The contribution of ethnography to the evaluation of quality improvement in hospital settings

reflections on observing co-design in intensive care units and lung cancer pathways in the UK

Sofia Vougioukalou, Annette Boaz, Melanie Gager, Louise Locock

Research output: Contribution to journalArticle

Abstract

Ethnography is increasingly being used in the evaluation of quality improvement and change initiatives in healthcare settings, particularly in the form of ‘focused’ and ‘rapid’ ethnographies. This new ethnographic genre is tailored to suit narrower enquiries within clinical pathways. However, the application of ethnography to the evaluation of quality improvement is not straight-forward or free from reductionist bias, particularly in hospital settings where interventions take place during a limited period of time and instigate change in busy and sensitive settings. This paper discusses problems and emergent solutions involved in conducting an ethnographic process evaluation of co-design projects in lung-cancer and intensive care unit services in two hospitals in England. The mixed-methods ethnographic evaluation consisted of observations of the co-design process and triangulation of findings with interviews, questionnaires, participant reflective diaries and service improvement logs. Limitations of observational time and distance from ‘the field’ were overcome by making most of the pre- and post- event observational periods, situating quality improvement within the wider context of clinical practice, achieving attunement with local clinical cultures and engaging participants in collaboratively guiding observational and interview design. This approach led to a focused ethnographic evaluation that accommodated ethnographic principles to obtain rich insights into quality improvement processes despite the limitations of short-timeframes and the hospital setting.
Original languageEnglish
Pages (from-to)18-32
Number of pages15
JournalAnthropology & Medicine
Volume26
Issue number1
Early online date26 Jun 2019
DOIs
Publication statusPublished - 2019

Fingerprint

Cultural Anthropology
Quality Improvement
ethnography
Intensive Care Units
Lung Neoplasms
cancer
evaluation
Hospital Oncology Service
Interviews
Critical Pathways
triangulation
interview
England
genre
Ethnography
Lung Cancer
Evaluation
Intensive Care
Ethnographic
Pathway

Keywords

  • ethnography
  • evaluation
  • quality improvement
  • cancer
  • intensive care
  • IMPACT
  • FIELD
  • METHODOLOGICAL DESCRIPTOR
  • ANTHROPOLOGY
  • Cancer

Cite this

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title = "The contribution of ethnography to the evaluation of quality improvement in hospital settings: reflections on observing co-design in intensive care units and lung cancer pathways in the UK",
abstract = "Ethnography is increasingly being used in the evaluation of quality improvement and change initiatives in healthcare settings, particularly in the form of ‘focused’ and ‘rapid’ ethnographies. This new ethnographic genre is tailored to suit narrower enquiries within clinical pathways. However, the application of ethnography to the evaluation of quality improvement is not straight-forward or free from reductionist bias, particularly in hospital settings where interventions take place during a limited period of time and instigate change in busy and sensitive settings. This paper discusses problems and emergent solutions involved in conducting an ethnographic process evaluation of co-design projects in lung-cancer and intensive care unit services in two hospitals in England. The mixed-methods ethnographic evaluation consisted of observations of the co-design process and triangulation of findings with interviews, questionnaires, participant reflective diaries and service improvement logs. Limitations of observational time and distance from ‘the field’ were overcome by making most of the pre- and post- event observational periods, situating quality improvement within the wider context of clinical practice, achieving attunement with local clinical cultures and engaging participants in collaboratively guiding observational and interview design. This approach led to a focused ethnographic evaluation that accommodated ethnographic principles to obtain rich insights into quality improvement processes despite the limitations of short-timeframes and the hospital setting.",
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author = "Sofia Vougioukalou and Annette Boaz and Melanie Gager and Louise Locock",
note = "This project was funded by the UK National Institute for Health Research Health Services and Delivery Research Programme (Project Number 10/1009/14). This study was approved by the National Research Ethics Committee North West, reference 11/NW/0653. At the time of writing Louise Locock was supported by the NIHR Oxford Biomedical Research Centre. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS & DR Programme, NIHR, NHS or the Department of Health.",
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