Using ethnography to examine health care practice

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Using ethnography to examine health care practice

• Dr Maureen Deacon
• The Manchester Metropolitan University

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The plan

• Brief overview of the study
• The purpose and process of ethnography
• Some of the advantages and limitations of using
  this method to examine professional practice in
  action
• Implications for practice development
• Learning points

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The study I cant get a thing done

• An ethnography of AMHN aim was to contribute to
  the body of knowledge in this under researched
  field by developing a systematic analysis of
  their routine occupational activities
• 3 years episodic participant observation in an
  inner-city MH unit. Ethical approval.
• A case study (Inclu PICU) setting shared
  problems described nationally
• Included virtual ward work (eg, ECT trips)

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The study cont.

• Worked with the ethnomethodologists attitude of
  wonder concerning the crafting of their work
• Main finding was that AMHNs enable acutely
  mentally ill people to recover using mundane
  social activity and talk as professional
  resources. They are multi-taskers experts in
  handling multiple realities, needs and demands
  they flexibly accomplish their work by
  manoeuvring around an implicit and explicit
  interpretive background.

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Findings cont.

• This is accomplished by endless, open-ended,
  diffuse and contingent activities where new work
  has to be constantly added in woven into
  ongoing work.

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The purpose and process of ethnography (EG)

• According to Brewer (200010) EG is the study
  of people in naturally occurring settingsby
  means of methods which capture their social
  meanings and ordinary activities, involving the
  researcher participating directly in the study.

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Cont.

• EG, therefore, refers to a style of research that
  is distinguished by its purposes, rather than a
  particular method of data collection.
• The purpose in my study was to analyse the
  routine work of AMHNs

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Cont.

• I used the data collection methods of participant
  observation, opportunistic interviewing and
  carefully listening to naturally occurring talk
  (Silverman, 1997).
• This was organised through a process called
  theoretical sampling (Silverman, 2001) and
  opportunistic sampling. For example

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Cont

• It was this process that led to the specific
  matters that were examined very closely (an
  aspect that I struggled with) importance of
  making defensible decisions.

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Cont.

• Focus is on members methods, social action, the
  lived order/detail, the unfolding, contingent
  and temporal nature of social life how this is
  used to make sense of the world.
• Follows that there is interest in routine,
  mundane aspects of work
• Accountable features what members take into
  account when orientating to, and sustaining
  interaction, practice and experience in a
  particular setting. The documentary method of
  interpretation

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Accountable features orientating, implicit
explicit organisational imperatives

• Discharge patients as quickly as possible
• Prevent patients disturbance from exposing the
  organisation to criticism
• Follow organisational rules
• Fit in with the wider organisation and outside
  agencies

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The interpretive context

• You know the case because you know the place
• Mundane matters are tools for formulating
  patients mental health status and their progress
  towards recovery
• Conceptual resources deserving cases features
  of absolution

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Advice to EGs

• Treat natural facts as accomplishments
  (practitioners find this very odd!). Observe
  lived detail.
• Analyse accounts and formulations

• Problematize reasoning
• Analyse the interpretive framework (general
  local)
• Look for normal natural troubles

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Advantages of this method

• This and that is what the world is made up of
  (Harvey Sacks)
• Respectful
• Gain deep, extremely complex understanding.
  Analytic purchase on how one thing unavoidably
  connects to another.
• Draws attention to invisible work what we do
  most of the time!
• The analysis of actual work its unfolding,
  contingent nature. Real life, not abstract
  theorising.

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Disadvantages

• Findings hard to articulate neatly
• Time consuming
• Does not meet canons of traditional scientific
  enquiry (problems influencing stakeholders)
• In-depth analysis of some things but not others
• Challenge to make principled choices regarding
  what data to analyse to make the familiar
  strange. You have to be close up but standing
  back simultaneously personally very demanding

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Some implications for practice development

• Critical importance of bringing these invisible
  skills in to conscious awareness,
• Articulating them
• Providing an evidence based framework for
  examining work in situ and developing it.

• For example, the management of disturbance.

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Learning points

• Practice is messy if researchers do not engage
  with this reality then their research will remain
  largely irrelevant to practitioners.
• EG respects the work of practitioners and tries
  to understand it, rather than coming for the more
  traditional corrective position
• EG reveals the huge complexity and accomplishment
  of everyday practice.

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References

• Brewer,A.(2000) Ethnography Buckingham OUP
• Pollner,M. Emerson,R.M. (2001) Ethnomethodology
  and Ethnography. In Atkinson,P. et al. (2001)
  Handbook of Ethnography. London Sage
• Silverman, D. (1997) Qualitative research.
  Theory, method and practice. London Sage
• Silverman, D. (2001) Interpreting qualitative
  date. London Sage