Greening Hospital Supply Chains: The Experience of Australia and Turkey


The purpose of this chapter is to present the research methodology selected for examining the set research questions. The research methods and design have been selected for this thesis with reference to their ability to effectively test the main research questions, as well as proposed sub-questions. This chapter is organised into several sections to provide the description of the appropriate research paradigm, approach, design, methods, instruments, sampling, and data analysis techniques chosen for this study. The validation of the selected research methodology and all details regarding the data collection and analysis are presented in this chapter with the focus on ethical questions pertaining to this research.

Research Paradigms

In order to investigate a certain phenomenon, make assumptions, and support reasoning, researchers use different types of paradigms or philosophies. These paradigms reflect researchers’ views regarding relationships between objects in the real world that influence their conclusions (Creswell & Poth 2017). In this sub-section, such philosophies as ontology, epistemology positivism, interpretivism, pragmatism, and realism should be discussed with the main focus on the research paradigm that is adopted for this study.


Ontology is a philosophical viewpoint regarding the nature of world phenomena and processes that exists in two forms: objectivism and subjectivism. Objectivists support the idea that social phenomena and processes exist externally to people who think about them or perceive them (Creswell & Poth 2017). On the contrary, subjectivists believe that social phenomena and processes should be viewed as results of social actors’ perceptions and visions (Bryman & Bell 2015; Edmonds & Kennedy 2017). Researchers select a relevant form of ontology to examine and analyse phenomena from the perspective that directly addresses their viewpoint regarding the world processes.


Epistemology explains how knowledge is formed with reference to certain aspects or constituents. Depending on the principles of epistemology, some researchers choose to focus on psychological aspects regarding the studied phenomenon, and other investigators become interested in different material aspects of this phenomenon (Bryman & Bell 2015; Creswell & Poth 2017). In order to examine certain phenomena in detail, researchers collect the knowledge of them with the help of concentrating on relationships, processes, development, and perceptions related to these objects for studying.

Positivist Paradigm

Positivism is a paradigm that accentuates the role of objective data received during the scientific research to conclude regarding the nature of certain phenomena. Positivists study actual attributes of phenomena and processes to use these findings in order to make objective conclusions (Creswell 2014). This paradigm is actively used by researchers in order to test their assumptions and hypotheses and present generalisations that are objective in their nature and can be applied widely.

Interpretivist Paradigm

Interpretivism differs from positivism by its focus on the subjective interpretation of all data that are collected by researchers. Thus, data analysed for a study are usually given from the perspective of individuals’ beliefs and views. When applying this paradigm, researchers choose to concentrate on individuals’ perceptions of certain processes and phenomena selected for studying, and the use of this philosophy means interactions with participants of a study in order to collect information regarding their experiences and beliefs (Creswell & Poth 2017). As a result, researchers focus on collecting subjective data, and this information can be biased.


A pragmatist paradigm combines the features of both positivism and interpretivism that allows for using this paradigm when conducting mixed methods studies that include quantitative and qualitative methods (Creswell & Poth 2017). The combination of two paradigms is important when researchers want to apply the more effective approach in their study to test or justify their hypotheses (Antwi & Hamza 2015). As a result, the focus on pragmatism contributes to increasing accuracy of study results because the application of only quantitative or only qualitative methodology can be viewed as limiting the overall relevance of study findings.


Realism is a paradigm that explains the view that social entities exist without references to individuals’ interpretations. From this perspective, objects are stated to be real without any dependence on people’s perceptions or results of the analysis in the human mind (Neuman 2014). However, there are also two forms of realism that can be applied by researchers: direct realism and critical realism (Bryman & Bell 2015; Mertens 2014). The proponents of direct realism believe that people’s senses perceive the true information about the reality, but supporters of the ideas of critical realism state that the true reality and objects in it exist without focusing on people’s senses, and the discussion of perceptions is not appropriate in this case.

Research Paradigm Selected for This Study

Depending on the type of research questions formulated for this study and the researcher’s expectations and assumptions, it is possible to state that pragmatism is a paradigm that is more appropriate for the study. The key quality of a pragmatist philosophy is that its proponents are oriented towards finding direct solutions to practical issues and problems in the world around without focusing on the nature of knowledge or truth, as it is typical of other paradigms (Bryman & Bell 2015; Creswell & Poth 2017). Thus, applying a pragmatist perspective, a researcher is interested in examining practical aspects and consequences of certain studied processes and phenomena.

In this study, the main focus is on identifying and analysing the major practical aspects, as well as benefits and risks, of greening supply chains in the healthcare sector with reference to two different national contexts. The practicality of this topic accentuates the necessity of selecting a paradigm that will contribute to analysing the aspects in the world with the focus on their real impact on such processes as the creation and management of green supply chains (Edmonds & Kennedy 2017). Therefore, referring to pragmatism, the researcher gets an opportunity to concentrate on collecting both numeric and narrative data for further analysis (Domínguez & Hollstein 2014; Neuman 2014). These advantages of pragmatism allow for selecting this paradigm as suitable for this study.

