Paper short abstract:

This paper examines the application of both ‘long-term’ and ‘short-term’ multi-sited ethnographic methods to the exploration of high-volume, safety-critical routines in UK general practice, and the how ethnographic findings can best contribute to a wider body of ‘evidence’ for policy and practice.

Paper long abstract:

Ethnography is a well-established approach to conducting research within healthcare organisations. While ethnography is usually associated with a long-term research process involving extended periods of fieldwork, more 'rapid' (Bentley et al. 1988) or 'focused' (Knoblauch 2005) approaches are increasingly being sought by researchers and policymakers that are responsive to the short-term cycles of healthcare policy implementation and change. Healthcare organisations are increasingly described as 'complex systems' (Rowley & Waring 2011). Within the field of patient safety, there is increased recognition of the need to understand the 'black box' of organisational safety practices and processes over time through long-term ethnographic engagement (Dixon-Woods 2003). It is also recognised that the tacit knowledge, innovation and flexibility used by local actors in the creation of safety varies across organisational settings, and that a wider range of methodological, practical, and analytical entry points are required to provide a fuller understanding of change across different organisational contexts.

The aim of this paper is to examine interprofessional safety practices across a range of high-volume organisational routines within UK general practice (e.g. repeat prescribing) through the application of both long-term and 'short-term' (Pink & Morgan 2013) multi-sited ethnographic methods. Drawing on findings from an ethnographic study conducted across 8 general practices (2010-14) and Pink's (2009) concept of 'ethnographic place', it explores how different 'types, qualities and temporalities of things and persons' come together through both long-term and short-term methodological approaches, and how ethnographic findings can best contribute to a wider body of 'evidence' for healthcare policymakers and practitioners.

Paper short abstract:

Considerations for documenting adaptation and temporal complexity in clinical settings will be discussed using examples from of an ethnographic evaluation of accelerated experience-based co-design in two intensive care units and two lung cancer pathways in English hospitals.

Paper long abstract:

An ethnographic process evaluation was used to understand the contribution of accelerated patient-led action research to patient outcomes and local clinical cultures in two intensive care units and two lung cancer pathways in English hospitals. We found that patient-led co-produced service improvement was embraced differently by managers, doctors and nurses and was enacted according to local organisational culture and a variable understanding of salient discourses on patient-centred design. Through participation in the project, different actors mobilised and acted upon their existing knowledge of service delivery and also incorporated new knowledge and non-hierarchical ways of working which involved diverse members of different clinical teams and patients. The flexibility that ethnographic insights provided throughout the research process, enabled documentation of the intricate and highly personalised facets of participatory health service design within four very different complex adaptive clinical environments. As this type of ethnographic evaluation occurred within highly medicalised knowledge-enfranchised settings, we will discuss the methodological and theoretical considerations for documenting adaptation and temporal complexity in organisational and focused ethnographies of clinical and patient communities.

Paper short abstract:

By ethnographically exploring multi-sited interventions of eldercare in Israel, I examined the ways in which the intersection between practices of care and regimes of cure shape and form the process of being old.

Paper long abstract:

By ethnographically exploring multi-sited interventions of eldercare in Israel, I examined the ways in which the intersection between practices of care and regimes of cure shape and form the process of being old.

The current Western and biomedical discourse views aging as a life-long process based upon the scientific exploration and self-governing individual. This process relies on preventive and health promoting measures that extend from clinical and healthcare institutions into the everyday lives of elderly. Eldercare practices, such as 'aging in place', 'anti-aging', 'active aging' and 'healthy aging' function as methods of managing populations. Such regimes produce experiences of being aged, frail and cared-for, construed around a norm of active, independent, and long-living subjects. As such, aging becomes a complex site of political, global and local neoliberal economics, medical and social interventions that connects different issues and temporalities.

This paper based on an extensive fieldwork in three diverse sites to capture the complex and different shapes and tempos of eldercare: the first site is in the homes of elderly patients cared-for by Filipina caregivers; the second site is at a pain clinic in an hospital and the third site is at the Jerusalem municipality's aging department promoting the "Age-friendly city" initiative to prepare for a dramatic increase in the city aging population. Each field offers different tempos of change and rearranges the humanity of being old.

