave me their time
and insight. It was a great pleasure to interview all of them.
This thesis is in memory of Participant B, who was so generous in sharing his very
precious time. It was an honour.
9