Research Approaches

In their work, researchers usually apply two different types of research approaches that are known as the deductive approach or reasoning and the inductive approach. However, there is also abductive reasoning that combines the features typical of these two approaches (Bryman & Bell 2015). It is important to note that the deductive approach is associated with positivists’ philosophy, and interpretivists use the inductive approach for their studies (Chan 2017; Hamad et al. 2016). Therefore, pragmatists traditionally apply abductive reasoning in order to cover both deductive and inductive approaches.

Deductive Approach

Those researchers who choose the deductive approach are known as positivists, and they need to test assumptions and the general theory referring to objective information or data collected for this purpose. Thus, the path of deductive reasoning in this case is from making assumptions and formulating hypotheses to analysing collected objective data and making conclusions (Bryman & Bell 2015; Creswell & Poth 2017). The received findings are usually objective in their nature, they prove or disprove hypotheses, and they can be generalised to the wider population (Bryman & Bell 2015; Edmonds & Kennedy 2017). Thus, the deductive approach is used when researchers plan to test specific theories and hypotheses with the focus on understanding the nature of relationships between selected variables.

Inductive Approach

Interpretivists choose the inductive approach for their studies because their reasoning is based on the following steps: the collection of certain data for the analysis, the focus on individuals’ perceptions associated with these data, the analysis of data, and the formulation of the theory referring to these findings (Creswell & Poth 2017). The use of the inductive approach allows for working with subjective information that directly reflects individuals’ experiences, emotions, views, and ideas (Bryman & Bell 2015). As a result, the final conclusions of researchers are usually associated with formulating certain theoretical ideas that can explain tendencies and themes determined with the help of a study.

Research Approach Selected for This Study

In this study, the focus on the pragmatist paradigm explains the choice of the approach that can combine the features of both deductive and inductive reasoning. This type of applying both principles to examining the phenomenon is known as abductive reasoning, and it is selected as the key approach for this study (Edmonds & Kennedy 2017). According to Bryman and Bell (2015, p. 27), “Abduction involves the researcher selecting the ‘best’ explanation from competing explanations or interpretations of the data,” and “this is related to the philosophical idea of the ‘hermeneutic circle,’ through which understanding is seen as a continuous dialogue between the data and the researcher’s preunderstandings.” The nature of the formulated research questions and the aim of the research explain the necessity of using the assumptions typical of inductive and deductive approaches in order to use different meth­ods for examining the issue under discussion.

As a result, while referring to the idea of intersubjectivity typical for the combination of inductive and deductive approaches, it is possible to state that abductive reasoning allows for testing certain assumptions from both theoretical and empirical perspectives (Bryman & Bell 2015). Applying the combination of deductive and inductive approaches in the form of abductive reasoning, the researcher in this study receives an opportunity to examine the problem from different sides, without selecting this or that approach. Moreover, the researcher overcomes the limitations associated with using the other discussed approaches.

Research Design

In addition to selecting the research paradigm and approach, it is also necessary to focus on the research design. It can be explained as a specific focus that a researcher follows while using different research methods in order to address the set research question (Bryman & Bell 2015). The selection of the research design influences the further choice of techniques to be used in order to examine the problem. Depending on the approach to studying the variables, researchers can focus on descriptive, exploratory, or causal research designs.

Descriptive Design

It is important to pay attention to the fact that researchers select a descriptive research design for the purpose of describing specific qualities or attributes of objects, processes, phenomena, relationships, and individuals. Therefore, this research design is based on collecting data that provides information about the selected object or subject, analysing these data, and making conclusions that are descriptive in their nature (Bryman & Bell 2015). The descriptive research design is correlated with positivism because, collecting data required for analysis, researchers do not change or interpret them in order to remain objective and unbiased (Creswell & Poth 2017; Domínguez & Hollstein 2014). However, it is important to note that, while presenting the description of specific phenomena, processes, and relationships in the context of this study, researchers do not provide explanations regarding the causes of these relationships (Hancock & Algozzine 2016). The analysis of possible relationships between variables is realised without changing conditions with the help of experiments or interventions.

Exploratory Design

One should note that interpretivists concentrated on using the inductive approach to their research traditionally choose the exploratory research design. The reason is that this design allows for studying the issue or problem that was not examined in detail by other researchers. Thus, after conducting a literature review, a researcher can determine certain gaps in the existing or recent research and choose to examine this uncovered area (Hancock & Algozzine 2016). For this purpose, it is important to recruit the participants who can provide additional information regarding the issue, interview them, and analyse the collected data referring to their interpretations of the problem. In this case, a researcher receives a full picture regarding the studied problem with the focus on gaps that were not covered in previous studies (Bryman & Bell 2015). As a result, it is possible to speak about the detailed exploration of a certain issue with the help of tools that are applied in the context of the exploratory research design (Creswell & Poth 2017). Therefore, using this design, researchers prefer to rely on the qualitative methodology when conducting their exploratory research.

