As a PAR project, a key goal was to provide feedback and information to health system leaders throughout the process of restructuring, allowing them to maintain an awareness of emerging leadership activities and needs. For instance, how many bombs would the Russians need to drop on the United States to destabilize the U. S. infrastructure? All these first-level codes were analyzed and further narrowed into several major pattern codes using the details of the text. There are challenges, however, with this research design. The following section provides a description of the Delphi process that focuses on the qualitative elements of the method. It isolated the independent role of leadership in constructively addressing this tension. Literature on the Delphi method indicated that participant attrition can be a major challenge, especially in the final rounds of a multi-round Delphi study (McKenna, 1994; Rotondi & Gustafson, 1995). Change management training was seen as most important for Groups 2 and 3 and second most important by Group 1, whereas training in communications was ranked highest by Group 1 and second highest by Groups 2 and 3. The theoretical foundation of the accuracy of prediction (prediction theory) appears to depend on a wide set of variables, including the individual and that individual’s knowledge background, preferences, and biases. This allowed participants to provide feedback on the findings and observations as they emerged. While the scale of their study was impressive, the number of participants (almost 300) would be very difficult for a doctoral dissertation. The study employed a modified Delphi method with the participation of health leaders as research partners. Simply select your manager software from the list below and click on download. For example, many were unable to discuss their own leadership or provide examples based on their experience. The second challenge identified was engagement, which was defined by most as ensuring “buy in” and involvement amongst health system actors at all levels. Although exercising very different levels of authority, from senior executive roles to front line implementation and delivery, all 39 were defined as change agents whose leadership characteristics and behaviours would influence the success or failure of Shared Services (Battilana, Gilmartin, Sengul, Pache, & Alexander, 2010). A typical Delphi study includes at least two rounds of questionnaires. PAR creates space for “non-academic community members to contribute to knowledge construction about the issue being studied” and seeks to understand how the issue plays out in participants' everyday lives (Billies, Francisco, Krueger, & Linville, 2010, p. 278). For the second round, the researcher provides the first-round data back to the group in a way so that bias is not introduced. The point here is that almost any topic is appropriate. A similar combination was used by Totikidis (2010), who conducted community-based participatory action research using Nominal Group Technique (NGT) to explore community health issues. However, less attention has been given to the specifically qualitative techniques in the process—particularly coding. Participants work anonymously. At present, the Delphi method has not seen widespread use in CEM research. Recommendations are provided to researchers wishing to use the Delphi method qualitatively (i.e., without statistical consensus) in a PAR framework while protecting the confidentiality of participants who work at different levels of authority. The PAR framework emphasizes participant involvement at all phases of the research project. As such, it s primary characteristics match those of interpretivism. The research can also add new information from a literature review to add to the information garnered from the panelists. (. Healthcare is probably the most common area of application for Delphi studies, and this may be because 1) it is easier to qualify "experts" to use as participants, and 2) the field of healthcare is so complex that it offers many crossovers into other areas such as education (e.g. Introduction - The Delphi technique is a research design, usually considered a qualitative method, which was designed to forecast viable solutions to problems where data was missing or incomplete. In searching the ProQuest Dissertations & Theses database, the growth in Delphi studies has been almost exponential. For participants in Group 1, the most desirable strategy was to increase engagement between the central Shared Services office and the front-line leaders in Group 3. An experimental application of the Delphi method to the use of experts, Developing an integrated career and competency framework for diabetes nursing, Using the Delphi technique to identify topics for a protected area co-management capacity building programme, The Delphi technique in health sciences education research, The practice of leadership in the messy world of organizations, Transformations in Canadian health systems leadership: An analytical perspective, Complex leadership competency in health care: Towards framing a theory of practice, Applying the Delphi technique in a study of GPs' information requirements, Enhancing rigour in the Delphi technique research, Research guidelines for the Delphi survey technique, Protecting respondent confidentiality in qualitative research, Consulting the oracle: Ten lessons from using the Delphi technique in nursing research, Successive surveys of an expert panel: Research in decision-making with health visitors. I look for people who are published or who present at professional meetings. There were four principal reasons the Delphi method was selected for this PAR project. As mentioned earlier, there are instances where using qualitative forecasting is more useful than quantitative methods. For more information view the SAGE Journals Sharing page. The original Delphi study set forth several key features of the method, specifically the use of a purposively selected panel of experts to achieve consensus on a particular issue or question over multiple survey rounds. Distributing leadership in health and social care: Concertive, conjoint or collective? However, because these concerns were voiced in a variety of ways, this important theme would have been missed if we had relied only on the deductive codes derived from the NVivo word frequency search. The first option authorized the research team to use all information provided by the participant, with the exception of the participant's name. Because it is exploratory in nature, the method is not recommended for use in areas with abundant theory and empirical literature, or where topics are already well defined (Mead & Moseley, 2001; Ziglio, 1995). The open-ended questions, which were asked first, provided an opportunity to inductively test the leaders' own experiences and perceptions against the LEADS framework. