Devising a Qualitative research methodology for conducting an Implementation study in Pakistan: A case of Hospital Autonomy Reforms

Abstract

This paper describes a research methodology which was developed to study the implementation of Hospital Autonomy Reforms in Pakistan. The research attempted to answer two questions: what happened? And why did it happen? (with regards to the implementation process of hospital autonomy reforms). The environment for this study was very political and characterized by high power distance and low rule of law. Moreover it had an aura of formality and reservation. Few respondents were willing to share information due to their status and busyness. The researcher had to develop a strategy to be flexible and innocuous to be able to accumulate relevant information. Moreover, respondents would rarely honor any official request for information about the process, so the researcher had to use personal connections to gain entry into the environment and to extract data. Main stakeholders were donors, politicians, bureaucrats and doctors. Long unstructured interviews were conducted with them.  For the second question, the technique of sense making was used to find out why reform adopted the specific strategy that it took. Use of contextual historical back ground data was made in this regards.

Key words: implementation study, sense making, qualitative research, stakeholders