Table 1

Approaches to the use of narrative in quality improvement research

Approach	Operational definition	Unit of analysis and analytical approach	Main research methods	Intended output of research	Example
Note: In practice, many empirical studies contain elements of more than one of these (e.g. the organisational case study that includes narrative interviews as one data source).
Narrative interview	Researcher collects the stories of service users and/or the people involved in the quality improvement initiative	Individual narrative, analysed for structure, coherence, and meaning in a particular social context	Unstructured or semi-structured interview	Insights into individual experiences in the hands of the organisation/system	Patients’ experiences of dying of heart failure or lung cancer¹²

Naturalistic story gathering	Researcher becomes a field worker immersed in the organisation so as to collect “real” stories in informal space and interpret them in context	Organisational subgroup, e.g. junior nurses. Analysed for subtleties in individuals’ and groups’ different interpretations of the same event/action over time	Ethnography	Thick description of organisational culture and how it influences particular behaviours and choices of individuals	Nurses’ experience of introduction of computerised records (involved both formal interviews and informal story-gathering)⁴⁹

Organisational case study	Researcher presents an account of the quality improvement initiative in the form of a detailed story	“The case” (perhaps the organisation), analysed for complex and dynamic influences on key events and processes	Multiple qualitative and quantitative methods e.g. interviews,questionnaires,documentary analysis	Detailed description of “the case” as a context for events,plus chronological account of particular events as they unfolded during the study	Impact of learning facilitators on organisational change³⁴

Collective sense-making	Researcher joins quality improvement team and works with them to develop a shared perspective on the problem and its causes, and to plan and implement action	Change team analysed for development and enaction of shared meanings/purpose	Action research	Action intended to change (“organisational drama”)	Action research study of quality improvement in a “failing” hospital trust⁴⁵