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. http://www.rand.org/content/dam/rand/pubs/papers/2008/P3558.pdf, https://hangouts.google.com/chat/person/111966120928693716501, Center for Leadership Studies and Organizational Research, Center for Educational and Instructional Technology Research, Center for Workplace Diversity and Inclusion Research, College of Information Systems and Technology. An Enterprise can opt one or multiple of the above methodology for Qualitative Risk Analysis. Presentation of the data is commonly the priorities in the order (averaged) as suggested by the panel, with some commentary noted from the participants. In this way, the Delphi method encourages careful data processing and responsible interpretation by keeping the researcher accountable to the participants' meanings and intentions. DELPHI METHOD IN QUANTITATIVE RESEARCH A graduate-level illustrated introduction to and tutorial the Delphi method, discussing quantitative applications and explaining fuzzy math approaches to Delphi networks. This is the round where the participants are asked to elaborate in detail as to the issues, their preferences, methods to fix the problem or help implement the solution(s). In this model, participating experts are questioned about their forecast two or three times. In the future, Delphi researchers should be careful to provide a detailed description of the process occurring between the first and second rounds of Delphi, wherein data are often converted from open-ended to survey or questionnaire format. These were questions that most people would not know, although some of the participants might be able to make more educated guesses than others. Shared Services is a controversial health restructuring initiative with potentially negative effects on health system employment and private sector as well as community-based suppliers of goods and services to individual health regions. Our use of a post-interview confidentiality form proved instrumental in obtaining ethics approval. The process resulted in 23 codes. Jiang, R., Kleer, R., & Piller, F. T. (2017). You can be signed in via any or all of the methods shown below at the same time. A similar question was also asked about strategies that were seen as conducive to Shared Services thus far. When statistics are available, quantitative analysis is more objective and precise. Members of _ can log in with their society credentials below, International Journal of Qualitative Methods, Postdoctoral Research Fellow, Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan, Canada, Professor and Canada Research Chair, Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan, Canada, This is an Open Access article distributed under the terms of the Creative Commons-Attribution-NonCommercial-ShareAlike License 4.0 International (. Questions as to who is an “expert” need to be answered. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? The project provided an opportunity to test and evaluate the accuracy of the new LEADS framework. Leadership development initiatives underlie individual and system performance in a US public healthcare delivery system, Jazz and the banyan tree: Roots and riffs on participatory action research, Nobody in charge: Distributed change agency in healthcare, Implementing strategic change in a health care system, Application of Delphi method in selection of procurement systems for construction projects, Change agency in a primary health care context: The case of distributed leadership, Leadership in public services networks: Antecedents, process and outcome. When I present the data, I show an abbreviated list of categories and (maybe) subcategories, and then present the themes and explain their development from the categories and subcategories. The study was a two-round Delphi project carried out over a period of 9 months (see Figure 1). The Delphi method is a formal, in-depth systematic qualitative methodology which was first studied by a team at the RAND Corporation in 1950, who made multiple practical applications of the method (Dalkey & Helmer, 1963). It has been suggested that because Delphi was a central point of activity in the Mediterranean world, the priests were also very adept at listening to what people were saying and putting together a future forecast based on “expert” knowledge. T. Kaplan, A., Skogstad, A. L., & Girshick, M. A. • Delphi focuses on participant anonymity from one another (there are rare exceptions). The interview questions were designed to foster a deeper understanding of the leadership abilities that most accurately constitute a “best practices” framework in health system redesign. The research project discussed here was one of five regional studies or “nodes” in a broader pan-Canadian project called “Leadership and Health System Redesign.” The main purpose of the pan-Canadian project was to examine effective leadership practices in various cases of health system change across the country and to compare them to existing frameworks for best practices in health leadership, such as the LEADS framework discussed below. Intellectual disability and independent living: Professionals’ views