On the Problems of Mixing RCTs with Qualitative Research: The Case of the MRC Framework for the Evaluation of Complex Healthcare Interventions

In the perceived hierarchy of research designs, the results from randomized controlled trials are considered to provide the highest level of evidence. Indeed these trials have been upheld as the gold standard in research. The benefits and limitations of the randomized controlled trial as a method of evaluating the effectiveness of healthcare interventions are presented. The article then examines the different levels of complexity within healthcare interventions and the problems this poses in determining effectiveness. In an effort to provide a solution to this problem, the Medical Research Council produced a framework to assist investigators to develop and evaluate complex healthcare interventions. The framework is described with reference to an example of implementing and evaluating protocols for weaning patients in the intensive care unit. The framework is critiqued on the basis that it involves an ambiguous or contradictory ontology, which fails to articulate the relationship between the positivism of randomized controlled trials with the relativism of qualitative approaches. It is concluded that the use of realist strategies in combination with randomized controlled trials provides the most coherent solution to this quandary

Reconceptualising employee silence: problems and prognosis

A growing literature has emerged on employee silence, located within the field of organisational behaviour. Scholars have investigated when and how employees articulate voice and when and how they will opt for silence. While offering many insights, this analysis is inherently one-sided in its interpretation of silence as a product of employee motivations. An alternative reading of silence is offered which focuses on the role of management. Using the non-union employee representation literature for illustrative purposes, the significance of management in structuring employee silence is considered. Highlighted are the ways in which management, through agenda-setting and institutional structures, can perpetuate silence over a range of issues, thereby organising employees out of the voice process. These considerations are redeployed to offer a dialectical interpretation of employee silence in a conceptual framework to assist further research and analysis.