In-Depth Interviewing with Healthcare Corporate Elites: Strategies for Entry and Engagement

Abstract

Interviewing corporate elites has received limited attention in the methodological literature. Such elites are considered highly difficult to gain access to and, if involved, are believed to use their power asymmetry to dominate the interview. Understanding the context is considered essential to elite access, interview conduct, and interpretation of findings. The healthcare sector provides interesting challenges for in-depth elite interviewing, including historical norms regarding interview access, types, and duration. In this article, the authors report on the strategies used to gain access to and engage healthcare elites who participated in multiple personal interviews using the Seidman in-depth phenomenological interviewing method. Techniques for identifying and recruiting potential participants, scheduling and preparing for the interview, and establishing rapport are described. Concept mapping is presented as a way of fully engaging the elites in the tripartite interview process and facilitating trustworthiness. The lessons learned offer important strategies for those undertaking phenomenological research with elites.

Keywords

phenomenological interviewing elites concept maps

Introduction

At some point in their fieldwork, most business researchers will interview elites, but only modest scholarly attention has been paid to the process (Odendahl & Shaw, 2002; Thomas, 1995; Welch, Marschan-Piekkari, Penttinen, & Tahvanainen, 2002). Hertz and Imber (1995) explain the underlying problem:

Business elites have been historically the most difficult settings to gain access to by social scientists. The hierarchies of business organizations are designed to protect those who work there and to deter outsiders from learning more about how they operate. (p. x)

Much of the general literature on elite interviewing focuses on defining and categorizing elites, addressing problems in gaining access, and dealing with power differentials (Delaney, 2007; Dexter, 2006; Harvey, 2010; Hertz & Imber, 1995; Richards, 1996; Odendahl & Shaw, 2002). Other contributions stress the importance of the researchers' understanding of the specific context and its norms as determinants of who and how to interview and discuss the roles of opportunism, pragmatism, and professionalism in gaining access and querying elites (Cochrane, 1998; Dexter, 2006; Hirsch, 1995; Odendahl & Shaw, 2002; Ostrander, 1993; Sabot, 1999; Yeung, 1995).

The healthcare sector, specifically hospitals and healthcare delivery systems, is one context for which there is little research design guidance regarding elite interviewing. Norms that are important to understand in this context include a historical focus on the use of brief telephone interviews or surveys. In addition, inquiries for participation in research are commonly vetted by trade and occupational organizations, which instruct their members on whether or not to participate. Finally, few of the executives in hospitals and healthcare delivery systems are exposed to qualitative research, which may portend limited appreciation for this type of research and, thus, lack of willingness to participate or fully engage.

This article describes strategies used to gain access to and engage healthcare elites who participated in personal interviews using the Seidman (1998) tripartite in-depth phenomenological interviewing method. Techniques for achieving entry are detailed as a three-stage process of identifying potential participants, contacting them, and gaining a commitment to participate. Practices related to scheduling and researcher preparation for the interview, as well as rapport establishment to minimize the power differential, are discussed. The use of concept mapping to fully engage the participants and help ensure trustworthiness is described. The strategies discussed are transferable to other studies both within and outside of the healthcare sector.

Elite Interviewing

Definitions of an Elite

Much of the methodological literature is concerned with defining elites. The term “elite” in social studies can be traced to the early 1900s, where those with superior talents in any field were considered elites and, thus, came to govern others (Woods, 1998). By the 1950s, theorists adopted a functional rather than qualitative definition, identifying “power elites” as legislators, judges, military officers, and business leaders. Recent definitions reflect the power and privilege of elites rather than their job description. Woods (1998) suggests that elites may be defined as those who can use their privileged access or control over resources (physical, financial, and informational) to exercise power without significant challenges; who are linked to other elites by social and professional networks; and who are deemed elites by themselves and others. Other theorists note elites' elevated knowledge, money, and status as compared to the rest of the population (Odendahl & Shaw, 2002) and specify their key places in power networks (Undheim, 2003). Researchers also classify elites into various categories. According to Keller (as cited in Odendahl & Shaw, 2002), “strategic elites” can be identified as those with sustained social impact. The most common groupings are business or corporate, political, professional, and community elites, which are noted as not mutually exclusive (Hertz & Imber, 1995; Morris, 2009; Odendahl & Shaw, 2002). Delaney (2007) further specifies “ultra-elites” as those at the very top of organizations. Finally, Undheim (2003) differentiates experts from elites, describing the former as narrow specialists and the latter as generalists. Thus, there are several ways to consider who might qualify as an elite based on attributes, behavior, and relationships, and there are numerous ways to further designate them. We are concerned here with corporate elites, who as Woods (1998) indicates, are likely to enjoy both privilege and power and to participate in various networks.

