Although qualitative research has considerable strengths both in assessing
the effectiveness of organizational models of health care provision and in
contributing to their development, its impact on local and national decisio
n making in the United Kingdom appears to be negligible. This article exami
nes three obstacles to the acceptance of qualitative research, illustrating
some ways around them drawn from recent research at the Centre for Mental
Health Services Development. However, our illustrations throw into relief t
he potential for tensions between the pragmatic world of health care manage
ment and the quality and integrity of qualitative research. The authors, th
erefore, examine these tensions with reference to recent work on the develo
pment of quality criteria and discuss some of the solutions they have attem
pted.