Paper short abstract:

Much autism research follows a linear narrative from problem/deficit through ‘intervention’ to outcome. In evaluating experience of social care I propose a kairological rather than chronological temporality to illuminate the complex dynamics of autism services that support rather than ‘intervene’.

Paper long abstract:

Much autism research is focused on the evaluation of educational, clinical and psychological 'interventions'. These evaluations seek defined and measurable results according to a linear process that moves from 'problem/deficit,' through 'intervention' to 'outcome.' Yet implicitly medical models of Evidence-Based Practice are not always suited to analyzing and understanding the more holistic support offered in social care services. Social care practitioners are not in the business of 'intervening', but supporting individuals with autism to achieve a desired quality of life, often through relationships developed over long periods of time. Here I highlight the potential of ethnography as a departure from linear, chronological temporality - of 'outcomes' achieved in the life of an intervention − to a kairological paradigm which admits of the temporal boundedness of research but takes a particular moment or period to illuminate the complex social dynamics and entanglements that inform experiences of social care. Where anthropological discourse increasingly talks of theoretical 'turns' and 'interventions', I likewise suggest we should be wary of unilinear narratives that undermine the theoretical diversity of anthropology. If we instead acknowledge the multiple threads and contributions offered by different scholars we can better envisage ways in which anthropology might contribute to interdisciplinary fields such as autism research.

Paper short abstract:

In this paper we explore the tensions, challenges and opportunities encountered when combining ethnography and systems approaches to capture the tempos and flows of relations and processes in an evaluation of a major multi-site area-based initiative in community empowerment.

Paper long abstract:

Ethnography is recognised as a valuable tool for understanding 'how' interventions work (for example; Khoo 2001). When combined with systems theory, ethnographic approaches have the potential to reveal the complex processes by which interventions embed and co-evolve with the local contexts in which they are implemented and the shifts in relations and interactions that result (Hawe et al 2009). However, such an approach has very rarely been attempted (Durie & Wyatt 2013). In this paper we explore the tensions, challenges and opportunities encountered when combining ethnography and systems approaches in an evaluation of a major multi-site area-based initiative in community empowerment. We consider the value of ethnography in capturing the tempos and flows of relations and processes across multiple field sites and the opportunities this provides for producing "better" evidence about the intervention. We identify temporality as central to the dynamics of the study in multiple ways - both in terms of understanding systems changes as the intervention embeds and in the evaluative framework. Challenges arose from: the complexity of capturing the precariousness of power and relationships; the bringing together of data across multiple sites that were at different stages and progressing at different rates at different times; and the difficulty in producing "generalizable" accounts through the temporary 'interruption' of the researcher. We argue that the temporal (dis-)alignment of fieldwork approaches with intervention processes was crucial to what we were able to know and capture about the nature of the intervention.

Paper short abstract:

This paper considers the concealments, disconnections and absences that arise around the intersection of ethnography and evaluation, and explores how different tempos and temporal expectations mediate and highlight the tensions of this intersection, for both researcher and ‘researched’.

Paper long abstract:

Attempting to align ethnographic practice with a public health evaluation agenda raises a number of tensions, questions and possibilities relating to the kinds of 'knowns' and 'unknowns' that may be produced as a result. Reflecting on experiences of conducting ethnographic research on 'community' alongside the evaluation of a community-led empowerment initiative highlighted what was concealed, distanced or disconnected from my 'gaze' in the field. It also led me to consider how this was paralleled in the experiences and perceptions of disconnection among the 'subjects' of my research - the 'community'. In this paper I will examine how attending, in particular, to the range of temporalities underpinning both the ethnographic encounter and the subject of the research, proved a valuable lens through which to examine the relations and interactions that gave rise to the sense of 'missing out'. The flow of personal tempos, intersecting and diverging from the collective work of delivering the initiative as a 'community', and often conflicting temporal expectations (of progress, of things 'happening' and of research practices) contributed to spaces, relations and experiences of disconnection, for both the researcher and 'researched'. Thus, this paper considers the value of a focus on temporality, how it varyingly unfolds and is experienced in the field, to reflect on how the sometimes uncomfortable experiences of aligning ethnography with evaluation can help shed light on the relations of connection and disconnection at play, for example within a community-led, empowerment initiative.