Interviewing Considerations

Given that corporate elites are influential, prominent, and/or well-informed people in an organization, there are numerous advantages to interviewing them. Simply because of their position in the organization, elites may have information other staff do not: They can usually provide a detailed overview of the organization and discuss external relationships; they are likely to be more familiar with legal and financial structures; and they are usually able to discuss organizational policies and future plans (Marshall & Rossman, 1999).

At the same time, there are many challenges to interviewing elites. The literature focuses on two general challenges—gaining access and dealing with elites' power (Harvey, 2010). Access issues relate to difficulties in contacting elites without a connection and obtaining time in their busy schedules (Marshall & Rossman, 1999). If one does get access, numerous interview hurdles may develop, including elites' attempts to control the interview and question the interviewer about different study elements. As Sabot (1999) notes, elite interviewees can be “defensive,” engaging in behaviors that thwart cooperation because they feel threatened, or they can be “conventional,” viewing academic investigations as valuable to society and being anxious to make their contribution. Several authors provide suggestions for enhancing access and minimizing elites' attempts to control interviews. These ideas are general in nature and must be adapted to the specific research situation (Cochrane, 1998; Dexter, 2006; Hirsch, 1995; Odendahl & Shaw, 2002; Ostrander, 1993; Sabot, 1999; Yeung, 1995). After a summary of our study, we discuss this general advice and our adaptations.

Overview of the Study

This article is a reflexive analysis of the research design used in a qualitative doctoral dissertation. The authors of this article are the author of the doctoral dissertation and a research methods professor (respectively). The author of the dissertation provided the material that focuses on the internal aspects of the study – the structure – while the research methods professor provided an external analysis of the aspects of the study that made it both unique in terms of design and effective as a qualitative inquiry. We build on the original study by taking “what was done” and extracting lessons learned and key takeaways for researchers to consider when designing an interview-based study of elites.

The purpose of the doctoral dissertation on which this article builds was to understand the development of an individual's ability to think strategically (Goldman, 2005). Firms have attempted to develop the strategic thinking ability of their executives through work experiences and in the classroom, but it is unclear what work experiences are most beneficial. A working description of strategic thinking was formulated from a review of the strategy literature (Hanford, 1995; Liedtka, 1998; Mintzberg, 1978). The literature on expertise development fosters the view of strategic thinking as a developable ability; indicates that by studying experts in a domain, specifics useful to developing novices can be identified; and provides techniques for identifying such experts (Chi, Glaser, & Farr, 1988; Ericsson & Smith, 1991; Shanteau, 1988; Sternberg, 1994, 1999). The expertise literature also points to experience as the developmental catalyst. This allows for connections to experiential learning theory, an adult learning theory which emphasizes the role of the individual in constructing meaning from experience (Kolb, 1984). The lack of specificity about what experiences initiate the learning cycle led to the identification of the problem to be addressed here. In addition, the notion that specific environmental features are associated with learning experiences informed the formulation of the research question and subquestions.

The study explored experiences considered important for developing expertise in strategic thinking and sought to understand how these experiences occur. The main research question— What is the structure of experiences that contributed to the development of expertise in strategic thinking?—had four related subquestions: What experiences contributed? What is the meaning provided by these experiences? How does the meaning occur over time? What facilitates the contributions? For the purposes of the study, “experiences” included any formal or informal activities, events, observations, practices, feelings, or reactions of the participant.

