This was a descriptive cohort study that entailed a review of Training records of several training records in Isalu Hospitals Limited.
In this study, the meta-analytic design was employed in the early phase, followed by a quasi-experimental technique in a later phase. Regardless of the precincts associated with quantitative meta-analysis, more than a few conclusions were drawn, which assisted in drawing formula for getting sample size. A quasi-experimental design was executed using an online questionnaire at the pre-intervention baseline. Participants answered questions premeditated to elicit rejoinders that elucidate their knowledge of the subject matter. The questions checked the level of Training of participants, the impact of Training and development on the junior staff and senior management staff of Isalu Hospitals, and gave answers on know-how Isalu hospital’s junior staff and the senior management staff contributed to the attainment of sustainable competitive advantage. Analysis of the Outcomes was done to examine if all the factors are deemed useful in the know of the knowledge and frequency of to know how Isalu Hospitals junior staff and senior management staff were contributing to the attainment of sustainable competitive advantage. Age, gender, and position of staff in the Management of Isalu Hospital were considered.
Threats to Validity of the Research Design
External and internal validity are ideas that reflect if the results of a study are meaningful and trustworthy. Whereas internal validity focuses on how effectively a study is carried out (its structure), external validity gives focus to how usable the findings are in the actual world.
During my research, I identified a number of Factors that posed Threat Internal Validity. These included;
Instrumentation: The impact of the online questionnaire utilized in a study would affect the response of the participants. Whereas it appears to be strange, it’s probable that participants would be primed into a study in particular ways and measures used, which would make some them show a reaction in a manner that differs from what they would have reacted.
Statistical regression: It is possible that several participants would respond in a given direction just as a result of passing the time and not as a result of any particular intervention.
Attrition: Some participants individuals could stop studying, which therefore means that the outcomes would be centered on a subjective sample group of persons who chose to continue.
Diffusion: This means the treatment in studying spreading from the participating group to control the groups by ways such as interactions as well as conversations with each other as well as observation. This may culminate in another issue, such as resentful demoralization. Here, the control group fails to take part in activities as they direct hate on another group.
Factors That posed Threats to External Validity
External validity will always be endangered if the study fails to put into account the interactions of variables in reality. Some of the dangers include but not limited to;
Situational factors: For instance, as the time during the day, noise, researcher behavior, location, as well as the number of measures deployed might have an effect on the generalization of the findings.
Pre/post-test effects: It means that before the test and after the test situation, which is coherent with the effect observed in the study in given ways, for example, the cause-and-effect relationship vanishing despite lack of those additional tests.
Sample features: Pointed out to the case whereby particular characteristics of a given sample was the cause of the effect (or maybe partly responsible), resulting in the insufficient generalization of the findings.
Selection bias that included the issue of variations among individuals in a study group that may result from the independent variable (for instance, readiness self-motivation to participate in the study, specific groups of participants ending up with a more likelihood of resulting to an online study.
To enhance the study’s external validity of a study and avoid threats, these points were taken into account;
Exclusion and inclusion criteria well utilized in order to guarantee a categorically defined population in study research.
Psychological realism: The aim of the study was well explained to ensure that, participants behaved the way they would in real life
Replication: Meta-analysis was used to regulate the effect of the variable that is independent.
Field experiments would as well be deployed whereby you carry out a study without utilizing thee laboratory hence doing it outside in a natural environment.
Reprocessing or calibration: This was deployed as a form of regulation of problems related to external validity.
The Figure of the Design
The study was conducted at Isalu Hospitals Limited. Isalu Hospitals Limited was chosen based on its ability to provide high quality medical and related services to clients using the best existing professionals, empowered with a suitable level of technology and progressive Training. It was noted that Isalu hospital had grown in an enormous way over the years and developed a good reputation and goodwill in the society. The Hospitals also enjoyed enormous goodwill and occupied a desirable position as a strong and competitive leader in the market within the healthcare industry since it offered. Due to the different services offered in the hospital, it became the ideal hospital for the study.
Sample Size Consideration
The Cochran formula (51) was applied to determine the minimal sample size.
Equation one: Cochran formula for sample size calculation.
n= Z2 * p (1-p)
Where: Z is level of significance (1.96) at an α-value of 0.05 for a two-tail hypothesis.
