Table 1

 Approaches to the use of narrative in quality improvement research

ApproachOperational definitionUnit of analysis and analytical approachMain research methodsIntended output of researchExample
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 interviewResearcher collects the stories of service users and/or the people involved in the quality improvement initiativeIndividual narrative, analysed for structure, coherence, and meaning in a particular social contextUnstructured or semi-structured interviewInsights into individual experiences in the hands of the organisation/systemPatients’ experiences of dying of heart failure or lung cancer12
Naturalistic story gatheringResearcher becomes a field worker immersed in the organisation so as to collect “real” stories in informal space and interpret them in contextOrganisational subgroup, e.g. junior nurses. Analysed for subtleties in individuals’ and groups’ different interpretations of the same event/action over timeEthnographyThick description of organisational culture and how it influences particular behaviours and choices of individualsNurses’ experience of introduction of computerised records (involved both formal interviews and informal story-gathering)49
Organisational case studyResearcher 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 processesMultiple qualitative and quantitative methods e.g. interviews,questionnaires,documentary analysisDetailed description of “the case” as a context for events,plus chronological account of particular events as they unfolded during the studyImpact of learning facilitators on organisational change34
Collective sense-makingResearcher joins quality improvement team and works with them to develop a shared perspective on the problem and its causes, and to plan and implement actionChange team analysed for development and enaction of shared meanings/purposeAction researchAction intended to change (“organisational drama”)Action research study of quality improvement in a “failing” hospital trust45