A qualitative inquiry paradigm was selected for this study, as the research question reflected an initial foray into the topic (Creswell, 1998). Furthermore, given that the focus of the study was to understand and appreciate the participants' experiences and the meaning made of them, this was determined to be a phenomenological study, and the Seidman (1998) model of in-depth phenomenological interviewing was identified as appropriate for data collection. In this model, three interviews are conducted with each participant. The purpose of the first interview is to establish “the context of the participants' experience” (Seidman, 1998, p. 17); the purpose of the second interview is to “allow participants to reconstruct the details of their experience within the context in which it occurs” (Seidman, 1998, p. 17); and the purpose of the third interview is to “[encourage] the participants to reflect on the meaning their experience holds for them” (Seidman, 1998, p. 17).

Gaining Access

As noted above, much of the literature on interviewing elites focuses on problems of gaining access (Delaney, 2007; Dexter, 2006; Harvey, 2010; Richards, 1996; Odendahl & Shaw, 2002). For this study, access occurred as a three-stage process, and each stage had different issues, resulting in distinct strategies.

Identifying Potential Participants

The methodological literature related to identifying participants suggests reviewing business listings, databases, directories, and publications, and using personal contacts and snowball sampling techniques to identify whom to interview (Dexter, 2006; Odendahl & Shaw, 2002; Thomas, 1995; Yeung, 1995). While effective, these strategies can result in the identification of participants who may not have in-depth knowledge of the phenomenon under study (Odendahl & Shaw, 2002).

The participants in the study of the development of the ability to think strategically were first defined as exclusive to one industry because expertise is considered domain-specific (Chi et al., 1988). Healthcare, particularly the service delivery setting, is familiar to the researcher (Goldman) and, as such, had the best potential for identifying participants. However, the researcher is a healthcare consultant and inclusion of her clients could affect the professional working relationship; thus, they were deemed off limits for this study. There were no published lists of strategic thinkers or a measurement tool that could identify them, which also eliminated those avenues for participant identification.

Two strategies were used to address these identification issues: (1) the formulation of a working definition of strategic thinking based on the strategy literature and (2) the enlisting of qualified healthcare strategy consultants and leaders of a national healthcare association (whose members include hospitals and healthcare delivery systems) as referral sources. These groups were selected because of their broad knowledge of the healthcare industry, regular contact with potential participants, and name recognition as facilitators of introductions among the base of potential participants. The selected consultants were identified from industry publications, lists, and conferences; they met specific criteria as qualified sources (e.g., full-time strategy consultants with regional or national practices and tenure in the field). The selected association leaders included the executive responsible for strategy and policy and the director of a membership group of strategic planning executives.

These referral sources were contacted in writing and asked to identify two or three individuals with whom they had worked that met the provided definition of an expert strategic thinker. This business-like approach conveyed the seriousness, rigor, and professionalism of the study (Richards, 1996; Yeung, 1995). All of the referral sources were known to the researcher, which facilitated the responses to follow-up telephone calls and emails. The process of using referrals within a profession is known as “social labeling” and has been used widely to identify research participants in studies of expertise development (Shanteau, 1988; Sternberg, 1994). The referral sources identified 36 possible participants, all of whom were chief executive officers (CEOs), although position was not specified in the criteria. Because the healthcare industry values demographic representation, efforts were made to recruit both male and female participants from different geographic regions, both urban and suburban environments, and both teaching and community organizations. Overall, the process of identifying potential study participants was situation specific, professionally executed, and industry sensitive (Dexter, 2006; Odendahl & Shaw, 2002; Richards, 1996; Useem, 1995; Yeung, 1995).

Contacting Potential Participants

Advice in the literature for contacting potential participants includes using an influential person or one's own contacts to make introductions, sending a very strong introductory letter stating the purpose of the study and its benefits to the participants, and mentioning any institutional support or coauthors of note that may give legitimacy to the research (Delaney, 2007; Richards, 1996; Thomas, 1995; Yeung, 1995). The impressions made by this first contact are considered lasting; they can indicate sound academic work and a well-thought-out study (Lilleker, 2003). Other advice cautions against the use of academic jargon and saying too much about the project, which might lead to the researcher being referred to a staff specialist, rather than gaining access to the elite desired (Dexter, 2006).

The methodological literature acknowledges the control of elites' gatekeepers. A secretary or assistant is portrayed as either an obstacle to be circumvented or a protective servant who will get researchers what they want, such as information and appointments with the elite, if the researchers are very polite in their requests (Cochrane, 1998; Dexter, 2006; Richards, 1996; Undheim, 2003). Harvey (2010) provides a departure from this negative view of gatekeepers; he suggests they be viewed as opportunities and he describes an experience in which he met with an assistant to explain his study and was referred to 60 potential participants.