Causal Design

One more research design used by investigators is causal or explanatory. This design is selected by those researchers who are inclined to explain how the chosen variables can affect each other with the help of focusing on experiments and changing conditions for these variables. During conducting this type of research, investigators are interested in applying not qualitative or quantitative methods but explanatory ones, including the use of experiments, a series of experiment-based studies, and interventions with control and test groups (Edmonds & Kennedy 2017; Hesse-Biber & Johnson 2015). Thus, it is important for researchers focused on the causal design to examine the nature and direction of relationships between variables with the focus on causes and outcomes of these relationships (Bryman & Bell 2015). Conclusions can be related to finding positive or negative relationships between variables, as well as differences in effects of one variable on another (Creswell & Poth 2017). The collected results are usually generalisable in their nature, and they can be widely used to state whether certain triggers can predict some outcomes as it was assumed by the authors of an explanatory study.

Research Design Selected for This Study

In order to address the research questions and purpose of this study, it is necessary to apply the research design, according to which it is possible to answer questions requiring the analysis of both qualitative and quantitative data. Therefore, the application of both descriptive and exploratory research designs is reasonable for this study (Edmonds & Kennedy 2017). The principles of the descriptive design are important to be implemented in order to work with quantitative data to explain factual benefits and weaknesses of selecting and integrating green supply chains in hospitals of Australia and Turkey. The principles of the exploratory research design should be used to collect and evaluate qualitative data in order to examine the problem from the perspective of participants involved in implementing green supply chains in the healthcare sector (Domínguez & Hollstein 2014). Thus, the rules typical of a convergent parallel design need to be applied to this study (Creswell 2014; Creswell & Poth 2017). In this case, the collection and analysis of quantitative and qualitative data are realised not sequentially but independently.

Research Methodology

After selecting the research design to be applied to the planned study, it is necessary to choose the appropriate research methodology. The most appropriate methods are selected depending on the characteristics of the proposed study (Bryman & Bell 2015). Still, it is important to note that, traditionally, researchers select between quantitative and qualitative methodologies, or they choose the combination of both approaches in the form of mixed methods. Differences in these methodologies need to be described in detail.

Qualitative Methodology

The qualitative methodology is based on collecting and analysing data for answering the research questions on specific features of certain phenomena, processes, and situations that require further investigation. Thus, qualitative studies are usually selected in those cases when there is little information on a particular subject or problem (Creswell & Poth 2017; Domínguez & Hollstein 2014). This methodology is used for exploratory research, and as a result, investigators receive opportunities to study the determined issues from the perspective of participants (Edmonds & Kennedy 2017). The aim of qualitative studies is to focus on the experiences of individuals and understand them with the help of research (Leavy 2017; Merriam & Tisdell 2016). Certain conclusions about the nature of phenomena and processes are usually made referring to the analysis of a lot of narrative data. Therefore, the result of conducting qualitative studies is often the formulation of a specific theory based on the findings.

This methodology is often used in order to support or expand the findings determined with the help of quantitative data. The reason is that qualitative methods are associated with more tools for researchers in order to study a certain problem from several perspectives. However, there are also limitations in using only qualitative techniques because the received results cannot be generalised and applied to a wider population, as it is in the case of using quantitative methods (Miles, Huberman & Saldana 2014; Yin 2015). Moreover, the qualitative methodology associated with inductive reasoning provides the discussion of a problem or an issue only from one perspective that is rather subjective in its character.

Quantitative Methodology

The quantitative methodology depends on collecting and analysing numerical data for the purpose of testing hypotheses. This methodology is appropriate to provide statistically significant conclusions regarding the relationships between certain variables. As a result, researchers can use quantitative methods in order to describe different phenomena, processes, and participants with the focus on proving or disproving formulated hypotheses (Creswell 2014; Edmonds & Kennedy 2017). This aspect explains the popularity of this methodology among positivists when it is necessary to describe existing relationships between variables and when it is necessary to determine possible causes of relationships (Jason & Glenwick 2016; Treiman 2014). Moreover, one of the key advantages of the quantitative methodology is the possibility to generalise the results of a study based on numerical data (Queirós, Faria & Almeida 2017; Zhu 2014). Such results are traditionally viewed as objective if their statistical significance is proved, and these findings are discussed as applicable to the wider population.

Mixed Methods Research Methodology

In contrast to qualitative and quantitative methodologies, the mixed methods research tends to present the alternative theoretical understand­ing of conducting studies and examining phenomena with the focus on combining strong features of both qualitative and quantitative methods. These specific methodologies allow for examining the same processes or objects from different perspectives, and results of qualitative and quantitative studies on the same topic can be different in their type and nature (Chan 2017; Hamad et al. 2016). However, the mixed methods research is appropriate to avoid these limitations associated with different methodologies while conducting a well-developed study.

Thus, the mixed methods research is used to provide investigators with opportunities to refer to both empirical data and narratives or lived experiences. Researchers get a unique understanding of the studied aspect because of the applied pragmatic approach to studying the phenomenon (Chan 2017; Hay 2016; Mertens 2014). When they use the mixed methods research, it is possible to expect that findings of a study will be reliable, accurate, and credible in contrast to the results of only qualitative or quantitative studies (Hay 2016). It is possible to state that the reason is in applying an abductive process for researching the problem (Domínguez & Hollstein 2014; Pelto 2015). As a result, the mixed methods research provides investigators with opportunities to rely on both quantitative and qualitative assumptions and generalise the findings, as well as to focus on their subjective character.

