How do we work as researchers in the real world? Mapping the trajectory of methodological decision making in health services research

To the disbenefit of qualitative health services research, the generation of study design is too often implied as a logical consequence of aims or questions. Limited space is afforded to describing the critical processes we go through to devise our research for the ever-complex services we seek to understand. This article offers an in-depth examination of qualitative health services research design and the considerations inherent in the process. To illustrate, we present a worked example of our experience developing an investigation to characterize and explore multidisciplinary cancer service provision in hospital outpatient clinics. We map the development of our investigation from the a priori conceptualization of the phenomena of inquiry through to the detailed research plan, explicating the design choices made along the way. We engage with key issues for qualitative health researchers, which include how we make sense of and account for context; address multisite research considerations; design with and for stakeholder engagement; ensure epistemological, ontological, and methodological coherence; and select analytical and interpretative strategies. We arrive at a complex staged investigation that employs mixed and multi-methods to be conducted across a range of settings. Our purpose is to stimulate thinking about many of the contemporary design challenges researchers negotiate.