v... Avolio, B. J., Walumbwa, F. O., & Weber, T. J. As far as the number, Delbecq et al. Introduction - The Delphi technique is a research design, usually considered a qualitative method, which was designed to forecast viable solutions to problems where data was missing or incomplete. Delphi has been described as a qualitative, quantitative, and mixed-methods approach. suggested that the number be “a minimally sufficient number of respondents and seek verification of results through follow-up survey research” (p. 89). Is the Delphi technique valid? Overall, in both the self-assessment and assessment of others, the LEADS characteristic “modelling qualities such as integrity, honesty, resilience and confidence” was rated highest. Participants are seen as collaborators with the knowledge and agency to contribute to an understanding of the research and its results. The prediction of social events. (2002). Participants had the opportunity to withdraw such statements through the post-interview confidentiality form; therefore, their decision to ultimately provide the information indicates trust in the confidentiality of the process. The major determinants of the prediction of social events. In the Prairie Node research, we isolated and examined the leadership factor in this major health system redesign project. The studies by McGregor and Cantril both focused on psychological variables related to predictions, such as bias and preference. The Delphi method is a structured communication technique originally developed as a method of systematic and interactive forecasting based on a panel of experts. Priorities are condensed into those that are essentially the same and percentages calculated for the occurrence of each priority. Leadership development: Does it make a difference? Participants in the study represented three levels of authority within the health system and were categorized into three corresponding participant groups. There are no specific criteria established for selecting Delphi participants, but in my own study for an article I am writing on this topic, the primary consensus is that an expert has the appropriate education background and work experience and is regarded by peers as an expert or someone to whom they seek out for advice. Like PAR projects, the Delphi method produces information that can be put into practice by participants, making it particularly useful for policy- and decision-makers. The Delphi technique: Making sense of consensus. Ultimately, the researcher must do due diligence in defining the number of participants and support the decision as to the number used. Expertise and Number of Participants (“Sample size”) -. Purpose • Delphi is a group process for eliciting, collating, and generally directing informed (expert) judgment towards a consensus on a particular topic. The ideas of all participants are then subjected to discussion and evaluation by the entire group. An open comment field allowed participants to offer additional commentary or items they believed had been missed. Third, as discussed below, the Delphi method facilitated participants' use of the research results in their daily work on Shared Services. Although the literature provides advice on the use of quantitative and statistical measures in Delphi, particularly in the context of information systems research (Okoli & Pawlowski, 2004; Schmidt, 1997), little has been written about the process of qualitative data processing within the Delphi process, despite the fact that the first round typically involves an open-ended questionnaire or interviews to determine priority issues for subsequent rounds. The Delphi method: A powerful tool for strategic management. In contrast to Kaiser's form, ours excluded names by default because we perceived little benefit, and even potentially negative consequences, from including names. Modifications of the Delphi method abound. Our project focused on an in-progress case of health system change and, as such, followed the implementation of Shared Services in real time. However, many researchers argue that in Delphi studies, as in qualitative research generally, trustworthiness can be enhanced by presenting a clear “decision trail” that describes the appropriateness of the Delphi method for the particular problem under study and for the research procedures (Fink, Kosecoff, Chassin, & Brook, 1991; Powell, 2003). Delphi research occurs across several rounds and often over an extended period of time; as such, it requires a substantial commitment from participants. The method has been modified to serve a variety of purposes such as ordering issues by importance, defining an issue or concept, determining priorities, and identifying best practices. A fourth reason for selecting Delphi methodology is related to the PAR goal of action and change. (, Buchanan, D. A., Addicott, R., Fitzgerald, L., Ferlie, E., & Baeza, J. I. We would typically also indicate what was being sent back to the panel for the start of round two. They do not know who the other participants might be. Hsu, C.-C., & Sandford, B. The Delphi technique originated in the 1950’s as a research project funded by the United States Air Force and developed by the RAND Corporation. Delphi technique 1. To be thorough, the deductive process was combined with inductive open coding (Auerbach & Silverstein, 2003). McGregor, D. (1938). Nonetheless, the recognized importance of leadership is growing in both the scholarly literature and in health institutions (Avolio, Walumbwa, & Weber, 2009; Dickson, 2009), and there is a documented link between personal leadership and long-term improvement in health services (Boaden, 2006). Contact us if you experience any difficulty logging in. Consensus methods: Characteristics and guidelines for use. Poll method II & III III only I only I & II. Leadership: Current theories, research, and future directions, Leadership competencies for implementing planned organizational change, Chief executives and the modernization of the English National Health Service, Common factors across theories of marriage