Harvey's (2010) suggestion seems understated after the recruitment experiences of this strategic thinking study—the administrative assistants to healthcare CEOs were not only the key to recruiting their elite bosses, but they were also the catalyst for the entire interview series running smoothly. Consistent with the institutional review board approval, potential participants were sent a letter inviting their participation in the study. The letter began by referencing the referral source and included information on the study's purpose and details of participation. Some letters were sent via email and some by regular mail, depending on the information provided by the referral source. A follow-up phone call was placed within a week. This recruitment process was met with a number of responses: (1) the elites told their assistant to tell the researcher they were not interested; (2) the elites said they would give the researcher ten minutes on the phone to ask questions (which is representative of the ways in which surveys were done with healthcare executives at the time); or (3) the elites could not recall receiving the letter. After a handful of rejections, one assistant told the researcher her boss would participate. This assistant was particularly friendly and mentioned the name of the referral source several times as someone she admired. After this positive outcome, the initial contact strategy changed to calling the assistant of the elite (e.g., calling “administration” and asking for the name and phone number if the referral source did not have it); introducing oneself to the assistant as referred by the consultant or industry association executive and asking if he or she had a moment to speak with the researcher (if not, setting a call-back appointment); explaining quickly that the boss was selected for inclusion in a university-affiliated research study because the referral source had identified him or her as an expert strategic thinker (this statement was usually met with an affirmative remark); and asking if the researcher could have the elite's mail or email address to send a letter describing the study.

This strategy of treating the administrative assistants professionally proved fruitful. Some assistants gave the researcher the elite's email address (and also their own to be copied on the information sent). More often, the researcher was asked to send the material to the assistant for forwarding. The researcher's concern was that the request would end up in the trash. What actually occurred was that the assistant would “summarize” the study for the elite and ask the elite about participation, which usually resulted in the assistant reporting back to the researcher that the elite was not interested. Once savvy to this problem, the researcher used the “strictness of study protocol” in advising the assistants that while they could certainly receive copies of the material, the researcher needed to personally explain the study to the elite and would require a scheduled five-minute phone call to do so. These additional strategies brought immediate results, and phone calls were scheduled with the elites. (Strategies used during the calls are discussed in a later section.)

Odendahl and Shaw (2002) describe the process of identifying and contacting elites as one that “calls for the incorporation of strategies that include a mixture of ingenuity, social skills, contacts, careful negotiation, and circumstance” (p. 307). This certainly describes the researcher's experience. Yeung (1995) characterizes the process as “a tedious and time-consuming business” requiring “patience and perseverance” (p. 333). While this sentiment is certainly true, the time invested paid off immeasurably once the elite agreed to participate. The assistants became the contact point for scheduling and, given that they had read the materials that indicated the need for three interviews, spaced a week or so apart, the assistants voluntarily rearranged elites' calendars to accommodate interview scheduling. Many also offered the researcher assistance with transportation from the airport to their organization, recommended hotels if needed, and even made the reservations. At one organization, the assistant arranged a prime, secured parking spot so the researcher could avoid negotiating and incurring the expense of an inner-city garage.

Gaining Commitment to Participate

As described above, a five-minute telephone call was established with potential participants to discuss the study. At this point, the CEOs were aware of the referral source who had suggested them for the study and may or may not have read about the details (more likely not). Some assumed the call was the interview, others kindly advised the researcher that she was asking the busiest people for a lot of their time with little known benefit, and a few deemed the methodology ridiculous because of its tripartite 90-minute requirements.

The methodological literature acknowledges, but provides little guidance on, how researchers should deal with these types of responses. Undheim (2003) notes that knowing why the elite may or may not participate should be part of the research agenda; Morris (2009) suggests emphasizing that the elite's input is valuable to the research; and Sabot (1999) and Thomas (1995) advise stressing the researcher's desire to understand the world from the elite's point of view. Delaney (2007) provides the most specific guidance to researchers: “Make it obvious that the person whom you wish to interview will bring unique and even essential expertise to the topic …. their particular set of experiences and expertise are critical to gaining a full understanding of the issue at hand” (p. 212). These suggestions are stated from the researcher's point of view, not the participants', and assume the elite is the conventional type, interested in furthering research (Sabot, 1999). Dexter (2006) identifies as beneficial to the interviewees the opportunity to tell their story, which is especially attractive to those being queried by younger interviewers, and the opportunity to engage in self-analysis. These may be valuable aspects of many interview studies; however, the potential audience was generally not familiar with this type of interview research and, therefore, could not appreciate these features before they agreed to participate.