Rationale for Selecting Mixed Methods Research

For this study, mixed methods research is selected as the most appropriate option to address the set research questions. The reason is that the mixed methods methodology provides a researcher with a variety of approaches and techniques to choose from in order to conduct the high-quality research that will not be limited by the approaches typical of only qualitative or only quantitative methods (Domínguez & Hollstein 2014; Edmonds & Kennedy 2017). This study is aimed at determining possible benefits and risks associated with implementing green supply chains in hospitals of Australia and Turkey with the focus on possible similarities and differences in these countries’ experiences. The complex character of this purpose supports the idea that only the combination of qualitative and quantitative methods can help a researcher to collect appropriate data for analysis to conclude regarding the experience of the Australian and Turkish healthcare systems in greening supply chains.

The provided research questions can be effectively answered only with reference to collecting both quantitative and qualitative data for further analysis. The financial data explaining the establishment of green supply chains in hospitals can be successfully analysed with reference to the principles of descriptive research and the quantitative method (Jason & Glenwick 2016; Pelto 2015). On the contrary, ideas and views of managers implementing green supply management principles, administrators in hospitals, and the personnel should also be taken into account, and the qualitative methodology allows for collecting this information (Merriam & Tisdell 2016; Pelto 2015). Views regarding possible advantages or challenges associated with greening supply chains in healthcare systems of two different countries can be collected with the help of interviews. As a result, focusing on the mixed methods methodology, the researcher receives more opportunities to examine the situation with greening supply chains in Australia and Turkey from objective and subjective perspectives to make accurate and relevant conclusions.

Case Studies

The purpose of this subsection is to discuss what case studies have been selected for their further analysis and discussion in the context of this research. The chosen type of case study analysis is also described in this section in order to accentuate its role in contributing to finding the answers to the research questions that guide this study (Domínguez & Hollstein 2014; Hancock & Algozzine 2016). The key aspects related to selecting specific cases in Australia and Turkey are described in detail in the following sub-sections.

Types of Case Study Analysis

The case study approach is viewed by researchers as providing investigators with much flexibility in studying certain phenomena or qualities while focusing on real-life examples. This empirical inquiry allows for analysing specific cases in the context of real factors that influence their development. In addition, while focusing on studying cases, researchers usually examine different types of data and evidence with reference to a variety of sources, and this aspect contributes to making relevant and credible conclusions (Hancock & Algozzine 2016). Case studies are suitable when researchers need to explore one of the phenomena in detail, and investigators can use observations, reviews, surveys, and other approaches to collecting data while working on their study.

It is possible to distinguish between descriptive, selective, and explanatory case studies, but there are also other classifications of this research design. Descriptive case studies can also be viewed as exploratory, depending on the amount and quality of data analysed. These case studies aim at describing a specific phenomenon, object, or subject in detail, providing a direct answer to the set research question (Hancock & Algozzine 2016). Selective case studies should be considered as a type of descriptive studies, and they will be discussed in the next sub-section. Explanatory case studies are used when researchers have the purpose of understanding the causes and outcomes related to a particular phenomenon (Yazan 2015; Yin 2017). From this perspective, explanatory case studies can be used to explain certain processes, situations, or trends under analysis.

Selective Case Study Approach

In the context of descriptive case studies, it is possible to accentuate selective case studies. These cases allow a researcher to concentrate on studying a particular aspect, phenomenon, or feature, and cases are chosen for the examination depending on their ability to provide information about this studied aspect (Hancock & Algozzine 2016; Yin 2017). Thus, the examples under discussion are chosen selectively in order to be studied in detail during the research and provide answers to the set study questions. From this perspective, the key advantage of a selective case study approach is the possibility to focus only on those cases that can be directly used for responding to the research questions (Hesse-Biber & Johnson 2015). In this context, much attention should be paid to the effective selection of the most appropriate cases or examples for their further study and analysis.

For the purpose of this study, it is important to select only those hospitals in Australia and Turkey for their further analysis which have tried to apply green supply chains. Furthermore, one should state that the key principle of this case study approach is selectivity. Therefore, it is necessary to choose only one hospital in each country (Australia and Turkey) where the implementation of green supply chains has been associated with both positive and negative aspects of the process in order to concentrate on a full picture related to this process.

However, while planning the research based on a selective case study approach, it is also necessary to pay attention to possible limitations of this method. The problem is that a researcher can select cases depending on the purpose of the study while focusing only on the examples of the successful realisation of strategies or programs or unsuccessful realisation of strategies. In order to address this limitation, the researcher has selected hospitals in Australia and Turkey for further analysis with reference to both successful and unsuccessful steps on their paths to greening supply chains, as it was stated earlier in this sub-section. As a result, this study allows for analysing the question of implementing integrated green supply chains from different perspectives.

