Faced with new responsibilities and skeptical about the relevance of qualitative research techniques, you nevertheless try them and learn in the process that developing an ideal clinical operation will require effort and patience. With small discretionary funds and an equipment request for a VCR and monitor, you can easily improve the quality and appeal of educational material in the waiting room. But finding alternatives to an oversold parking structure to help diminish unmanageably late arrivals and patient frustration will be virtually impossible. You learn that although your department's plans to increase the profile (and profit) of the outpatient clinics holds potential rewards for all involved parties, little has been done to negotiate limited resources from overextended hospital services. This will be a large portion of your Job, and possibly its greatest challenge. Without qualitative techniques you most likely would have discovered this information when programs or changes you proposed met resistance and perhaps frustrated or angered others. But with them you gain the foresight to anticipate and avoid obstacles rather than run in to them. You do so in a way that includes contributors at all levels of the hospital, enlisting them prospectively in programs both you and they can see as collaborative. With the goodwill of a newcomer, you establish meaningful contacts in multiple hospital services and better understand their responsibilities, affiliations, ambitions, and limits. You thereby identify likely areas of administrative movement and friction throughout the system that you can account for in present and future plans. Beyond this administrative scenario, qualitative approaches can be equally useful in managing clinical, educational, and other challenges that arise in outpatient settings (Table 2). Whether physicians are seeking to improve patient adherence, recruit trainees into generalist careers, or negotiate with superiors, taking time to discover what is important to patients, students, educators, section heads, and other leaders can put physicians in a position to elicit the best performance and contributions of each. Physicians may already consider themselves well trained to observe and gather facts from other people, but qualitative research provides the principles and structure to do so in an empiric, trustworthy, and systematic manner. Admittedly, the procedural differences between qualitative research and everyday practice may not seem nearly as great as those between daily practice and quantitative research. Although this fact might be used to reinforce the impression that qualitative investigation lacks rigor, it requires much of the same effort, attention to procedures, resistance to bias, and attention to data integrity that characterize other methods. We have hoped to illustrate that the 'proximity' between this form of research and practice can be used to practical advantage-to enhance our understanding of our patients and day-to-day settings, the meaningfulness of our interventions, and thereby our effectiveness in dally professional responsibilities.