The researcher found a combination of the following strategies to be successful for securing the commitment of healthcare CEOs to participate in the study: Restating the identification of the elite as an expert by known strategists in the healthcare field (i.e., the referral sources); indicating that this was a university-sponsored study in order to contrast it with consulting firms' studies, which are often considered precursors to sales; and indicating that the elite's participation would help the leadership development of future healthcare executives. This last strategy emerged from a conversation with one elite who, during the initial telephone conversation, instructed the researcher in how to best approach his colleagues. This suggestion was not an attempt to control the interview; it was a genuine interest in helping. The elite noted that his contemporaries were extremely busy but also concerned about their legacies, and framing the request as a way to codify their experiences for others to learn from had great appeal. Queried later about why he took the time to instruct the researcher, this participant indicated that he was impressed with the professionalism of the study as shown by the written material and the determination in the researcher's voice to explore the topic.

All participants were asked at the conclusion of the study why they chose to participate. Most indicated they benefitted tremendously from the self-analysis and had never been asked about this topic before—the interviews were likened to psychotherapy. The reasons for their initial agreement ranged from pure curiosity and a desire to help others to their long-standing interest in strategy and how to improve it in healthcare. A few indicated that their alma mater was the same as the researcher's and they wanted to support the school; in fact, they mistakenly thought the researcher was a graduate of the same program. Thus, the elites participated not based on “what's in it for me,” but based on their perceived contribution.

Interviewing

In addition to gaining access, the methodological literature on interviewing elites focuses on their attempts to use their power to control the interview (Harvey, 2010). While this concern is important, other issues require attention to conduct successfully in-depth interviews with elites.

Scheduling

The methodological literature advises researchers to be flexible in scheduling interviews with elites and to accommodate times and venues of the participants' choosing to ensure their convenience and comfort (Harvey, 2010; Odendahl & Shaw, 2002; Thomas, 1995). Lunch, a common occasion for business discussions, is not considered a good time for an interview because the public location is likely to result in only general conversation (Dexter, 2006). Delaney (2007) suggests that researchers state that their projects are ongoing and elites can be interviewed at any time convenient to them over a range of weeks or months. At the same time, he advises using the pressure of the researcher's calendar, such as being in town for a conference, to help scheduling. Methodological literature describing how to achieve the scheduling requirements of the Seidman (1998) method, three 90-minute interviews, approximately one week apart, was not located. In addition to affecting the participant's calendar, these requirements also had a significant impact on the calendar of a researcher employed as a consultant and on the cost of the study, especially given that the CEOs were located throughout the U.S. In addition, close coordination with the transcriptionist was required so that participant data from one interview could be available at least one day before their next interview.

To deal with all of these requirements, a number of strategies were employed. It was suggested that CEOs give their permission for the researcher to work with their assistants to schedule the required three interviews. No more than three participants (of an expected ten) were scheduled during the same time period; a denser schedule was too complicated to juggle and did not allow room for contingencies. The researcher maintained a project management schedule on an Excel spreadsheet to keep track of interview dates, travel details, transcripts, and times to contact additional participants. Two participants who traveled frequently were met at the location of a conference they were attending—one was interviewed over lunch in an unused room secured by working with a hotel and its restaurant. The researcher contacted the participants' assistants to confirm the first interviews three days in advance and confirmed the second and third interviews while on-site. Managing this process and conducting the interviews was the researcher's full-time job for three months. The researcher's calendar was cleared of on-site client work in order to offer as much scheduling flexibility as possible to the participating CEOs.