Sampling Approach

Researchers distinguish between probability and non-probability sampling techniques. While focusing on a selective case study approach, the researcher has chosen purposive sampling as a type of a non-probability sampling technique because of the necessity to concentrate on particular cases that are characterised by certain features. Thus, researchers also identify purposive sampling as selective sampling (Hay 2016; Kumar 2014). This approach allows for identifying only those cases for this study which are appropriate to be analysed for this research because they have certain features and characteristics. This technique is actively used by those researchers who conduct qualitative and mixed methods studies.

In the context of purposive sampling, it is also necessary to use critical case sampling. This type of the selected purposive sampling approach is appropriate to be used when a researcher is concentrated on examining specifics that are related only to a small number of cases that represent the studied phenomenon (Hesse-Biber & Johnson 2015; Mertens 2014). This approach is also useful when the elements of the qualitative research are used, as it is in the case of developing the mixed methods research (Hancock & Algozzine 2016; Mangla, Kumar & Barua 2015). Case studies selected with reference to critical case sampling should clearly represent the features or qualities under analysis, or they need to be decisive in their nature to support the idea that the studied phenomenon exists.

The Selected Case and Setting in Australia

For the purpose of this research, the Royal Melbourne Hospital located in Parkville, Victoria, was selected as an Australian public hospital to be included in this study. This hospital is one of the largest public healthcare facilities not only in Melbourne, Victoria, but also around Australia. This hospital was established in 1848, and today it belongs to the Melbourne Health group (The Royal Melbourne Hospital 2018). The Royal Melbourne Hospital has the reputation of a healthcare facility, the leaders of which are oriented towards adopting the latest technologies and applying the most innovative approaches to their practice. Furthermore, the hospital has developed an effective program oriented towards greening their operations and achieved certain successes in designing and integrating green supply chains. The examination of the experience of this hospital in implementing supply chain management is important in the context of this case study research.

The Selected Case and Setting in Turkey

Anadolu Medical Centre (Anadolu Sağlık Merkezi) is located in Gebze, Kocaeli, Turkey, and it is one of the leading private hospitals in the country that operates in affiliation with Johns Hopkins Medicine International. The hospital is famous for paying attention to clinical research and implementing innovative methods and practices to deliver care. Moreover, the hospital has received ISO 9001–2000 and ISO 14001 certifications, and it has experience in improving its supply chain management to address global standards (Anadolu Medical Centre 2018). This particular experience needs to be studied and explained in the context of this selective case study.

Quantitative Research Design

The purpose of this sub-section is to discuss how the quantitative methodology has been applied in this study. The focus of this sub-section is on presenting the specific variables to measure as well as data collection tools that have been selected for the research (Bryman & Bell 2015). Furthermore, much attention is paid to describing the data analysis procedure with the focus on the specific information collected with the help of quantitative techniques.

Constructs to Measure

The constructs to measure with the help of tools of the quantitative methodology are derived from the research questions formulated for the study. In order to understand what benefits and challenges are associated with implementing integrated green supply chain management in Australian and Turkish hospitals, it is necessary to evaluate these hospitals’ changes in financing supply chains, waste management, recycling, and the application of ISO 14001 and ISO 9001 certificates among other initiatives (Dadhich et al. 2015; Feng et al. 2017; Jayaram, Dixit & Motwani 2014). It is significant to collect numerical data and financial figures on changes in costs and revenues related to implementing green supply chains and after the implementation, related to applying ISO 14001 and ISO 9001 standards, and related to the overall performance of the selected hospitals in terms of their sustainability. From this perspective, for the purpose of this study, it is necessary to empirically test how the implementation of integrated green supply chains can affect the value related to the chosen hospitals.

Collection of Quantitative Data

For the purpose of this study, annual financial reports provided by the administration of the selected hospitals have been examined to retrieve the numerical data, figures, and charts on these healthcare facilities in terms of applying green supply chains. The key focus was on retrieving data on the expenses associated with implementing green supply chains (integrated chains) in the discussed hospitals, possible unexpected costs, and expenditures related to waste management. These quantitative data were collected with the help of reviewing hospitals’ annual reports and other financial documentation provided by the managers in the selected Australian and Turkish hospitals, who are responsible for greening supply chains in their organisations.

Data Analysis

The quantitative data collected with the help of reviewing hospitals’ financial documents have been analysed not in connection with the analysis of qualitative data, but simultaneously (Creswell 2014; Treiman 2014). The determined changes in the financial performance of hospitals before and after the implementation of integrated green supply chains have been compared and analysed for both hospitals located in different contexts of Australia and Turkey. Some types of financial performance have been evaluated with the focus on the operating performance, the accounts performance with the focus on actual financial data, and the environmental performance.

It was important to determine any changes in figures indicating hospitals’ financial performance in order to speak about possible advantages and disadvantages of integrating green supply chains in the healthcare sectors of two different national contexts. The comparison of financial performance indicators before and after implementing supply chains, as well as for Australian and Turkish hospitals, is important to address the set research questions. It is significant to note that the application of statistical analysis is also required for this research in order to present descriptive statistics regarding the findings associated with the numerical data provided in hospitals’ reports (Bryman & Bell 2015; Creswell 2014; Hamad et al. 2016).

