Table 1.

Strategies for Ensuring Rigor

Criteria	Strategies to assure criteria are met
Confirmability: unrecognized researcher biases are controlled	RK and RA (and later the research team) serve as the check and balance for uncovering assumptions and suggesting rival hypotheses. Member checks will be used to confirm findings.
Dependability: candidate performance remains consistent over time	Guides will be used for all data collection. RK and RA will meet bi-weekly to review data collection and refine techniques. An electronic code book will be used to track all data transformations. An audit trail will be established. RK and RA will read and each code at least 50% of the field notes and compare coding. We will discuss and come to agreement about codes and interpretations.
Credibility: results are plausible and authentic	Triangulation of data from multiple sources: direct observation (multiple healthcare disciplines and organizational hierarchical levels) and documents. Member checks will be used to confirm findings.