Odendahl and Shaw (2002) relate cautions from their experience that elites may keep researchers waiting for long periods, announce upon their arrival that the interview time is shortened considerably, or interrupt the interview to conduct business without replacing the scheduled amount of time. During this study, the researcher experienced none of these scheduling issues. Rather, the researcher herself had to cancel the first set of interviews and redirect her travel upon learning her mother was seriously ill. With another participant, the researcher had to reschedule an interview because she could not fly due to her own illness. In both cases, the assistants were understanding and rescheduled the interview times. The only change made by a participant was the slight rescheduling of a final interview time and conducting it via telephone because the CEO was recovering at home from an unanticipated surgery.

Preparing

The methodological literature advises researchers to do their homework to understand the culture, context, and social norms they are entering, including areas such as the style of dress and rituals of interaction among elites (Odendahl & Shaw, 2002; Ostrander, 1993; Richards, 1996; Thomas, 1995), though no specific guidance is provided as to how to uncover this information. Other preparatory advice suggests sending the interview guide in advance to signal professionalism, help with control issues, and maximize the use of the elites' time. However, this advance notice was not recommended by Seidman (1998). Seidman prefers questions to emanate from active listening on the part of the researcher, playing off of what the participant has begun to share in exploring his or her experience.

Before conducting research with the healthcare CEOs, a number of preparatory strategies were employed. The researcher reviewed the organization's website to gain an overview of its history and services and studied the background of the CEO and the individuals on the management team and board. The researcher performed a web search on the region served by the organization to gain an appreciation of area geography, businesses, resources, important historical and community events, other healthcare providers, and related information. Assistants were asked, when confirming the interview time, if anything special was occurring that day that might affect the CEO's time or the researcher's access to the facility (with mention of employee barbeques, holiday parties, and other events leading to questions related to appropriate dress, for example). The researcher sent an email to the CEOs two days before each interview, thanking them for their time and providing a few brief statements regarding the topics to be covered in the upcoming session. The strategies used to prepare for the interviews provided the researcher with ample contextual information and continued to demonstrate the professionalism of the study.

Establishing Rapport

Elites' attempts to control interviews is one of the two areas (the other is access) given the most attention in the methodological literature (Harvey, 2010). Interviewers are advised to assume that elites, who are used to being in charge, will try to control the interview by constantly questioning the study methods and the researcher's credentials; altering questions and dominating through elaborate responses; and using the interview to present themselves only in a positive light (Delaney, 2007; Morris, 2009; Odendahl & Shaw, 2002; Ostrander, 1993; Welch et al., 2002). Large age differentials and gender differences are also identified as potential barriers to the interviewer being taken seriously (Cochrane, 1998; Odendahl & Shaw, 2002).

Suggested solutions are for the interviewer to arrive first to set up the audio recorder and determine the seating arrangement; establish control by handing over a business card at the onset; assume a collegial (not deferential) position by being courteous and professional; keep introductions brief and indicate that data collection has just commenced; begin by clarifying the ground rules; flatter the elite to encourage more forthcoming responses; and move from nonthreatening to more threatening questions (Delaney, 2007; Morris, 2009; Odendahl & Shaw, 2002; Ostrander, 1993; Richards, 1996; Thomas, 1995).

Although helpful to those conducting single, journalistic types of interviews, these suggestions are not effective for the rapport required with the tripartite Seidman (1998) method. To assist in rapport building with healthcare CEOs, the researcher employed the following strategies: breaking the ice with a comment or question about the facility, a displayed picture, or an award (Odendahl & Shaw, 2002); using the referral source as a connection to create a trusting relationship (Kezar, 2003); explaining that recording is necessary so the researcher can listen rather than take notes; restating the informed consent language about protecting the elites' confidentiality to remove this concern; describing the interviews as a collaborative learning process (Morris, 2009); and indicating that there are no “right” or “wrong” answers, just the elites' experiences for exploration.

The researcher was within a ten-year age differential of the participants, who were both male and female. No age or gender issues were perceived. Rapport was very comfortable, probably because of the researcher's familiarity with the field and environment (Hirsch, 1995). However, in designing the study, the researcher was concerned that the CEOs, as action-oriented individuals, would lose interest in participating in something with no concrete result. Accordingly, the mapping of participants' experiences was added to the research protocol and proved a valuable tool.

