Jessica Mesman

Disturbing Observations as a Basis for Collaborative Research

In the last decade, there has been a growing awareness that ethnography and intervention are not distinct but interwoven practices. Especially approaches such as interactive social science, participatory design, computer-supported cooperative work and action research have attracted a lot of attention. These approaches consider doing ethnography as a matter not just of describing practices, but of changing them as well. Moreover, doing an ethnographic study inevitably intervenes in the field studied. In other words, intervening is not a choice but an unavoidable condition of ethnographic research (Henriksen, 2002). Just by being there the ethnographer is already making a difference. Moreover, instead of trying to be just ‘a fly on the wall’, researchers aim explicitly to affect the practices they study. In these approaches that explicitly aim at intervening in practices the researcher operates in close collaboration with the professionals in the field. Collaboration with the practitioners provides a basis for what Zuiderent-Jerak (2007) calls ‘preventing implementation’, which avoids the classical distinction between phases of design, implementation and evaluation of results. Instead of presenting an outsider’s assessment report, one acts from within to make a difference. However, acting in close collaboration with practitioners to make a difference is not without difficulties. This is not a problem as such—after all, non-problematic methods do not exist—but calls for an explicit reflection on the actual consequences of this methodological route. What does it mean to operate ‘in close collaboration with’ the professionals in the field? What kind of opportunities and constraints are linked to this position? Moreover, regardless of our intentions, research effectively intervenes by accepting, challenging or diversifying problem definitions of the actors we study. We need to ask ourselves what this means in our particular case. What are the consequences of practising this kind of approach for the day-to-day activities of the researcher? In other words, what are the methodological and normative choices we can be confronted with while practising an approach of intended intervention? Do Science as Culture Vol. 16, No. 3, 281–295, September 2007

Moving in With Care About Patient Safety as a Spatial Achievement

This article argues that patient safety is also a spatial achievement. To demonstrate this, the author aims to accomplish a spatial analysis with a focus on the coordinating and problem-solving role of the (material) environment and a focus on the way spatial order is produced by safety activities. To gain insight into the spatiality of patient safety, the author follows doctors and nurses while they deal with an unplanned admission of a newborn baby to the neonatal intensive care unit. The analysis especially focuses on the crucial role of the collaborative work of the doctors and nurses in the preservation of patient safety. As the point of departure for the analysis, the author considers space as integral to social action and as something created in the turbulence of social action. This enables the author to go beyond a mere description of how the spatial arrangement of the ward is a part of safety measures. The mobility work that is involved in a safe and smooth collaboration will also be taken into account. The analysis of their mobility patterns on different levels of scale displays the intertwinement between layers of safety and the spatial layers of the neonatology ward.

Exploring the nature of interprofessional collaboration and family member involvement in an intensive care context

Abstract Little is known about the nature of interprofessional collaboration on intensive care units (ICUs), despite its recognition as a key component of patient safety and quality improvement initiatives. This comparative ethnographic study addresses this gap in knowledge and explores the different factors that influence collaborative work in the ICU. It aims to develop an empirically grounded team diagnostic tool, and associated interventions to strengthen team-based care and patient family involvement. This iterative study is comprised of three phases: a scoping review, a multi-site ethnographic study in eight ICUs over 2 years; and the development of a diagnostic tool and associated interprofessional intervention-development. This study’s multi-site design and the richness and breadth of its data maximize its potential to improve clinical outcomes through an enhanced understanding of interprofessional dynamics and how patient family members in ICU settings are best included in care processes. Our research dissemination strategy, as well as the diagnostic tool and associated educational interventions developed from this study will help transfer the study’s findings to other settings.

Diagnostic Work in Collaborative Practices in Neonatal Care

This chapter aims to show how diagnostic work is an integral part of collaborative medical practices. The argument’s starting-point is the notion that collaborative accomplishments in health care practices are in fact extraordinary achievements and that diagnostic work plays a crucial role in this. Some chapters in this volume demonstrate how diagnostic work requires collaboration (see also O’Neill, Chapter 3; Goodwin, Chapter 5; Rouncefield et al., Chapter 13). This chapter adds another, important dimension by focussing on the role of ‘interactional’ diagnostic work in and for collaboration. Drawing on workplace studies, science and technology studies and medical sociology, I explore the dynamic web of individuals and other actors, including the devices and machines with which they interact, with the aim of gaining insight into the role of diagnostic work in the coordination of ephemeral teamwork during complex situations in health care.