Descriptive Statistics

In this study, it was important to compare financial performance figures before and after implementing green supply chains for hospitals in Australia and Turkey. Moreover, it was necessary to compare changes in determined financial indicators for different healthcare settings in these two countries. Therefore, the analysis of quantitative data retrieved from the hospitals’ documentation was performed with reference to presenting descriptive statistics and charts regarding the observed changes in figures and ratios (Leavy 2017; Neuman 2014). These steps were important to conclude about the efficiency of developing integrated green supply chains in the healthcare sector.

Financial Ratios

While analysing the financial, operating, and environmental performance of the selected hospitals associated with the implementation of the principles of green supply chain management, it was important to calculate certain financial ratios as indicators. The following types of ratios were calculated: profitability ratios, liquidity ratios, debt management ratios, and asset management ratios (Feng et al. 2017; Jin, Jeong & Kim 2017). Profitability ratios include the profit margin (Net income/Sales), the return on equity (Net income/Common equity), and the return on assets (Net income/Total assets). These ratios help to estimate the profitability of hospitals as entities in spite of the fact that one of these hospitals belongs to the public sector.

Liquidity ratios calculated for this study include the current ratio (Current asset/Current liabilities), the cash ratio (Cash and equivalents/Current liabilities), and the quick ratio (Current asset + inventory/Current liabilities). Debt management ratios are the following ones: the total debt ratio (Total Debts/Total assets), the long-term debt ratio (Long-term liabilities/Long-term liabilities + Common equity), and the debt to equity (Debt/Common equity) (Feng et al. 2017; Jin, Jeong & Kim 2017). These ratios estimate an organisation’s debt.

Asset management ratios are important to be measured in the context of understanding how changes in supply chains could influence the organisation of assets and resources in the studied hospitals. These ratios include the receivables turnover ratio (Sales/Receivables) and the fixed assets turnover ratio (Sales/Fixed assets) (Feng et al. 2017; Jin, Jeong & Kim 2017). The focus on these financial indicators was important to determine possible changes in the selected hospitals’ profits depending on their experience in implementing supply chains with a particular interest in integrated supply chains.

Qualitative Research Design

This section represents the details of organising the qualitative component of the case study analysis. The focus is on describing the aspects of data collection and data analysis by means of specific qualitative tools. Moreover, in this section, much attention is paid to discussing protocols for semi-structured interviews that are adopted for this study in order to collect the required narrative information from the sample appropriate for this research.

Data Collection

While using the qualitative methodology, researchers collect data using such techniques as interviews, observations, and focus groups. These strategies are used with reference to the purpose of investigating a phenomenon or a situation from the perspective of participants who are directly involved in the studied processes. The participants’ perspective can be learned and reported when researchers conduct interviews and communicate with individuals having the specific experience regarding the problem under analysis (Miles, Huberman & Saldana 2014). The insider’s perspective can also be learned with the help of organising focus groups where several participants discuss their personal experiences in contrast to individual interview sessions (Creswell 2014; Leavy 2017). In addition, important data regarding the studied issue can be collected with the help observations that are conducted in a specially selected setting in order to provide a researcher with as much information as possible (Creswell & Poth 2017).


This section explains the choice of instruments and tools for collecting qualitative data with reference to conducting interviews. The first sub-section provides the justification for conducting interviews with the participants of the study in order to gather narratives regarding their experiences in implementing supply chains. The second sub-section presents the information on designing a specific interview protocol that has been used in this study in order to guide interview sessions and collect all the required information for analysing and responding to the research questions (Bryman & Bell 2015; Creswell & Poth 2017).

Justification for Conducting Interviews

While applying the qualitative methodology as the component of mixed methods research, the author of the study is oriented towards investigating, understanding, and explaining a certain phenomenon. As a result, the focus of a researcher is on collecting as much data on a certain issue as possible in order to develop in-depth meanings regarding the studied problem (Castillo-Montoya 2016). For this purpose, interviews are selected as a tool that allows a researcher to gather information on participants’ ideas, views, experiences, and beliefs associated with the studied phenomenon. These interviews are usually conducted in the form of one-to-one sessions (Alshenqeeti 2014). In order to address the purposes of their studies, researchers can choose from structured, semi-structured, and unstructured interviews that differ in terms of protocols that are used for organising interview sessions (Creswell & Poth 2017; Neuman 2014).

Structured interviews are based on preparing a list of questions to ask without focusing on differences in interviewees. These interviews are standardised, and they do not allow for collecting much information about respondents’ experiences. As a result, this type of interviews is not appropriate for this study. Unstructured interviews are not based on a certain framework or a set of questions, and interviewers ask questions following interviewees’ responses (Taylor, Bogdan & DeVault 2015). This type of an interview can provide a researcher with a lot of data that are not suitable to address a research question, and this aspect does not allow for using it in this particular study.

