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The British news interview turn-taking system operates through a simple form of turn-type preallocation. This article shows that a large number of the systematic differences between the news interview and mundane conversation are a product of these constraints on the production of types of turns. It then explores the relationship of turn-type preallocation in news interviews to the background legal and institutional restrictions on British broadcast journalists. In so doing, it notes how the organisation of turntaking in two other types of broadcast interview can differ from that in the news interview due to differences between the institutionalized footings that the interviewers are conventionally required to maintain within them. (Conversation analysis, mass communication, British speech, turn-taking systems, institutional talk)

General practice consultations were video-recorded before and after the introduction of a desk-top computer system into the practice. The recordings were analysed by detailed qualitative scrutiny of tape and transcripts (conversation analysis) to discover regular patterns of interaction. This analysis confirmed that the introduction of computers into the consultation had a significant impact on the communication between patient and doctor. In particular, we found that computer technology has had an impact on the practitioners' conduct and on the disclosure of information by the patient. The analysis also points to some recommendations both for training general practitioners in the use of computerized systems in the consultation, and for the (re)design of the technologies themselves.

This paper reports on a qualitative study of the use of an expert system developed for the British telephone triage service NHS Direct. This system, known as CAS, is designed to standardise and control the interaction between NHS Direct nurses and callers. The paper shows, however, that in practice the nurses use CAS in a range of ways and, in so doing, privilege their own expertise and deliver an individualised service. The paper concludes by arguing that NHS Direct management's policy of using CAS as a means of standardising service delivery will achieve only limited success due not only to the professional ideology of nursing but also to the fact that rule-based expert systems capture only part of what 'experts' do.

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No abstract

NHS Direct is a relatively new, nurse-based, 24-hour health advice line run as part of the UK's National Health Service (NHS). The service delivers health advice remotely via the telephone. A central aspect of the service is the attempt to provide a standard level of health advice regardless of time, space or the background of the nurse. At the heart of this attempt is an innovative health software called CLINICAL ASSESSMENT SYSTEM (CAS). Using a number of qualitative methods, this article highlights how the interaction between the nursing staff and this technology is key to the service. The technology is based on management's attempt to standardize and control the caller-nurse relationship. Thus the software can be seen as part of an abstract rationality, whereas how it is deployed by nurses is based on a practical rationality that places practice and experience first and sees the technology and protocols as tools.

This paper reviews the contribution of qualitative methods to health services research (HSR) and discusses some of the issues involved in recognizing quality in such work. The place of qualitative work is first defined by reference to Archie Cochrane's agenda for HSR and the limitations of the recent focus on randomized trials as the standard method. Health care practice involves large elements of improvisation which cannot be captured by evidence-based approaches. Qualitative methods offer ways of understanding this improvisation and of identifying more efficient and effective practices, as well as considering the traditional topics of equity and humanity. The methodological procedures of qualitative work reflect a long-established inductive tradition in scientific practice. The logic of grounded theory provides a contemporary specification. In its application, it is quite different from the methodological anarchy of postmodernism. The use of qualitative research and the theoretically stated generalizations which arise from it inform reflective work by health service managers, planners and clinicians.