Paper short abstract:

Tensions between ethnography and evaluation play out in notions of size, scale and perspective, raising questions about the relevance and connection of individual lives to wider changes. Exploration of these tensions is needed when trying to bring individuals’ experience to bear on service improvement.

Paper long abstract:

In this paper I explore ideas of size, scale and perspective in turning from an ethnographic to an evaluative approach; from fieldwork to generating ideas for service improvement. My ethnographic fieldwork is part of a multi-level case study of integrated care, focusing on people's experiences of living with multiple long-term health conditions. My dual role within the study site as researcher and NHS commissioner raises questions about the links between ethnography, evaluation and service improvement. Here I explore responses to the data generated by fieldwork; the data is seen as both too "big", in terms of quantity and detail, and too "small", in terms of generalizability. Scale is also of concern, as tensions between ethnography and evaluation play out in questions of relevance. Ethnography foregrounds embodied, day-to-day lived experience, bringing the minutiae of daily life into sharp focus. Evaluators, however, need a wider angle to foreground larger objects of interest; organisations, teams, services. The discrepancy between these two viewpoints raises questions about their relevance to each other, and the connections between "big" changes and individuals. A further source of tension between ethnography and evaluation emerges in defining interventions as distinct from "context", when the conceptual boundary required to distinguish the shape of the intervention within a social world, blurs and dissolves under the close gaze of an immersed ethnographer, rendering attempts to inform causation impossible. Exploring these tensions and aspects of complexity (Strathern 2004) is important in attempting to bring individuals' experiences to bear on improving services.

Paper short abstract:

This paper examines how I "dis/embed” my ethnographic with people with dementia taking part in a randomised controlled trial by including and removing myself from the trial's everyday activities in terms of space, time and location so as to negotiate the complexities of working in this context.

Paper long abstract:

Pressure from government and external funding agencies increasingly require complex national or international research projects to explore how interventions and phenomena studied affect research participants directly and stakeholders indirectly. This challenges qualitative social scientists to work in a variety of new organisational and cultural research contexts. However, qualitative methodologists are challenged to design and implement an appropriate methodology to complement the work produced in these large-scale projects: Participant groups may be constituted by processes of randomisation rather than 'natural' communities, how trialists and ethnographers understand what 'meaningful' data is may be contested, and specific types of knowledge and expertise are favoured by different stakeholders involved in the management of the study. This paper will reflect on how I designed and conceptualised my ethnographic fieldwork with people with dementia and their informal carers using technology at home linked with a national, randomised controlled trial. This drew on Marcus' concept of "multi-sited ethnography" and Lewis and Russell's concept of "embedded ethnography" to conceptualise how my field is "de-territorialised" by operating in the context of national trial yet still enabled me to "be there". I also examine how I "dis/embed" by regularly negotiating my including and removing myself from the trial's everyday activities in terms of space, time and location so as to negotiate the practicalities of research design, ethical approvals, participant recruitment, and data collection.

Paper short abstract:

This paper is based on ethnographic research in a multi-disciplinary project evaluating a community health intervention. Discussion is focused on the tensions around the dangers of making claims in a relatively short time frame and the need to reflect on the temporal boundaries of the study.

Paper long abstract:

In this paper we discuss some of the tensions in obtaining meaningful data when attempting to understand change in a relatively short-term ethnographic study, embedded in a longer-term area based intervention. Balancing the requirements of the evaluation with an ethnographic approach can generate thick descriptions of processes and events. A necessarily limited timeframe of fieldwork however, can provide a perspective that neglects to engage with the temporal dynamics of community relationships and decision-making. This may lead to misguided interpretations of the lived realities of how change unfolds for individuals and communities. We discuss the dangers of sharing findings at particular times in the data generation period without adequate consideration of the temporal boundaries of the study. For example there may be moments of tension and conflict that emerge, which are conceived by both researchers and participants as having a negative impact or a 'dampening' effect on community empowerment, but when looking back such moments may be re-framed as positive and re-interpreted as amplifying positive change. We discuss how we considered temporal contingencies that operated within the areas being studied, in order to avoid misconceptions about the significance of particular events. We also reflect on the place of conflicts and tensions during the intervention process and suggest that a temporal lens offers opportunities to re-vison them as integral to the non-linear process and shifting dynamics of positive change.