While many reject the label of “soft science” that is often used derogatorily to characterize qualitative research in the health sciences, we propose we should embrace and redefine the label, asserting its methodological potency for understanding health and health care, and as an expansion of the scientific field. In this paper, we reflect on the strategies we have developed over the last 25 years, as we worked together as teachers of qualitative research at the graduate level in the health sciences. The main outcome of our collaboration was the establishment and development of the Centre for Critical Qualitative Health Research at the University of Toronto. As former directors, we reflect on how to practice and teach in a world of limited literacy in qualitative research; how to make an institutional place for critical qualitative research in the health sciences; how to understand critical qualitative research as a potent form of “soft science”; and how we positioned ourselves in a marginal scientific location, at the edges of the academic system, while celebrating our potent “soft” methodologies and methods.

Discourses of research impact shape the ways in which critical qualitative research and researchers are evaluated in contemporary academic environments. Mainstream conceptualizations of research impact arise from a positivist perspective that challenges the aims and approaches of critical qualitative research. In this paper, we propose a framework for conceptualizing the impact of critical qualitative research on policy, practice, and science. After critiquing literature that presents mainstream views on research impact, we summarize a recent framework for conceptualizing the impact of critical research specifically. We then add to the Machen framework by highlighting the impacts of critical qualitative research on the institutions and practices of science. We provide examples of ways in which researchers at the Centre for Critical Qualitative Health Research at the University of Toronto have made contributions to the impact of critical qualitative research on science, and conclude by addressing implications of this framework for the ways in which critical qualitative researchers can plan and evidence the impact of their work.

Much qualitative research produces little new knowledge. We argue that this is largely due to deficits of analysis. Researchers too seldom venture beyond cataloguing data into pre-existing concepts and scouting for “themes,” and fail to exploit the distinctive powers of insight of qualitative methodology. The paper introduces a “value-adding” approach to qualitative analysis that aims to extend and enrich researchers’ analytic interpretive practices and enhance the worth of the knowledge generated. We outline key features of this form of analysis, including how it is constituted by principles of interpretation, contextualization, criticality, and the “creative presence” of the researcher. Using concrete examples from our own research, we describe some analytic “devices” that can free up and stretch a researcher’s analytic capacities, including putting reflexivity to work, treating everything as data, reading data for what is invisible, anomalous and “gestalt,” engaging in “generative” coding, deploying heuristics for theorizing, and recognizing writing as a key analytic activity. We argue that at its core, value-adding analysis is a scientific craft rather than a scientific formula, a creative assemblage of reality rather than a procedural determination of it. The researcher is the primary generative and synthesizing mechanism for transforming empirically observed data into the key products of qualitative research—concepts, accounts and explanations. The ultimate value of value-adding analysis resides in its ability to generate new knowledge, including not just the “discovery” of things heretofore unknown but also the re-conceptualization of what is already known, and, importantly, the reframing and reconstitution of the research problem.

Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Canada Medical Officer of Health, Lambton Public Health, Sarnia, Ontario, Canada Public Health Sudbury & Districts, Ontario, Sudbury, Ontario, Canada Sociology, York University, Toronto, Ontario, Canada Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Hiring and promotion of qualitative researchers in the health sciences, in Canada and internationally, is impacted by the prestige of quantification as the ultimate measure of scientific quality in current academic and health-care settings. This is further exacerbated by neoliberal notions of productivity, which offer very limited forms of assessment for different ways of producing knowledge or doing science differently . While qualitative researchers share the effects of the politics of productivity and corporate university policies with other academics, we argue that they are disadvantaged by the combination of the latent biomedical conservatism that characterizes the health sciences in Canada with the lack of frameworks to acknowledge and properly assess alternative forms of interdisciplinary scholarship. In our experience, it is challenging for qualitative researchers to advance in Canadian health sciences faculties. In light of this, we propose a framework for evaluating their scholarly work. We have structured this article in three sections: (a) to characterize the academic landscape in which qualitative health scholars find themselves when housed in Canadian faculties of medicine and their schools of health sciences, (b) to report on an organizational scan we undertook in order to understand current practices of evaluating scholarly productivity at these institutions, and (c) to propose a set of criteria that could more appropriately evaluate the contributions made by qualitative researchers working in the health sciences.

This chapter demonstrates the context of return-to-work (RTW), the discourse of abuse is constituted and operates, and how it creates suffering for injured workers by adding social injury to existing physical injury. Although the analysis was spawned by and constructed upon findings from a study of a particular occupational health issue in a particular place, it attempts to make evident the generic aspects of the phenomenon. The chapter provides the possibility that the case of RTW is a proxy for a hidden epidemic of suffering that extends far beyond the field of occupational health. Although most workers injured at work recover and get back to their original jobs successfully, others take a long time to get back to work, or make repeated unsuccessful attempts, or are unhappy in the jobs they return to, or never return to the labor market at all.