Variation and adaptation: learning from success in patient safety-oriented simulation training

Simulation is traditionally used to reduce errors and their negative consequences. But according to modern safety theories, this focus overlooks the learning potential of the positive performance, which is much more common than errors. Therefore, a supplementary approach to simulation is needed to unfold its full potential. In our commentary, we describe the learning from success (LFS) approach to simulation and debriefing. Drawing on several theoretical frameworks, we suggest supplementing the widespread deficit-oriented, corrective approach to simulation with an approach that focusses on systematically understanding how good performance is produced in frequent (mundane) simulation scenarios. We advocate to investigate and optimize human activity based on the connected layers of any setting: the embodied competences of the healthcare professionals, the social and organizational rules that guide their actions, and the material aspects of the setting. We discuss implications of these theoretical perspectives for the design and conduct of simulation scenarios, post-simulation debriefings, and faculty development programs.

Ethnographies of diagnostic work : introduction

Doctors, mechanics, technicians, helpline operators do it, as do the police, prison officers, therapists, designers and many other professionals. Diagnostic activity — aimed at identifying and categorising problems (or opportunities) and defining scope for action — is crucial in many different contexts; aviation (Dekker, 2005), the chemical industry (Reason, 1997), healthcare (Kohn et al., 2000), business (Weick and Sutcliffe, 2001), as well as engineering and design, are just some of domains within socity that rely on it. The product — ‘the diagnosis’ — can be mundane (sometimes a cough is just a cough), or hugely consequential, such as the confirmation ‘you are well clear of friendlies’ in a 2003 friendly-fire incident in Iraq that killed one soldier and injured four others (Nevile, 2009). Diagnoses are important for a number of reasons: through diagnoses, understanding of underlying facts and causes can be measured or expressed quantitatively; diagnoses can be transformative, reflexively shaping the material and experiential reality of people’s lives; they can provide access to resources or treatment, and they can be a meeting-ground for different perspectives (those of patients and healthcare professionals, users and designers, or pilots and ground controllers, for example). Visions of alternative futures and the ‘mapping out’ of paths towards them are built on diagnoses of the status quo.

What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study

BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies. OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents. METHOD: Scoping study. We searched PubMed and Web of Science for peer reviewed, quantitative and qualitative, original, primary research in Western societies on communication and collaboration in maternity care among professionals (Search 1) and between professionals and parents (Search 2). FINDINGS: The 40 studies (14 in Search 1; 26 in Search 2) that met our selection criteria highlighted several factors associated with good communication and collaboration. We grouped these factors into 6 categories: Expertise, Partnership, Context, Attitude, Trust, and Communication style. Studies of communication and collaboration among professionals foregrounded work-related aspects, whereas studies examining collaboration between professionals and parents paid more attention to interpersonal aspects. Before 2012, few studies covered positive aspects of communication and collaboration. We also found an underrepresentation of parents in study populations. CONCLUSION: Our study is part of a growing trend of identifying the positive aspects of communication and collaboration in maternity care. As the study of collaboration in practice continues, researchers need to be sure to involve all stakeholders, including parents.

Ethnographic context meets ethnographic biography: A challenge for the mores of doing fieldwork

Abstract Research involves a complex network of universities, external funding bodies and industry, and researchers are increasingly faced with pressure to produce outcomes within tight temporal deadlines. This offers fresh challenges to research practice, including ethnographic research, which is traditionally based on long-term engagement in the field. This article details challenges to our ethnographic assumptions as a result of working on a highly time-bound video project in an Australian hospital. We frame the unexpected challenge to our latent ethnographic mores by forming a framework of two approaches to research: the descriptive-analytic approach and productive-reflexive approach. The article reveals how the unexpected foregrounding of our ethnographic mores played a critical role in questioning research practice. This article highlights the importance of researcher biography and the plurality and flexibility required of researchers in contemporary collaborative networks.

“Crying Whenever Monday Comes”: Older Unmarried Women in the Netherlands and the Game of Comparison, 1955-1980

The Dutch Womens Action Committee for Early State Pensions advocated the reduction of the retirement age for unmarried women. In doing this, the committee brought forward an image of older unmarried women that was rather different from the self-images the older unmarried women presented in letters and questionnaires sent to the committee. And the image presented by the committee was again different from the image of older unmarried women that emerged in the parliamentary debate. Such a variation in images and self-images is related to the legal nature of the welfare state and the consequent comparison between social categories.

Multiple Researcher Roles in Video-Reflexive Ethnography:

Hospital-based video-reflexive ethnography (VRE) is a collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals’ work practices and patients’ experiences. For more than a decade, the VRE methodology has spread throughout (research) institutions and hospitals internationally, and VRE has evolved and broadened. Different ways of doing VRE have implications for the role of the researcher. A thorough examination of the consequences for the researcher’s position is the central focus of this article. We outline three typical styles of researcher engagement with VRE: clinalyst, affect-as-method, and planned obsolescence. We argue that by examining these different styles of doing VRE research, academic researchers can then critically review and carefully choose which styles of VRE research best meet the needs of their research questions, their field relationships, their disciplinary background, and the expectations of their clinical research collaborators.