P was the prevalence of MRPs
d was precision of estimate around MRPs (5% or 0.05).
N was the sample size.
Sampling Method and Sample Size
A convenient sampling method was employed. Every staff who met the inclusion criteria outlined in the eligibility checklist was included in the study until the desired sample size was met. Convenient sampling was to be adopted in the research in order to eliminate voluntary response bias as well as to eliminate under coverage bias. The research population was made up of the entire 220 staff (170 junior staff and 50 senior management staff) employed by the organization while the sample size was made up of 22 senior management staff and 75 junior staff. Both the senior and junior management staff were considered for the study because they were both responsible for the daily running of activities of the organization, and they all interacted with customers at one level or the other. The senior management staff comprised of heads of departments and strategic business unit managers who oversaw the various departments of the hospital while junior staff comprised the nurses, assistant nurses, pharmacy technicians, records personnel and other operational staff.
Staff was included if they had worked in the hospital for at least five years. Staff who had worked for less than five years were excluded.
Data Analysis Approach
Analysis of data would be carried out in descriptive statistics with a five (5) point Likert scale. The advantage of Likert scales is that they produce a cumulative response process, i.e., they make it possible to sum up, the scores and produce a cumulative score. Likert scales enhance speed, confidentiality, and collection of honest feedback. However, it is possible for the respondents to give false information in an attempt to maintain privacy. Lack of understanding of the question asked may also make respondents give wrong feedback. Another major shortcoming of Likert scales is difficulty in achieving the internal consistency of the scale, which can affect result interpretation. Also, intervals between the different points on the scale may not be a true representation of the changes in individual attitudes.
In view of the hypotheses stated above, nominal and ordinal data would be collected for the research because they were both classified as categorical data, i.e., non-quantitative and could be represented by string variables. Nominal data do not have quantitative values and are used for the ‘naming’ of variables, as the name implies. Ordinal data, on the other hand, have their variables arranged in an ordinal form but are not measured mathematically. They are in the form of labels used form representing opinions. Similarly, a nonparametric test would be conducted since the hypothesis was aimed at determining how senior management and junior staff contributed to organizational performance as well as the impact of Training and development on the organization’s competitive advantage. A nonparametric test was considered because the analysis does not require data to fit a normal distribution. Nonparametric tests rely mostly on ranking and orders in which data are sorted.
Validity and Reliability
Reliability and Validity of research mean to the depth of the outcomes of the study. The results` validity could either be external or internal. Internal validity is defined as the analysis of the preciseness of the achieved results. External validity means analyzing the results in relation to if it is possible to generalize them (Ghauri & Grönhaug 2005). Whereby measurable quantities are utilized, there are various kinds of validity; face, that explains the magnitude to which the measurement deployed is sensible and is able to obtain such measurement, convergent validity, this one explains the depth in to which the utilized measurement may end up with same outcomes if used elsewhere and then divergent validity which explains the degree to that one construct is differentiated from each other (Ghauri & Grönhaug 2005). More so, particularly, four types of the validity of qualitative research is available, and are mostly emphasized upon. They are interpretative, theory-based, descriptive, and can be generalized. Descriptive validity is usually linked to the extent where the real description of the outcomes factual. Interpretative validity is often linked to good interpretation.
Theory-based validity leads to sufficiency that the 39 theory proposed is, for example, if the theory backs up the subject of study. Generalizable validity is known as to which degree the outcomes of the study may be generalized. For example, are the outcomes of this study coherent with those of other organizations in the same category? (Ghauri & Grönhaug 2005). In this study, validity was considered. For instance, since the questionnaire is framed by the researcher, it is constructed on the basis of the researcher’s requirements in relation to the topic of study t and therefore is advantageous in the sense that it measures precisely what the researcher wants to. The researcher, therefore, does not depend on any other researchers for any data on, for instance, problem areas and significance of the items incorporated in the questionnaire. In addition, also, interpretative, descriptive, and theory-based validity considered. Exhaustive review literature in the areas of study was carried out cautiously before commencement of the research. That made it possible for the theories as well as the questions in the questionnaire to be recognized. Themes as well as theories are well supported by the research findings. Reliability means the steadiness of the measure utilized to study the correlations between different variables (Ghauri & Grönhaug 2005, 81). The questions in the questionnaire were framed, considering the issues pertaining to the problem and goals of the study and the subject theories. Therefore, it is believed that the answers and results from this study are trustworthy.