and family therapy: A modified Delphi study. e.g. The use of PAR in this particular context posed three specific challenges related to confidentiality: first, the research context was one in which participants were likely to be acquainted with one another; second, participants represented various levels of authority within the system, which meant that at times they were asked to comment on the leadership styles of those senior to them; and third, the inclusion of four health system actors as research partners, although a key feature of PAR, necessitated a careful balance between confidentiality and disclosure. Furthermore, the method allowed us to provide just-in-time information that participants could put into action. This proved an important finding and will be discussed further below. These authors are trying to evaluate the economic and societal implications of this relatively new technology in the year 2030. To do this, we used the word frequency query function of NVivo 9. Objectives • Become familiar with the qualitative research method known as the Delphi Technique. The majority of participants selected the first and most basic confidentiality option; however, four participants (at least one from each level of authority in the sample) selected the second option. At the same time, confidentiality was paramount. Available research on the combined use of Delphi and PAR is very limited; as such, we provide a rationale for this particular methodological combination, describe a research design using the combination to study health leadership, and illustrate how significant ethical issues were addressed using a post-interview confidentiality form (Kaiser, 2009). The project was designed to respond to current pressures within the Canadian health system, particularly a perceived tension between accessibility and quality in the context of escalating costs. This indicates that the Delphi method is not only suited to quantitative and consensus-building research but can also be applied to qualitative, participatory research. Practical Assessment, Research & Evaluation, 12(10), 1-8. Kaiser's original form contained four confidentiality options for participants to select from. The second part of the interview involved quantitative rating questions using a Likert-type scale of 0 to 10. Despite the potential of the qualitative Delphi for use in social science, far less methodological guidance exists in the literature for qualitative Delphi studies than in quantitative or mixed method studies. However, there are no limits. The least popular strategy was to increase communication between the Shared Services office and the Ministry of Health, possibly because this would bypass the health regions and might therefore be seen as less transparent. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. View or download all content the institution has subscribed to. Despite its importance, health leadership evades easy articulation, and its study requires a thoughtful methodological approach. I typically alphabetize my answers so there is no hint of the order of importance. We report several key findings to illustrate how the methodology produced useful information for health decision makers, and to show how it led us toward a more concrete articulation of the elusive concept “leadership.”. As issues and priorities were typically resolved at the end of round two, this third round can provide a very rich thematic underpinning to the data. Ethics approval was obtained from the University of Regina, the University of Saskatchewan, and four health regions, although only the two universities and one health region (the Regina-Qu'Appelle Health Region) had their own ethics boards. Create a link to share a read only version of this article with your colleagues and friends. I. Delphi method II. Because Delphi rounds occur without face-to-face meetings, individual participants' comments remain confidential while still facilitating “virtual” dialogue about the aggregated findings. As a PAR project, it was important that participants were able to verify, discuss, and shape the findings as they emerged. OM Test 2 Ch 4 Business Forecasting 63 Terms. The Delphi technique: A worthwhile research approach for nursing? Some had difficulty finding the words to describe leadership, which supports Dickson's (2009) assertion that “for many people, the qualities and actions that define quality leadership [are] elusive” (p. 296). Like Delphi, NGT is a tool for gathering group opinion, in which participants generate ideas silently and independently of each other. Each round provides an opportunity for the experts to respond and to revise their answer in light of the group members' previous responses. These challenges often necessitate restructuring and change. After round one, the aggregated data were returned to participants along with the researchers' interpretations of it. Round two data deals with the initial prioritization, commonly associated with textual defense of their priorities. After the first Delphi round, a high-level member of the decision-making reference group reported that, “the research project has given me a better understanding of the problems with the [Shared Services] Initiative … it was clear we had not engaged enough with front-line leaders and that is something that I am addressing now.” The Delphi method allowed us to return results to participants when they needed them, and not simply as a report presented after the fact. Health system partners were best able to identify key areas of correspondence and difference the... Important: the Delphi technique processes and its application to social policy and Public health problem of. Technique drawn from grounded theory ( Auerbach & Silverstein, 2003 ) as such, this important theme have. Site you are agreeing to our use of time but is essential in validating study... Relying on one single method is a qualitative, quantitative, and resource availability accessibility, quality, the... 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