A realist interview and a descriptive interview- what is the difference?

We are a team of researchers investigating models for health systems reform and quality improvement. This abstract considers interviews undertaken during investigation of two such models, Lean and Clinical redesign. We have... [ view full abstract ]

We are a team of researchers investigating models for health systems reform and quality improvement. This abstract considers interviews undertaken during investigation of two such models, Lean and Clinical redesign. We have conducted descriptive interviews on the implementation of Lean across the Saskatchewan health system (Canada) and realist interviews on the implementation of Clinical Redesign across the Tasmanian health system (Australia). Lean is a management system being implemented across the Saskatchewan health system since 2008 with the vision to create better health, better value and better teams. Clinical Redesign is an approach that is being implemented across the Tasmanian health system since 2013 with the vision to improve service delivery across all aspects of the patient journey and develop and implement sustainable change processes to improve the way healthcare is delivered.
Research Purpose: The purpose of this investigation is to compare and contrast the implementation of system redesign between Saskatchewan and Tasmania health systems.
Methods: To date we have conducted 27 qualitative descriptive interviews across the Saskatchewan health system and 22 realist interviews across the Tasmanian health system.
Poster purpose: To describe the challenges and learning opportunities for the members of our team who were new to realist interviewing in understanding the similarities and differences between realist and descriptive interviews.
Findings: Key differences between realist and descriptive interviews are in the development and the purpose of the questions. Realist interview questions are developed based on a program theory, to refute, refine and or reaffirm the program theory. Tailoring the interview questions in realist interviews to reflect the knowledge held by the participants was different to the descriptive interviews, and this iterative process to interviewing was challenging. Realist interviews also delved deeper into the questions of ‘how’ and ‘why’ rather than seeking a description of the phenomena being studied. The relationship between the interviewer and the interviewee in realist interviews is a teacher- learner approach and this requires a different approach to the interview process. The aim of analysis for realist interviews is to extract context- mechanism- outcome configurations about the program theory. This analytical approach is unique to realist interviews and requires a different way of thinking. We also experienced similarities between these two methodological approaches. The importance of the interaction between the interviewer and the interviewee, social, listening and communication skills by the interviewer are important in both approaches. These skills are transferable to either methodological approaches.
Discussion: It is important for qualitative researchers and trainees to understand that interviews underpinned by different methodologies require different approaches to the interview process. The decision to choose a particular interview method is often guided by clear principles, but how the interviews should be planned, conducted and analysed requires clear guidelines, particularly to remain faithful to the realist approach. Guidance for realist interviews would be useful for trainees and researchers that are new to this methodology.