While qualitative inquiry has been a part of the Canadian Journal of Public Health (CJPH) for many years, CJPH does not yet have the reputation as a home for qualitative research that has a critical focus and that is cqqqonversant with contemporary developments in social theory and qualitative methodology. This paper describes efforts to establish CJPH as a welcoming home for critical, theoretically engaged qualitative research in public health. The paper introduces the Special Section that heralds the forward vision for qualitative research at CJPH. We specify what we mean by critical, theoretically engaged qualitative research and make the case for its significance for public health research and practice. We describe changes made in how qualitative manuscript submissions are handled at CJPH and highlight the contribution to public health scholarship made by the articles that comprise the Special Section. We issue an invitation to the public health community to support and participate in our vision to enhance critical, theoretically informed qualitative research in public health.

Drawing on long experience as a sociologist in the health academy, I explore the challenges of practicing and teaching critical qualitative research in an environment dominated by very different scientific reasoning. I account for the transgressive positioning of qualitative research in the health sciences in terms of the role of social theory in interpretive research, rising interest in qualitative approaches among health professionals, research and educational doctrines that impede value-added analysis, and the ascendance of applied, post-positivist forms of qualitative research. Strategies for producing critical qualitative researchers who can both survive and thrive in the health arena include creation of institutional authority, prioritization of methodological depth over breadth, teaching pragmatic but non-compromising survival skills, and forging supportive communities of practice. I describe how one particular academic organization is engaging with these strategies and reflect on future prospects for educating critical qualitative researchers in the field of health.

BACKGROUNDThis study sought to identify impacts of compensation system characteristics on doctors in Québec and Ontario.METHODS(i) Legal analysis; (ii) Qualitative methods applied to documentation and individual and group interviews with doctors (34) and other system participants (31); and (iii) Inter-jurisdictional transdisciplinary analysis involving cross-disciplinary comparative and integrative analysis of policy contexts, qualitative data, and the relationship between the two.RESULTSIn both jurisdictions the compensation board controlled decisions on work-relatedness and doctors perceived the bureaucratic process negatively. Gatekeeping roles differed between jurisdictions both in initial adjudication and in dispute processes. Québec legislation gives greater weight to the opinion of the treating physician. These differences affected doctors' experiences.CONCLUSIONSPolicy-makers should contextualize the sources of the "evidence" they rely on from intervention research because findings may reflect a system rather than an intervention effect. Researchers should consider policy contexts to both adequately design a study and interpret their results. Am. J. Ind. Med. 59:1070-1086, 2016. © 2016 Wiley Periodicals, Inc.

Based on findings from an institutional ethnography in a large mental health organization, we explore how institutional forces shape the experiences of health care workers with mental health issues. We interviewed 20 employees about their personal experiences with mental health issues and work and 12 workplace stakeholders about their interactions with workers who had mental health issues. We also reviewed organizational texts related to health, illness, and productivity. In analyzing transcripts and texts, silence emerged as a core underlying process characterizing individual and organizational responses to employees with mental health issues. Silence was an active practice that took many forms; it was pervasive, complex, and at times, paradoxical. It served many functions for workers and the organization. We discuss the theoretical and practical implications of the findings for workers with mental health issues.

Part-time, casual, contract, temporary and self-employment are some of the more commonly known forms of ‘contingent work’. Recent employment surveys indicate an increase in these forms of work while permanent forms of employment have ostensibly declined. Contingent work has become a focus of concern for those interested in the effects of changing labor market patterns on health. There are however two significant impediments to understanding the contingent work and health relationship. First, its current conceptual apparatus is diffuse and inconsistent. Definitions of contingent work and the assumptions that underlie its numerous descriptors differ within and across disciplines. Second, there is little conceptual clarity around what aspects of contingent work might be related to health. In this article, we distil and synthesize literature from a range of disciplines and develop a framework for conceptualizing contingent work and its relationship to health. We suggest that low reciprocity, uncertainty, discontinuity and marginality are core concepts that underlie many conceptualizations of contingent work. Drawing on related theoretical insights and empirical findings from the literature, we identify possible structural, social and psychological pathways between these four features of contingent work and ill health.