Semi-structured interviews are based on using the questions prepared in advance, but these questions are open-ended, reflecting the topic of the interview, and playing the role of probing questions that are used for developing an interview in a conversation on the studied topic. Thus, semi-structured variants of interviews “are carefully prepared lists of questions that stimulate each informant in a comparable way,” and the answers of respondents are unanticipated in this case (Domínguez & Hollstein 2014, p. 186). This type of interviews is selected for this study because the researcher received an opportunity to get answers to the prompts that can help in addressing the research questions, but he or she can remain flexible and ask additional questions if necessary (Edmonds & Kennedy 2017). Furthermore, the gathered information can be classified as valid in this case.

Designing an Interview Protocol

The process of designing a semi-structured interview protocol for this study included the following stages: the review of the literature and questionnaires used in other studies to select questions that are aligned with the research ones; the adaptation of the selected questions to this research and the formulation of original open-ended questions; editing and proofreading. At the first stage, it was important to review the literature on the topic to understand what models for formulating effective questions were used by other researchers (Cosimato & Troisi 2015; Dadhich et al. 2015). At the second stage, it was necessary to adapt the selected questions and formulate additional ones in order to guarantee that these questions are valid and can contribute to collecting data required for answering the set research questions. Open-ended questions written in English were proposed to receive full and descriptive answers regarding the issues mentioned in these inquiries. As a result, eight probing questions were formulated:

What is your role or position in the organisation’s supply chain?

  1. How has the financial, operational, and environmental performance changed after the organisation’s focusing on supply chain management?
  2. What benefits of implementing green supply chain management have you noticed?
  3. What challenges associated with implementing green supply chain management in your organisation can be named?
  4. How are ISO 14001 and ISO 9001 standards applied in your organisation?
  5. What integrated green supply chain management procedures related to ISO 14001 and ISO 9001 are applied in your organisation?
  6. How the application of ISO 14001 and ISO 9001 has changed the organisation’s performance?
  7. What differences have you noticed regarding the implementation of green supply chain management in contrast to following previous supply chain models or environment sustainability projects?

At the final stage of designing a protocol for a semi-structured interview, it was important to edit and proofread the questions to ensure that they are accurate. These questions need to be written in the language that can be easily understood by respondents. Furthermore, they should include details that can be discussed wider during a conversation with the focus on other additional questions. As a result, the proposed interview probing questions have the potential to be expanded during interview sessions depending on the participants’ answers.

Data Collection Procedure

In this study, the collection of qualitative data was based on conducting a series of interviews with six participants who are the representatives of two hospitals in Australia and Turkey selected as cases for this research. The invited participants work at different positions in hospitals (senior managers, administrators, medical workers), and they were directly involved in the process of integrating green supply chains in their healthcare facilities. As a result, these selected persons are able to describe their experiences in greening supply chains in the chosen hospitals in order to compare these narratives during the analysis. For the purpose of this study, the researcher prepared the protocols for semi-structured interviews and contacted the selected participants using their e-mail in order to discuss the date and time for conducting interviews.

To contact participants in different countries, it is appropriate to use online tools and mobile applications that allow for calling the participant. In this study, the researcher used Skype for making calls and conducting time-consuming interviews. Each interview was scheduled in advance and conducted separately, and interviews lasted from 30 to 50 minutes. It is advantageous for the researcher to conduct phone interviews using modern technologies because of avoiding limitations regarding distance and time and receiving an opportunity to clarify different aspects in provided answers with respondents. The participants of the study were asked to answer several probing questions prepared in advance, and the researcher added more questions during an interview in order to get more details regarding the aspects mentioned by the participants. Interviews were recorded using technologies for making records of Skype calls, and these audio files were marked with certain ID numbers to avoid identifying participants’ personal information. The completed records were transcribed for the further analysis.

Data Analysis

Data analysis in this study included such steps as the preparation of data for further examination with the help of transcribing records, the process of coding and theme identification with the help of NVivo software, and the analysis of determined themes to answer the research questions (Chowdhury 2015; Zamawe 2015). All the records were transcribed to get narratives appropriate for uploading to NVivo. This software allows researchers to import qualitative data into the platform and provide their analysis based on the principle of coding narrative information for identifying themes in collected in-depth answers to the proposed interview questions (Edwards-Jones 2014; Sotiriadou, Brouwers & Le 2014; Zamawe 2015).

Therefore, it is necessary to state that coding as a technique integrated for data analysis in NVivo software is important for studying and evaluating qualitative data. The reason is that codes that are assigned to data components are automatically examined and combined in larger clusters or themes (Edwards-Jones 2014; Sotiriadou, Brouwers & Le 2014). After conducting the automatic analysis, all the data are represented in the form of themes that should be organised by the researcher in concept maps or tables, as well as other illustrative materials (Saldaña 2016; Yin 2015). The purpose of this action is to understand what concepts are associated with participants’ views regarding the process of greening supply chains in the selected hospitals of Australia and Turkey.