Incorporating Mapping

In this study of experiences that develop the ability to think strategically, a map depicting the insights of the CEOs was prepared. At the end of the first interview, the participants were informed that this mapping would occur and encouraged to think about what it might look like. As per the interview protocol, the participants were asked what “form” they thought the depiction of the development of their strategic thinking ability should take: “What might it look like? What might be included?” Some participants immediately provided a response. Two participants chose to draw their own maps, one coming into the second interview with a highly detailed drawing he had spent hours perfecting. Others indicated that they had thought about a specific shape, such as a circle, triangle, staircase, etc. The maps for participants were drawn by the researcher with each participant's input (except for the map already provided by the one interviewee). While the characteristics of the maps were largely left to the participants to determine, cognitive maps have some features in common that guided representational efforts: Concepts (i.e., ideas, events, and processes), categorizations of concepts (i.e., grouping and relative positioning), and causation (i.e., relationships, strengths of connections, and meaning) (Carley & Palmquist, 1992; Fiol & Huff, 1992). Between the second and third interviews, the researcher sent a graphic depiction of their maps to the elites for their review. Refinements were made during the third interview, when interpretations of the meaning of the maps and, thus, the experiences were discussed. At the conclusion of the interview series, all participants verified the content of their final maps.

There were several benefits of the mapping activity and no drawbacks were detected. Similar to how cognitive maps function for mapping concepts in strategic decision-making (Fiol & Huff, 1992; Huff, 1990), the maps in this study triggered memory, revealed gaps in information, highlighted more versus less important factors, and focused the participants' attention. The mapping activity kept participants engaged and concretized their time investment by providing them with a tangible outcome personally related to themselves. Kinchin, Streatfield, and Hay (2010) report on the use of concept mapping after interview completion to summarize interview transcripts, and they noted that the maps can raise questions about the data as well as effectively display it. Including the mapping in the study helped ensure trustworthiness by serving as a means of triangulation in data collection and of member checking (Maxwell, 2005). Having maps prepared before the third interview solved the problem of post-interview lack of cooperation in getting member checks.

Finally, traditional interviewing methods are criticized for their inability to transform the lives of those interviewed (Kezar, 2003). Suggestions for facilitating transformation include scheduling multiple interviews, encouraging interviewee journaling, and interpreting data in conjunction with the interviewee. The mapping in this study helped connect the three interviews and provided participants with a means for the collaborative discovery often advocated in qualitative research (Bartunek & Louis, 1996). Interviewees were encouraged to journal in a notebook provided by the researcher, though no one chose to undertake this practice. Many of the study participants commented that the interview process was enlightening to them and helped them to better understand their own histories. They frequently referred to the contribution of the mapping to these revelations. In addition, participants' body language during the review of their maps, and the related comments of surprise and elucidation, indicated that considerable insight was developed through the mapping process.

Summary

This article has reflected on the difficulties related to interviewing elites that are documented in the literature and provided an example of how potential problems were averted. In this tripartite in-depth phenomenological interviewing study, a research relationship was established with healthcare elites. This research relationship appears to be unique because published studies regarding elite interviews are reported as singular interactions and express limitations due to the nature of the interviewing that occurred (i.e., elite-imposed time limits and interruptions) (Odendahl & Shaw, 2002).

Three major practices enabled the relationship. First, by purposefully organizing and managing information—who was contacted and what was discussed with whom and when—the researcher was able to establish rapport with the elites' offices and successfully recruit. Second, the consistent professionalism exhibited in communications with the elites' offices and the elites themselves established rapport and diffused potential power dynamics. Third, the use of concept mapping in the interviews provided a connection and culmination to the three-interview cycle and aligned the researcher's interpretations with the interviewees' perceptions. The authors contend that the combination of these three practices created a relationship between the researcher and elite interviewees that resulted in an in-depth understanding of how healthcare elites developed the ability to think strategically.

Based on previous literature about interviewing elites, researchers might decide that such an undertaking is too risky—that they may not get access to those who hold the specific information desired and that if they are fortunate enough to gain access, they may be hampered in the amount of information gathered because of time limitations and/or power dynamics. The experiences discussed in this article indicate that elites can be accessed and can participate in not only one but three interviews and concept mapping. The techniques used to manage information, time, and power and to create alignment can be utilized by other researchers in their interview-based studies of elites.

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