Case studies / Healthcare
Reflexive Thematic Analysis of Forty-Five Staff and Service User Interviews
Building a transparent coding framework across 700 pages of transcripts, where the aim was interpretation rather than counting.
The challenge
What the organisation came with
A healthcare organisation had completed dozens of interviews with staff and service users and could not identify the key themes in a way they could defend. They had the material; what they lacked was a systematic route through it.
The interviews ranged widely. Participants moved between topics within a single answer, and the same experience surfaced in different vocabulary depending on whether it came from a staff member or someone using the service.
The real difficulty was building a coding framework transparent enough to be assessed: one that captured nuance across 700 pages, stayed consistent between coders, and could not fairly be characterised as one analyst’s impression of what the data said.
The approach
How it was analysed, and why that method
Why reflexive thematic analysis
Braun and Clarke’s six-phase reflexive approach was used: familiarisation, generating initial codes, constructing themes, reviewing them against the dataset, defining and naming them, and writing up.
Content analysis was rejected. It would have quantified how often topics were mentioned, which was not the question — the organisation needed to understand what the experiences meant, and frequency is a poor proxy for significance in interview data.
Reflexive thematic analysis is explicit that the analyst shapes the analysis. That is why the decision trail is documented rather than hidden behind the claim that themes emerged.
Keeping coding consistent across 700 pages
Every code was given a written definition, an inclusion rule and an anchor extract before the dataset was coded in full. Codes were merged, split and retired deliberately as coding progressed, with each change recorded in NVivo so the framework’s development is visible rather than reconstructed afterwards.
Themes were then reviewed against the whole dataset rather than against the extracts that generated them — the phase most often skipped, and the one that catches themes which look convincing but are supported by only three participants.
Delivered
What the client received
The value
What changed as a result
The organisation used the findings to redesign service delivery and to inform future policy development.
Because every theme traces back to named extracts through a documented framework, the analysis could be put in front of stakeholders who had not been involved in it — which was the point of commissioning it externally.
Written from the assigned statistician's own project notes. The client is not named and no identifying detail, data or figures are published. Scale and timeframe are approximate.
Related services
The services behind this work
Qualitative coding
Codebooks, systematic coding and themes evidenced back to the extracts.
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