ORR 5100 Module 4 Final Research Proposal: First-Year Experience of Hospital Registration Staff Example

Why New Registration Staff Leave: A Qualitative Research Proposal for an Urban Hospital

Student Name

Master of Science in Healthcare Management, Thomas Edison State University

ORR-5100: Qualitative Methods for Organizational Research

Mentor Name

Month Day, Year

Why New Registration Staff Leave: A Qualitative Research Proposal for an Urban Hospital

Introduction and Problem

Nearly two in five patient access representatives hired by an urban Camden hospital are gone within twelve months. Each departure costs roughly $9,000 to replace, and the vacancies slow registration in the emergency department. Exit surveys rate pay, schedule and supervision as unremarkable and attribute most departures to unspecified personal reasons. The hospital does not know why representatives leave, and without that knowledge it cannot design changes that would keep them.

Purpose and Research Questions

This study aims to understand, through representatives' own accounts, what the first twelve months in patient access are like at an urban hospital and what leads some to stay and others to go. The central question asks how representatives describe their first-year experience. Subquestions ask what aspects of the work they find most demanding and how they cope, how they describe the support they received, and what reasons current and former staff give for staying or going.

Literature Review Summary

Research on job embeddedness shows that links, fit and sacrifice keep people in jobs, and new employees have little of each (Mitchell et al., 2001). Research on emotional labor shows that managing displayed feelings can exact a cost, especially when employees fake expressions (Grandey, 2000). Research on newcomer adjustment shows that knowing one's role, feeling capable and feeling accepted all shape whether newcomers stay (Bauer et al., 2007). No study found in the review examines what the first year is like for frontline revenue cycle workers, who must show empathy to patients in distress while asking them for money. This study addresses that gap.

Research Design

The study takes a basic qualitative approach, aimed at the meanings people give their experiences (Merriam & Tisdell, 2016), within a constructivist paradigm. Data will come from semi-structured interviews, which allow participants to describe their experience in their own words while giving the interviewer a consistent guide.

Sampling and Recruitment

A purposive sample of 14 participants will pair seven people still in the role, each with between six and eighteen months of service, with seven who quit inside their first year during the last two years, varied by shift, entrance and prior experience. Research on saturation suggests that most themes in a fairly homogeneous group appear within about twelve interviews (Guest et al., 2006); up to four more interviews will be added if new themes continue to appear. Human resources, not the department manager, will send invitations, and former representatives will receive a $40 gift card.

Data Collection

A human resources interviewer will conduct 45 to 60 minute interviews using a seven-question guide that moves from descriptive to sensitive topics, with probes for each question (Kallio et al., 2016). Interviews will be audio recorded with consent, transcribed verbatim and supplemented by field notes. The guide does not ask about pay, schedules or supervision directly, so that participants' own priorities emerge.

Data Analysis

Analysis will follow the six phases of reflexive thematic analysis described by Braun and Clarke (2006).

Coding will be inductive, but the sensitizing concepts from the literature, embeddedness, emotional labor and newcomer adjustment, will be noted where they fit and set aside where they do not. A second coder, the human resources interviewer, will independently code three transcripts, and differences will be discussed to sharpen code definitions.

Researcher Role and Reflexivity

As manager of the department, I bring knowledge of the work and a stake in the results. Creswell and Poth (2018) ask qualitative researchers to state their position and consider how it shapes interpretation. My position could lead participants to soften criticism and could lead me to read the data in ways that protect my own decisions. The safeguards described above, a separate interviewer, de-identified transcripts, a second coder and a reflexive journal, are designed to limit both effects, and the report will state my role openly.

Pilot Interview

Before data collection begins, the interviewer will pilot the guide with one representative hired more than two years ago, who will not be part of the sample. The pilot will test whether questions are clear, whether the order feels natural and whether the interview fits within an hour. Kallio and colleagues recommend such pilot testing as the final phase of developing a guide, and any change the pilot prompts will be logged in the audit trail with its reason.

Trustworthiness

Qualitative work is usually judged on the four tests Lincoln and Guba (1985) set out: credibility, transferability, dependability and confirmability. Tracy (2010) offered broader criteria, including rich rigor, sincerity and resonance.

Ethical Considerations

Every participant will sign an informed consent form, may withdraw whenever they choose and will remain anonymous. Participants will be known only by codes; transcripts will sit on encrypted hospital storage, and audio files will be destroyed once transcribed. Because the researcher manages the department, interviews will be conducted by human resources and the researcher will see only de-identified transcripts. The proposal will go to the hospital's institutional review board before recruitment begins.

Timeline and Budget

The budget covers transcription of about 14 hours of audio at $1.75 per minute, about $1,470; gift cards for seven former staff, $280; qualitative analysis software for six months, about $600; and interviewer time of about 40 hours at $39 an hour, about $1,560, for a total of about $3,900.

Use of Findings

Findings will be presented to the director of revenue cycle and human resources with recommendations for onboarding, support and scheduling. If, for example, absorbing patients' anger emerges as a theme, the hospital could add de-escalation training and peer support in the first month. A later survey of all representatives could measure how widespread each theme is, building on this study's findings. Beyond the hospital, a summary with all identifying details removed may be submitted to a revenue cycle professional journal, since other hospitals face similar turnover.

Limitations

The study is set in one hospital and its findings will not generalize statistically. Former representatives may be hard to reach, and the ones who agree to talk may not resemble the ones who decline. Participants may still hesitate to criticize their employer despite the safeguards. The interviewer, though not the participants' manager, works for the hospital, and some former staff may distrust anyone connected with their former employer; offering video interviews from home may help.

Conclusion

This proposal sets out a feasible, ethical qualitative study that can explain why new registration staff leave. Its design, sample, interview guide, analysis plan and trustworthiness strategies are ready to implement, and its findings are tied to decisions the hospital can make. If the findings point to a change, such as peer mentoring in the first month, the hospital can test it with the next cohort of hires and measure first-year retention.

References

Bauer, T. N., Bodner, T., Erdogan, B., Truxillo, D. M., & Tucker, J. S. (2007). Newcomer adjustment during organizational socialization: A meta-analytic review of antecedents, outcomes, and methods. Journal of Applied Psychology, 92(3), 707-721. https://doi.org/10.1037/0021-9010.92.3.707

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage.

Grandey, A. A. (2000). Emotion regulation in the workplace: A new way to conceptualize emotional labor. Journal of Occupational Health Psychology, 5(1), 95-110. https://doi.org/10.1037/1076-8998.5.1.95

Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82. https://doi.org/10.1177/1525822X05279903

Kallio, H., Pietila, A.-M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954-2965. https://doi.org/10.1111/jan.13031

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.

Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and implementation (4th ed.). Jossey-Bass.

Mitchell, T. R., Holtom, B. C., Lee, T. W., Sablynski, C. J., & Erez, M. (2001). Why people stay: Using job embeddedness to predict voluntary turnover. Academy of Management Journal, 44(6), 1102-1121. https://doi.org/10.5465/3069391

Tracy, S. J. (2010). Qualitative quality: Eight "big-tent" criteria for excellent qualitative research. Qualitative Inquiry, 16(10), 837-851. https://doi.org/10.1177/1077800410383121