Abstract
Previous research found professionalism and regulation to be competing discourses when plans for medical revalidation in the United Kingdom were being developed in 2011. The purpose of this study was to explore how these competing discourses developed and how the perceived purposes of revalidation evolved as the policy was implemented. Seventy-one interviews with 60 UK policy makers and senior health care leaders were conducted during the development and implementation of revalidation: 31 in 2011, 26 in 2013, and 14 in 2015. Interviewees were selected using purposeful sampling. Across all interviews, questions focused around three areas: individual roles in relation to revalidation; interviewees' understanding of revalidation, its purpose, and aims; and predictions or experiences of revalidation's impact. The first two interview sets also included questions about measurement and evaluation of revalidation. Data were analyzed using the constant comparative method to understand changes and continuities. Two main discourses regarding the purpose of revalidation were present across the implementation period: professionalism and regulation. The nature of the relationship between these two purposes and how they were described changed over time, with the separate discourses converging, and early concerns about actual or potential conflict being replaced by perceptions of coexistence or codependency. The changing nature of the discourse about revalidation suggests that early concerns about adverse consequences were not borne out as organizations and professionals engaged with implementation and experienced the realities of revalidation in practice. Reconciling professional and regulatory narratives was arguably necessary to the effective implementation of revalidation.
Highlights
Elicit new theories of how revalidation influences medical performance, through its impacts on organisational systems and processes related to medical performance
One accessible way of thinking about them is in terms of “resources and reasoning” that actors may make use of/apply. This has been further complicated by our use of the term “mechanism” to refer to organisational systems and processes related to medical performance
Focus on new theory elicitation rather than on theory confirmation, at least in initial interviews. a. This will give the research team more time to consider how theory confirmation/development and triangulation will be integrated into the project, and we may gain useful learning from the first few interviews that will help with this
Summary
1. Elicit new theories of how revalidation influences medical performance, through its impacts on organisational systems and processes related to medical performance (job planning, CPD, clinical audit). 2. Confirm/further develop theories previously derived from the research/evaluation literature, policy analysis and previous interviews. 3. Snowballing: signposting to additional information sources (e.g., project evaluations, additional interviewees). 4. Secure appropriate further engagement in our project (e.g., input to prioritise theories for further investigation; membership of project steering group)
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