Data Collection Instrument
The research made use of quantitative technique and primary data, while the online questionnaire would be used for data collection. The quantitative technique was chosen because, being social science research, the research would explore social phenomena, and literature had confirmed the appropriateness of quantitative technique in measuring social phenomena such as perception, attitude, employee behavior, etc. (Collis and Hussey, 2013). The quantitative technique made it possible to easily analyze social phenomena and make statistical inferences.
The questionnaire would be used to collect vital information for the study. It would collect data that would be used to examine the application of Training and development as means to sustainable competitive advantage at Isalu hospital as well as the impact of Training and development on the senior management staff and junior staff. The questionnaire would be divided into two sections. The first section of the questionnaire would focus on participants’ demographic information, which includes sex, age bracket, education level, duration of employment, and the rate of Training in Isalu Hospitals. The second section would measure variables relating to ‘how training and development had helped the senior management and junior staff to contribute to attaining sustainable competitive advantage in the organization’ as well as how Training and development had affected employee intellectual capability, staff turnover, service or product innovation, brand equity (or value) and quality of service or product. The mean value will be calculated using a 5-point Likert scale whereby Disagree=2, Neutral=3, Strongly Disagree=1, Agree=4, and Strongly Agree=5.
Gathering of information by questionnaires varied in the techniques of contacting the participants in the means of delivery and the manner in which the questionnaire was administered, and these factors could impact on the level of accuracy of the collected data. These dissimilarities could render it difficult to pick out the impacts of each on the data quality and could mean the difference in the responses obtained. In order to evade this, the questionnaire would be designed in a simple and easily comprehensible manner devoid of bias. The questionnaires would be disseminated at the start of the day’s work, and the respondents asked to drop them in a box near the receptionist desk after completing it. This was to ensure that the researcher did not know the order in which questionnaires were dropped. The box containing the questionnaire would be collected later during the lunch break. Every participant would be issued with the same questionnaire to fill with no intrusion from the researcher so as to avoid the ‘Hawthorne effect,’ i.e., an alteration in participants’ behavior because they know that they are being monitored.
Reasons for Data Collection Method Used
This phase was executed in two months. It involved involving mixed reviews to investigate characteristics ranging from potential outcomes and barriers. The review focused on several variables. Additionally, the knowledge possessed by the hospital staff was to be reviewed. The contingent mixed review used quantitative and qualitative data. It also required tractability for describing the questions and extracting data in a method that brought forth the results of the questions and analysis. The literature verdicts should have scraps of facts to strengthen the analysis further. The purpose of the analysis was to use the results in every step of the study. Therefore, the following two measures would be used for the analysis.
Identified the research questions and the aspects that aided in the development of those questions. A review of the literature was to be used to come up with logical questions to aid the understanding of Training and development as a form of accelerating the achievement of sustainable competitive advantage in private hospitals of Nigeria:
The course of action shifted from the scope to the exploration level by applying systematic approaches. There was the development of inclusive and exclusive defined criteria, strategies, and screened literature. The search strategies in hospital database components were fashioned to pinpoint the trial’s descriptive studies in the views of the staff at different levels of management. The qualitative research was checked, and sub-questions centered on the findings were developed.
Once the primary components had been assembled, the student required to perform an in-depth interview with a sample of few participants. The interviews were conducted electronically via phone and video conferencing. During the interviews, the participants were asked how participation in the Training and development of junior staff, as well as senior management staff, put Isalu Hospitals at a maintainable competitive advantage. The interviewer was the team and carried the responsibility of ensuring the interview’s success. Every interview was recorded, transcribed then efficiently analyzed. Depending on the feedback, the methods` efficiency was analyzed to come up with a questionnaire and any other materials required to carry out the study.
For three months, results were collected. False identities, incognito, and sobriquet was used to guarantee secrecy. Before engaging in the research, both staffs gave informed consent. Data were collected as per the online questionnaire.
Very thorough interviews were transcribed and documented at all times. The evaluated process approaches were utilized to define patterns related to that which the intervention likes or dislikes. This would also be made use of to determine what components were lacking, used, and not included. Each of those elements centered on the preparation, duration, results, as well as evaluating aspects of the intervention. The outcomes of the research were useful and suitable in the adjustment to the process or preparation. The analysis was incense on the quantifiable measures used to estimate the changes in the scores and variances using median, mean percentage, or figures if it is applicable in the occasion.
