Sample Research Proposal on Proposal on Healthcare Associated Infections in UK Hospital

Introduction Poverty is one of the major causes of the uprising of health problems especially in poor nations and countries worldwide. Government and other people are burdened by the fact that the promotion of health is one of the most important responsibilities of every individual. However, the effect of poverty in the population health cannot be denied. Recent studies have shown that the wealthier nations are healthier as compared to economically challenged nations and countries (Schrecker, 2005). It was held by Harris and Sainsbury (2002) that in meeting the specific needs of the vulnerable populations and groups worldwide there must be a balance between accessible, high quality universal services, and targeted programs. With this, the World Health Organization have acknowledged the help that non-government organizations are extending to the poor people who are not able to access on proper health care system, sewage disposal, clean water, food safety.   Public health is the promotion of health at a community level by the government. It includes prevention of disease through supplying clean water, proper waste disposal, and legislation for clean air, health education programs, and medical care for the whole community through doctors, nurses, and hospitals (The Hutchinson Encyclopedia). Government acceptance of responsibility for public health began in the UK with the Public Health Act in 1848. Now, the welfare state, National Health Service, and health education and protection measures are a government responsibility. In the early 19th century concerned social reformers tried to improve the living conditions of the poor. In 1842, Edwin Chadwick recommended that investing in public health would improve the health and reduce the death rate among the poor. He contended that the expense of basic public health measures would be less than the cost of having to support a poor and unhealthy population (National Health Service in England).     Background An influence on the development of a new policy agenda for health promotion has been the rediscovery of the determinants or 'root causes' of excess morbidity and premature mortality which are external to individuals and provide the context for their behavior and actions. Several widely used models of health (Dahlgren & Whitehead, 1991; Labonte, 1998; Evans & Stoddart, 1994) illustrate the range of contextual factors, including the economic, psychosocial, cultural and physical environments, that shape overall population health and inequalities in health relating to socio-economic status, gender, age and other social positions.   Health promotion is increasingly characterized by working with key stakeholders or agents in decision making processes that affect outcomes (Springett, 2001), although the means of achieving collaborative practice are still not fully understood. Working with people and communities, 'people-centered health promotion' (Raeburn & Rootman, 1998) requires an ecological and holistic approach to health, one that can capture complex social phenomena (Springett, 2001).   Within health promotion, key principles of sustainability and community development are focused on. Health promotion approaches to justify the effectiveness of their practice and to demonstrate measurable outcomes. Internationally it has resulted in a number of initiatives, particularly in Europe, which aim to build an 'evidence base' for health promotion. Although in the process of the development of these initiatives there have been debates on what constitutes evidence in health promotion (McQueen, 2000; McQueen & Anderson, 2001) and the criteria by which evidence is defined have been subject to philosophical and theoretical scrutiny (Wiggers & Sanson-Fisher, 1998), there remains a danger that initiatives will encourage the very value systems they seek to challenge by buying into the notion of the existence of objective evidence.   Since 1997, the Government has set out a major program to improve public health and address health inequalities. The program includes action to eradicate child poverty, improve poor housing, raise employment, and strengthen communities, in order to address the deep-rooted causes of ill-health. It also includes major programs to prevent cancer and heart disease, and modernizing public health. The department's approach is to create an environment where people are encouraged and supported to adopt healthy lifestyles. This may be done by providing clear information to enable people to make their own decisions about choices that impact on their health, offering tailored support, personalized services and equal access, and by partnership working across communities (National Health Service in England).   The Department of Health in 2004 also issued the following standards, the minimum level of service that patients and service users have a right to expect, that health care organisations, including the NHS Foundation Trusts, and private and voluntary providers of NHS care are expected to meet in terms of safety; clinical and cost effectiveness; patient focus; accessible and responsive care; care environment and amenities; and, public health. The standards were divided into two categories – core and developmental. These standards are part of National standards, local action, the NHS three year planning framework, and are in line with actions set out in the NHS improvement plan (Department of Health, 2004).   