Small workplaces have particular injury risks and are enduringly difficult for the occupational health and safety (OHS) system to reach. This paper puts forward an "upstream" perspective on OHS in small workplaces that moves beyond the attributes of the workplace and those who work there.The paper draws on and synthesizes ideas and findings from emerging upstream OHS research, our own empirical investigations in Ontario and Quebec, and our collected research experience in small workplace health.Upstream structures and processes (regulations, policies, services, interventions, professional practices) are often misaligned with the conditions of work and social relations of small workplaces. Key upstream factors include regulatory exemption, subcontracting, unionization levels, the changing character of small enterprise, joint management, service and inspection constraints, competing institutional accountabilities, institutional orientation to large business, and inappropriate service and policy.Misalignment of the OHS system with the nature and practical realities of small workplaces can undermine prevention and the management of ill health and injury. To address such misalignments, the paper calls for: 1) restructuring of data collection and consultation processes to increase the visibility, voice and credibility of small workplaces; 2) "audits" of OHS-related legislation, policy and interventions to assess and address implications for small workplaces; 3) reflection on current terms and concepts that render workers invisible and capture poorly the essence and (increasing) diversity of these workplaces; and 4) extension of the upstream gaze to the global level.

This paper seeks to demonstrate the nature and value of a 'standpoint' perspective in occupational safety and health research. Argued through the case of workers in small enterprises, the paper discusses the notion of 'standpoint'; describes and accounts for the primacy of the managerial standpoint and the invisibility of workers in occupational safety and health research and practice; and draws on several of the author's research projects on small workplace health and safety to illustrate the kind of knowledge that can emerge from taking the workers' standpoint (including studies of the impact of injury and ill health on social relations in the workplace, of the experience of return to work, of small employers' perspectives and practices, and of frontline service work in a government agency that administers a workers' compensation scheme). The paper considers why a standpoint perspective matters in understanding occupational safety and health problems, and argues that the analytic integration of multiple standpoints is necessary to our understanding of the occupational safety and health system as a whole and the possibilities for change.

UNLABELLED:The purpose of this study was to explore patient training experiences related to the self-administration of hemodialysis at home. Researchers used a qualitative study using semi-structured interviews and a focus group. The setting was a hospital-based patient education program in Toronto, Ontario, Canada. Qualitative interviews and focus group study were conducted with 23 patients (who had end stage renal disease) and caregivers who have participated in Toronto General Hospital's Nocturnal Home Hemodialysis training program to learn how to operate a hemodialysis machine and to administer their own treatments at home without the supervision of clinicians.RESULTS:Experience as a trainee in the Nocturnal Home Hemodialysis program was framed by 5 diverse themes: patients' perceptions of anxiety, peer support, clinician empathy and understanding learning while ill, and the compatibility of learning preferences with training practices employed.CONCLUSIONS:The study revealed the complexity of the patients' experience with being prepared for a self-treatment regime at home. Although it was anticipated that the most important barrier to patient preparation would be the challenges of managing complex medical technology, psychosocial dimensions of their experiences were the primary factors impacting on the patients' ability to learn and to take on self-care responsibility. If the trend of patient self-treatment at home continues to increase, it is important for clinician educators to be attentive to self-treatment as a socially situated activity.

People with primary bone cancer typically are young (usual age-at-onset 16–35 years old) and undergo arduous treatments. The current standard of care (tumour resection and limb reconstruction with or without chemotherapy) results in survival rates in excess of 60%, but also results in significant disability at a time when patients are choosing career paths, establishing their independence and embarking on new roles. To date, the nature of the relationship between experiences of osteosarcoma illness and experiences of vocation has remained unclear. This study sought to examine this relationship using qualitative narrative methodology. In-depth audiotaped interviews were conducted with 14 osteosarcoma survivors (8 men, 6 women) who were being treated at Mount Sinai Hospital, Toronto, Canada. Interview transcripts were analyzed for story typology and thematic content via constant comparison. Respondents reported engaging in three types of ‘work’: ‘illness work’, ‘identity work’ and ‘vocational work’. Osteosarcoma illness represented a crisis for respondents, one which necessitated considerable illness work. Illness work was portrayed as all-consuming, whereby respondents were forced to stop vocational work for considerable periods. The illness crisis also precipitated ‘identity work’. Respondents recounted a transformative process, of ‘becoming other’ to whom they had been prior to illness. As a result, respondents told of re-entering the vocational sphere with a different sense of themselves from when they left it. When patients return for surgical follow up, clinicians routinely ask, “So, are you back to work yet?” expecting simple ‘yes/no’ answers. This study suggests that the answer is instead highly complex, and that patients could be seen as having been ‘working’ all along. This study offers a re-conceptualization of ‘work’ and ‘return to work’ in the context of osteosarcoma, with implications for clinical and return-to-work practices.

