Methodologies analysing individual practice in health care: a systematic review

Aim of the review. The aim of the systematic review was to identify, explore and evaluate the current level of knowledge of methodologies used in comparative analyses of the individual practice of doctors, nurses and midwives. Rationale. The question of how roles and responsibilities might be shared differently between professional groups in order to promote improved, cost-effective health care requires a systematic analysis of existing roles and practice. To do this effectively, knowledge of the methodologies available for such an analysis is essential. Methods. A systematic review of the literature published since 1989 comparing the practice of doctors, nurses and midwives was undertaken. Findings. The findings are presented in tabular format and include the following categories of published methodologies: experimental/quasi-experimental; descriptive/nonexperimental and qualitative studies. The discussion centres on a critique of quantitative methodologies used to analyse individual practice in relation to role substitution and diversification. The potential contribution of qualitative methodologies in the analysis of individual practice is discussed. Conclusions. The authors conclude that the current level of knowledge is biased towards quantitative research. It is argued that the assessment of health care roles and responsibilities would be well served by a more balanced approach that recognizes the strengths of both quantitative and qualitative work