Recognizing the multi-faceted nature of health, its production and maintenance, the tendency has been to assume that health promotion practice should encompass a similarly broad sweep. Whitelaw et al (1997) have argued that this tendency is unhelpful because it masks tensions between competing paradigms and agendas. Specifically, they warn that 'the creation of …"global" health promotion models could inhibit constructive debate around alternative perspectives on health' (480). They conclude by noting that 'permanent tensions' exist that need not necessarily be resolved. They identify three initial areas for attention: professional and political matters, technical and methodological dilemmas, and research questions. The challenge for practitioners is how they manage these tensions in order to deliver action that addresses contemporaneous policy agendas (Whitelaw et al, 1997, 487-8).     Statement of the Problem In this light, the following research questions serve as guidelines for the researcher to contribute to the existing data and information regarding the current condition of health promotion in UK focusing on the Healthcare Associated Infections in hospitals.   1.      What are the current healthcare problems among UK hospitals concerning healthcare associated infections?  2.      What are the problems and issues encountered among UK hospitals with regards to Ø      lack of cleanliness in NHS hospitals, Ø      poor levels of compliance with standard hygiene protocols and Ø      development of antimicrobial resistance|? 3.      How are the healthcare provisions and policies implemented and practiced among UK hospitals within the context of the general hospital strategies in response to associated infections? 4.      What policies should be reviewed in order to promote better healthcare provisions to the public concerning healthcare associated infections in UK hospitals?     Significance of the Study The effectiveness and cost-effectiveness of health promotion interventions are under increasing scrutiny in the new evidence-based cultural climate within the health sector in the UK. While there is some concern about the extent to which expectations relating to the success of health promotion practice are more pronounced than those relating to clinical practice, the problem most commonly identified by researchers is the unwillingness of funding and commissioning agencies to accept the validity and viability of non-experimental evaluation strategies.   This study will be able to divert limited resources from knowledge development to collecting evidence to satisfy a managerial agenda driven by searches for efficiency, cost effectiveness and quality assurance in public expenditure, which, in the UK at least, has led to an obsession with targets and indicators. Much better that those resources are invested in the development of approaches which address the complex holistic nature of the social change processes that constitute health promotion. It is also important that the methods and criteria of effectiveness used are consistent with the fundamental principles of health promotion, empowerment, participation, collaboration and equity.     Objectives of the Study In line with the presented research questions, the researcher aims to accomplish the following research objectives for the completion of the research activity:   1        To review and examine the current healthcare problems among UK hospitals concerning healthcare associated infections. 2        To determine problems and issues encountered among UK hospitals with regards to Ø      lack of cleanliness in NHS hospitals, Ø      poor levels of compliance with standard hygiene protocols and Ø      development of antimicrobial resistance|. 3        To determine how UK hospitals implement and practice healthcare provisions and policies concerning associated infections within the context of existing hospital strategies. 4        To assess and evaluate the existing policies in order to promote better healthcare provisions to the public concerning healthcare associated infections in UK hospitals.     Overview of Methodology This research study will be conducted under the qualitative paradigm using the qualitative means of data gathering. According to Gereffi (1999), in general, qualitative method is concerned with the quality of the collected data rather than the bulk of informants who participated. As such the study will operate primarily under the qualitative research approach wherein the quality of the information gathered rather than the quantity of sources that are available to the researcher, is highly recommended so as not to compromise the quality of the data (Guba & Lincoln, 1998; Lee, 1999; Gummesson, 2000).Due to the limited capability of the quantitative method as a single resource there is a need to provide a qualitative exploratory research procedure that will enable the researcher to perform in-depth analysis and extensive interpretation of the findings of the study (Flick, 1998).   Exploratory research normally involves open-ended study, unguided by theory and intended to provide a new body of empirical knowledge from which theories might be postulated (Yin, 2003; Robson, 2002) which the study will adapt in order to answer the study questions as well as answer to the objectives presented by the research project. As such the study will employ qualitative research method because it will attempt to find and build theories that will explain the relationship of one variable with another variable through qualitative elements in research. This permits a flexible and iterative approach. During data gathering the choice and design of methods are constantly modified, based on ongoing analysis allowing the investigator to drop unproductive areas of research from the original research plan. Through this method, qualitative elements that do not have standard measures such as behavior, attitudes, opinions, and beliefs will be analyzed.   