Validity and Reliability

In this mixed methods research, the questions of validity and reliability of the study are discussed from the perspectives of both qualitative and quantitative methodologies. Referring to the qualitative component of the study, the focus is on trustworthiness as the representation of validity (Neuman 2014). Thus, it is important to guarantee that the collected findings are worth discussing, and they can contribute to the existing research on the problem because of their accuracy. The organisation of the collection and analysis of qualitative data is realised according to the principles of dependability, credibility, transferability, and confirmability (Creswell & Poth 2017). As a result, much attention should be paid to the quality of interview protocols as an instrument for collecting data (Darawsheh 2014; Mann 2016). It is possible to speak about content validity in the case when collecting quantitative data and about credibility when focusing on gathering qualitative information.

Internal validity of the quantitative component of the study is guaranteed through the provision of the accurate analysis of collected financial data with the focus on calculating ratios and making relevant conclusions. In the context of the qualitative component, this aspect is associated with transferability of the received findings because of their accuracy (Leavy 2017). In addition, in this study, validity is also based on triangulation as an approach to improve the credibility of findings with the help of collecting and analysing both qualitative and quantitative data which is typical of the mixed methods research (Archibald 2016; Leavy 2017).

Reliability in the mixed methods research is applied to discussing the quantitative component, and the term “dependability” is associated with reliability of the qualitative component. Referring to these concepts, it is important to guarantee that this study can be replicated with the same results because of depending on the analysis of stable financial data (Domínguez & Hollstein 2014). Still, while focusing on the qualitative component, it is necessary to state that identical results cannot be expected and achieved, and it is necessary to guarantee the dependability of data (Neuman 2014; Reio & Werner 2017). Thus, it means that the collected findings remain unchanged and stable without depending on changes in conditions on when and how the participants’ narratives were gathered.

Ethical Considerations

This section presents the information on the procedures used to receive the participants’ informed consent and protect their confidentiality and privacy. According to Hancock and Algozzine (2016, p. 47), “the researcher must adhere to legal and ethical requirements for all research involving people. Interviewees should not be deceived and must be protected from any form of mental, physical, or emotional injury.” Thus, the aspects of using an informed consent form are described in detail. Approaches to resolving the issue of confidentiality in this study are discussed in the second sub-section in order to guarantee that all ethical concerns are addressed without violating the interests of the participants involved in the study.


In order to protect participants’ privacy and guarantee their anonymity, it is important to focus on the concept of confidentiality and how it works in the context of this study. Those personal data that are used in this study for collecting qualitative information should be secured and presented in this study only as anonymous answers to interview questions (Kumar 2014; Mertens 2014). The researcher ensures that all information that can be used for indicating participants is removed from records, and personal information is concealed. These procedures are required in order to avoid the situation of violating subjects’ confidentiality and disclosing their private information.

In the context of this study, the researcher keeps the names of participants and other personal data confidential while preparing records of interview sessions and transcribing them. In order to distinguish between participants, ID numbers are assigned to subjects, and they are used for marking records and narratives. The researcher is the only person who knows the names and contacts of subjects invited to participate in the study that are reflected in informed consent forms. This information is kept secret and secured by the researcher, and the access to the data which can be used for identifying participants is restricted.

Informed Consent

The participants’ agreement to join the study with the focus on its specific conditions and purpose is known as informed consent. Potential participants selected with the help of purposive sampling can be viewed as voluntarily deciding on being involved in the study, and informed consent forms reflect this decision (Bryman & Bell 2015). The selected respondents agreed to participate in interviews after receiving all the required information about the nature and purpose of this study. They reviewed and signed the prepared informed consent form before being invited to participate in interview sessions and answer questions. In order to guarantee that the informed consent form can be effectively used for protecting participants’ interests, some type of information should be added to this form.

Thus, the provided informed consent forms had the following details: the study’s purpose and type, the description of collecting the information with the help of interviews and associated procedures, and the information about options for withdrawing at any stage of research. Additional details include the information about protecting participants’ confidentiality and anonymity and the statement indicating the voluntary participation in the study (Creswell & Poth 2017). It is important to note that the researcher started to conduct interviews with the invited participants only after receiving the signed informed consent forms from all subjects. As a result of applying the informed consent form, it is possible to address ethical questions while conducting the study and guarantee the protection of participants’ interests.


In this chapter, the details regarding the selected research methodology have been presented in order to explain what research paradigms, approaches, designs, and methods can be effectively used in order to analyse data and provide the answers to the set research questions. Much attention is paid to the description of the details associated with applying the selective case study approach as the key design chosen to address the purpose of this investigation. This study is based on the principles of the mixed methods research; therefore, the data collection and analysis procedures have been described for the qualitative and quantitative components of the study separately. In addition, the chapter has presented the discussion of such important aspects as validity and reliability with the focus on challenges of applying these concepts to the principle of the mixed methods research.

Finally, the chapter ends with the description of how ethical concerns related to confidentiality and the use of an informed consent form are addressed in this study depending on the complex nature of the mixed methods research. The discussed research methods can be viewed as suitable to complete the purpose of the study with reference to the set research questions. The findings of this study are discussed in detail in Chapter 5.

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