All the data was collected at different phases. This study was crucial as it monitored junior staff and managers. Besides, the analysis involved sub-scales, which were calculated on a Likert scale of 3 points (Wu, 2017). According to Stacey et al. (2017), an appropriate value is 72 out of 100 per subscale.
Quality Assurance and Data Management
The data collection instruments were pre-tested and optimized appropriately by the researcher, where necessary. The filled instruments were reviewed by the researcher at the end of each day against the source documents for completeness and accuracy. All the raw data collected were entered into Epi-info version 7 (2007-2010) software, and a database created. The data was backed up on a weekly basis by the researcher. Data cleaning and validation were done before exporting to STATA (version 14) for analysis.
All information extracted was coded, and staff identifier information was not included. The electronic data was password protected. All hard copy documents were restricted to researchers and supervisors. The backing-up of data was done weekly to protect data from loss. Soft copies of documents were password-protected and encrypted. Hard copies of the interview notes and questionnaire forms were securely kept and locked in a filing cabinet, which could only be accessed by the principal investigator.
Approval to carry out this study was sought from the Isalu Hospitals Limited. The Chief Medical Director was granted permission to access the potential participants; hence there would be no barrier to data access. This study was registered with the Research and Development Department of the Isalu Hospitals Limited and an official research study number given and recorded in the registry as per the hospital research guidelines. To implement the study, permission was sought from the relevant hospital management—informed consent for participation. Potential Participants were met and informed about the objective of the research. It will be emphasized that participation was voluntary. They were being informed that questionnaires would be retained on a secure, password-protected University of Liverpool. The researcher took the utmost care to guarantee the maximum confidentiality and privacy of the information obtained during the study. Staff codes were used instead of staff identifier information. The data instruments were stored in a password-protected database only accessible to the researcher were to be secured under lock and key. At the end of the study, they were handed over to the department of Research and Development for a duration of 5 years. A password-protected electronic version of the primary data was also deposited to the department e-repository.
Reassurance was made that data would be used exclusively for the study purpose and kept until the finish of the Master’s dissertation module. Confidentiality, privacy, anonymity, and other ethical factors were given due consideration in the course of the study.
The Shapiro-Wilk test was used to check if continuous variables were distributed normally. Descriptive data analysis was done, and continuous variables were expressed as either the median, or mean and standard deviation, and inter-quartile range. Also, Categorical variables were presented in the form of proportions, percentages with the 95% confidence intervals. The main outcome calculated was Bivariate logistic regression. It was used to analyze associations between dosing errors and predictor variables identified in the data. Their odds ratio, 95% confidence intervals of the odds ratio, and the related p-values computed.
Multivariable logistic regression was constructed to investigate association while adjusting for possible confounding. The predictor variables associated with medication-related problems were determined using the Forward stepwise model building. STATA version 14.0 software, which was utilized for the purpose of analyzing. P values that were less than 0.05 were deemed to be significant statistically.
Assumptions Based on the Statistical Analysis
With regard to the statistical tests used, assumptions were made to ensure that the data collected were consistent with the nature of the analysis being conducted. These assumptions included normality, independence, linearity, and homosexuality. Failure to comply with these assumptions would have resulted in inaccurate results, which would have been problematic. Testing the data assumptions that violated the statistical test assumptions, depending on the violated assumptions, would have produced both false negatives and false positives.
The normalcy hypothesis meant that the data approximately matched the bell curve before any statistical or regression tests were performed. The hypothesis followed that the study was statistically independent. The hypothesis was that all participants in the sample would only count once. The use of the questionnaire allowed each participant to make independent comments. The independence of observations meant that the variations of each participant affected the overall analysis only once. The assumption of homosexuality ensured that the variance around the regression line was the same for all values of the predictive variables. The study did not break this assumption. The statistical software packages used do not automatically check these hypotheses but assume that they are fulfilled, as they are the conditions underlying the logarithmic functioning of the program.
Determination of Statistical Significance
Fixed standards were used to verify the significance of zero assumptions, and only 0.05 was used as a criterion for assessing or reporting statistical significance.