Non-profit organizations play an important role in the provision of health and social services. No longer temporary providers of emergency services, non-profit organizations appear to be permanent features of the social service landscape. Despite some of the intrinsic rewards that work in non-profit organizations offers, jobs in these organizations can be characterized by high demands, long working hours, low pay and exposure to violence and infectious disease, conditions which may be deleterious to worker health. This paper is based on an ethnography of three non-profit organizations: a homeless women's drop in, a drug treatment agency and a men's homeless shelter. We examine organizational 'mission,' a dominant discourse about the purpose and value of providing 'help' to marginalized clients, and the implications it has for work practices and for the way that workers understand work-related risk in these organizations. We describe how the notion of mission is continually reproduced, and trace its relationship to worker risk acceptance and risk taking. We suggest that the functions of such discursive commitments in organizations, and their implications for the well-being of workers, underscores the importance of understanding organizational culture and the social construction of risk when attempting to improve working conditions and protect worker health in social service non-profit organizations.

Chapter 7 Neoliberalizing Home Care: Managed Competition and Restructuring Home Care in Ontario Kim England, Search for more papers by this authorJoan Eakin, Search for more papers by this authorDenise Gastaldo, Search for more papers by this authorPatricia McKeever, Search for more papers by this author Kim England, Search for more papers by this authorJoan Eakin, Search for more papers by this authorDenise Gastaldo, Search for more papers by this authorPatricia McKeever, Search for more papers by this author Book Editor(s):Kim England, Search for more papers by this authorKevin Ward, Search for more papers by this author First published: 01 January 2007 https://doi.org/10.1002/9780470712801.ch7Citations: 8 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Summary This chapter contains section titled: Neoliberalizing Health Care, Policy Transfer and Managed Competition The Rise of Managed Competition in Home Care in Ontario Neoliberal Provincial Politics Managed Competition and Home Care Workers Conclusion Acknowledgments Notes Citing Literature Neoliberalization: States, Networks, Peoples RelatedInformation

A telephone survey of a random sample of 811 long-term home care clients from three geographically distinct regions in Ontario was conducted to illuminate the living and working conditions in households receiving long-term care services. The median age of clients was 77 years and 75 percent were female. The majority had not completed high school. Almost half were widowed, had income levels of $20,000 (Canadian) or less, and lived alone. Approximately one-third needed help with most basic activities of daily living. The vast majority could not bathe or dress themselves. More than three-quarters needed help with preparing meals, housekeeping, and shopping. Few clients could perform yardwork and home repairs. Many clients' homes required major and minor repairs, were not suitable in size, were not affordable, and lacked important household amenities. More than 30 percent required modifications to enable clients to live and be cared for comfortably and safely, and half the clients had not completed these because of exorbitant costs. Overall, many clients were living in homes less than optimal for domestic life and long-term care provision. These results highlight significant gaps in care provision and a need to link housing to health and social service policies.

This case documents the metamorphosis of an academic public health project on the implementation of Ontario's return-to-work policies and practices into a community theatre project, the production of a play called Easy Money. The result was a highly successful knowledge translation initiative. Injured workers, the focus of the academic study, intensely identified with the play and were given hope that their individual experiences could be broadly translated. For the researchers, the undertaking provided new perspectives on the original research problem, validated their original findings and generated numerous topics for subsequent research.

In Canada, food assistance is provided through a widespread network of extra-governmental, community-based, charitable programs, popularly termed “food banks”. Most of the food they distribute has been donated by food producers, processors, and retailers or collected through appeals to the public. Some industry donations are of market quality, but many donations are “surplus” food that cannot be retailed. Drawing on insights from an ethnographic study of food bank work in southern Ontario, we examined how the structure and function of food banks operate to facilitate the distribution of foods not marketed through the retail system. Our findings indicate that the handling of industry donations of unsaleable products is a labor-intensive activity, made possible by the surfeit of unpaid labor in food banks, the neediness of food bank clients, and clients’ lack of rights in this system. The marshalling of volunteer labor to serve a corporate need might be construed as a “win-win” situation because the work of salvaging edible foodstuffs from among industry “surplus” helps to “feed the hungry” while also diminishing the amount of refuse deposited in landfill sites, sparing corporations disposal costs and landfill tipping fees, and helping them forge an image of good corporate citizenship. However, the reliance of food banks on industry donations means that food assistance becomes defined as that which the corporate sector cannot retail. Moreover, the intertwining of food bank work with corporate needs may function to further entrench this ad hoc secondary food system and mitigate against initiatives to develop more effective responses to problems of hunger and food insecurity in our communities.