Qualitative research in Operations and Supply Chain Management, the importance of coding
This is practical guide on the usage of qualitative research coding, something I found challenging in my research. I used semi-structured interviews, and for the data analysis, I used NVivo, a qualitative computer-assisted software. NVivo is a powerful tool for codes, cases, and cluster analysis, while it is easy to use (Bryman & Bell, 2015). Most of the codes came from my Systematic Literature Review, and others emerged during my interviews. My study used first cycle and second cycle codes. I used the following elemental methods found in Saldaña (2016) and Miles and Huberman (2014): Descriptive coding, process coding, and concept coding in the former, and pattern coding in the latter. The coding process is following described.
First, I reviewed the De Vries model (2011) and adjusted it for this research, embedding it as the foundation of the new revised model. The surgeons were the only stakeholder group considered in my study. Also, I narrowed the research exclusively for physician preference items (PPI) inventory management (IM), a tough challenge for hospitals according to my literature review (Montgomery and Schneller, 2007).
Moreover, De Vries model embedded in the Resource Dependency Theory (RDT) introduced by Pfeffer (1979) proposed that power is crucial for analysing and comprehending resource-dependent relationships. According to RDT, power makes people do things they otherwise will not do, change the course of events or influence behaviours with the establishment of hierarchical authority. Hence, I suggested four first cycle codes for evidencing surgeon's power, and then I grouped them in a second cycle pattern code.
Another fundamental element of the RDT and the De Vries model is the surgeon's interests that mould the inventory system. During the empirical project, surgeons had concerns in the inventory systems for different motives like patient's health and safety, improved clinical outcomes and the construction or growth of surgeon's reputation. I proposed them as first cycle codes and presented a second cycle pattern labelled "interest of surgeons".
Surgeon’s power and interest shape or reshape the inventory system according to De Vries model. Therefore, I proposed codes for determining the elements of the inventory system that surgeons (re)shaped and how this process takes place. I seized these codes from my literature review that reported practices in the planning and control inventory system, the physical inventory system and the information system. Besides, I wanted to understand if the surgeons shaped other practices linked to the inventory management practices, and if so, which of these practices they changed and how they changed them.
I found in the SLR that the surgeons influence the selection of preferred items (PPI). Therefore, the code "influencing the purchasing process" was offered for seizing it. I listed the IM practices with first cycle codes and a second cycle code labelled “shaping the inventory management practices”. My research explored which of the IM practices changed and explained how the surgeon’s influence shaped them.
According to the De Vries model, the influence generates modifications in the inventory system. Those changes are perceived by physicians and enter the surgeon's characteristics as new information that may reshape inventory management practices, represented in the second-cycle concept “Perceived outcomes of the inventory system”. The De Vries model dealt with inventory project management and not inventory management practices, so my theoretical model can't capture if the surgeon's influence shapes the IM practices or reshapes them. Nevertheless, I considered it necessary to describe these inventory system perceptions in the first-cycle codes " Perceived improvements of the IM system ", " Perceptions of the logisticians ", and “Qualitative appraisal of the Inventory Management”.
The new (re)shaped inventory system fluctuates in its usage amongst the different stakeholders (physicians, logisticians and managers in this study). Consequently, surgeons may also influence the use of the (re)shaped inventory system. During the research, the second-cycle code "Influencing the usage of the inventory system" seized this last effect. I arrived at this pattern code after analysing how the pharmacy committee and the standardisation of clinical guidelines influence its usage.
As a final point in the De Vries model, the surgeon's influence in the IM practices affects the IM performance. I reported the inventory hospital's performance indicators during the empirical project as the second cycle code "IM performance" and four codes, "FTE in the logistics department", "inventory turnover", “inventory accuracy” and "surgery cancellation", formed it. The analysis produced comparisons among the efficiency dimension measured as full-time equivalent logistics employees, inventory turnover and inventory accuracy. Also, the perception of the availability of medical devices and surgery cancellation captured the perception of IM service, critical in healthcare.
The extended model
Then, I built the theoretical model. The new model elements are the De Vries model (2011), the vendor’s influence on the surgeon’s characteristics, the profit or non-profit hospital's orientation, its influence on surgeons, and the private or NHS funding orientation and its influence on surgeons. I also included in the model possible strategies that hospital’s managers can implement for engaging surgeons in IM practices. The extended model is shown below in
I reported in five codes the influence of PPI’s vendors in surgeons. The medical devices producers and the distributors were the vendors in the study. As seen in the author’s positioning study, the variability in surgery depends on the clinical product, the surgical technique and the patient’s physiology. Vendors influence products through the training of surgeons for a determined approach. These new methods influence the surgeon’s interest, especially the building and growth of his/her reputation. The second code found in the surgeon’s wish list specialities in PPIs possibly increases power or interest. The third code explored was the “vendor’s relationship” concept and how this influences the process. In the fourth code, the author found that vendors hired surgeons to receive salaries and influence IM practices. Finally, some of the interviews mentioned other benefits associated with non-ethical behaviours.
I also explored that hospitals that present a private-funding orientation created a context that influences the surgeon’s characteristics. This context was determined by the codes “Surgeon’s reputation as patient’s selection criteria”, in which physicians contribute to increase or maintain hospital patient’s demand. Hospitals in this context recruited and attracted surgeons offering any PPI wanted. The author used the “Open menu in PPI selected as a surgeon’s recruiting strategy” code for this purpose. On the other hand, NHS-funding orientation hospitals have a more limited PPI selection menu, and the author used the code “items funded by the NHS”. Efficiency and cost-efficiency concepts were mentioned and captured in the code “looking for efficiencies in the NHS”.
I also found that for-profit and not-for-profit oriented hospital created contexts in which the surgeon’s influence varies. For-profit oriented hospitals make different restrictions that influence IM practices through the financial department looking for efficiencies and captured in the codes “finance performance influencing the clinical performance” and “delivering profits to shareholders”. On the other hand, non-for-profit institutions presented codes like “clinical autonomy” and “educating and influencing the medical practice” that generates different behaviours toward power and interests, and I propose as traits of this context.
Finally, I explored with the first-cycle codes “hospital-based physicians” and “code of ethics” the strategies for managers to deal with the influence of surgeons in the inventory system. The former appeared in the SLR, whilst the second popped up during the interviews and formed the second-cycle code “engaging surgeons in the IM practices”.