The use of secondary data and information will be used as the primary data collection method which will also serve as validity and reliability indicators of the researcher ensuring that the collected data are balance and unbiased. Mac Naughton, Rolfe & Siraj-Blatchford (2001) elaborated that the protocols used to ensure accuracy of qualitative data through alternative explanations by utilizing different perspectives to examine issues are called triangulation. In case studies, this could be done by using multiple sources of data (Kaplan & Duchon, 1998; Foss & Ellefsen, 2002; Mingers, 2001). The need for triangulation arises from the ethical need to confirm the validity of the processes (Yin, 2003).   This involves the use of existing data, collected for the purposes of a prior study, in order to pursue a research interest which is distinct from that of the original work (Scarbrough & Tanenbaum, 1998; Ruspini, 2002). Single or multiple qualitative data sets, as well as mixed qualitative and quantitative data sets are used to support or challenge the findings of the study (Gilmartin, Hesse-Biber & Lydenberg, 1999; Heaton, 2000).   A triangulated research strategy wherein data, investigators, theories, and even methodologies are analyzed simultaneously to validate the findings of the study using different research approaches will be used (Darke, Shanks & Broadbent, 1998). The bulk of the study will be facilitated under the qualitative paradigm so as to elicit thick information which will be helpful in conceptualizing the arguments of the research endeavour.  An in-depth analysis on the findings from the information collected through secondary data gathering techniques will be made focusing on the comparison of the different cases that the study will reveal during the organization of the data. In this regard, an in-depth cross-case comparison analysis will be the main methodology.     Data Analysis and Presentation For the data analysis of the concepts of the study, content analysis will be utilized in the research study. Content analysis is the systematic, replicable technique for compressing many words of text into fewer content categories based on explicit rules of coding (Markel, 1998; Fico, Lacy & Riffe, 1998; West, 2001). It is not restricted to the domain of textual analysis but could also include the categorization of illustrations or drawings (Wheelock, Haney & Bebell, 2000) as well as behaviors of individuals that are video tape recorded (Stigler et al, 1999).   The data collected through the key informant interview method were used and manipulated by utilizing the open-coding and axial coding procedures (Fico, Lacy & Riffe, 1998). This facilitated easier analysis of the qualitative information gathered as patterns, similarities and differences of the responses made by the informants of the study were classified and categorized to form logical data analysis and presentation. As such labels, words and statements that were used by the participants to denote or connote similar concepts and themes were grouped and analyzed accordingly to summarize the core findings of the study (Kerig & Lindahl, 2001; Fairclough, 2003).   As such, content analysis enables researchers to sift through large volumes of data with relative ease in a systematic fashion (Markel, 1998; Fico, Lacy & Riffe, 1998; West, 2001) and is a useful technique for allowing us to discover and describe the focus of individual, group, institutional, or social attention (Kulm, Dager Wilson & Kitchen, 2005) which allows inferences to be made which can then be corroborated using other methods of data collection. In the cross-case analysis approach of the study, content analysis facilitated organized and logical sorting of large data from interviews in order to arrive at simpler concepts for analysis and discussion as well as in-depth interpretation of the specific cases that were explored so as to come up with holistic analysis of the findings of the study. As such attributes, constructs and other similar connotations of the topic of the study were grouped together to synthesize the results of the study as well as to mange the data more effectively and efficiently.   Limitations of the Study             The broad scope of the research topic is the foremost concern when it comes to the identifiable limitations and barriers of the research activity. But the holistic approach likewise will enable the researcher to contribute fully to the academe. Limitations and shortcomings could be expected in the data gathering procedures starting from the sampling techniques that will be used to identify and select the specific journal articles that will be used as the primary source of data as gathered by previous researchers. But with the support of the academe to the research activity and the explanations that will be provided regarding the important contributions of the study to the business industry upon completion, will serve as gateway to the successful research accomplishment. Other political, economic, as well as social issues and constraints are also expected while conducting the research activity which will be evident in the different stakes of the participants and the companies they represent.     Planning the gathering period while keeping in mind the possible constraints that could be encountered in the field as well as the time available to complete the investigation will prepare the researcher in the further execution of the research project.