Rowena Forsyth

Visibilising clinical work: Video ethnography in the contemporary hospital

Abstract This paper discusses the role of video-based research methods in social research. The paper situates these methods in the context of rising levels of visibility of professionals in government-funded organisations. The paper argues that while visual research may appear to play an ambiguous role in these organisations, it can also enable practitioners to confront the encroaching demands of post-bureaucratic work. To ground its argument, the paper presents an account of a video-ethnographic project currently underway in a local metropolitan hospital. This project focuses on negotiating understandings about existing care practices among a team of multi-disciplinary clinicians. Visual data gathered as part of that project are presented to specify issues which have thus far arisen during the project. Against this empirical background, the paper turns to considering the ambiguous potential of video-based research. The argument developed here is that, besides potentially exacerbating the pressure already imposed on clinicians - thanks to audit, surveillance and risk minimisation - video-based research may provide staff with new resources and opportunities for shaping their increasingly public and visible work practices.

The (im)possibilities of clinical democracy

Abstract In this article, we argue that homogenising discussions of medical dominance on the meta-level of professions do not fully capture the complexity that characterises current clinical care in multidisciplinary health care teams. We illustrate this through an empirical study of a multidisciplinary team attempting to enact their work in a clinically democratic way. The challenges that arose in putting this into practice highlight the depth and complexity of enculturated medical dominance in Australian hospital practice. Our study shows that effective facilitation of clinician reflexivity has the potential to challenge and change deeply embedded structures and behaviours.

Video Research in Health Visibilising the Effects of Computerising Clinical Care

This paper discusses video ethnography as part of a multimethod study of the introduction of information technology to streamline pathology test order entry in hospitals and its effect on the work of pathology laboratory scientists. The paper opens with an overview of video research in health care settings. After acknowledging the limitations inherent in video data, the paper offers a description of how video footage served to enhance insight in three ways. First, the footage enhanced the researchers’ own appreciation of the significance of particular facets of the data, which led them to reassess information collected through interviewing, focus groups and research field notes. Second, the footage enhanced the pathology laboratory scientists’ appreciation of the problems they experienced when incorporating the new information technology into their daily work practice, by enabling them to articulate these problems to outside researchers. Third, by being watched (by the video camera) and by watching themselves perform their work they were enabled to redesign their practices. The paper suggests that, as a result of interactively performing their work in front of the camera, the scientists came to apprehend their practices ‘from under a different aspect’. The paper concludes that by allowing video ethnography as a research method to remain underdefined and emergent, the modality of engagement and uptake shown by participants in the video research can be considered as a further enriching aspect of video ethnography as a research process.

Women׳s views about maternity care: How do women conceptualise the process of continuity?

OBJECTIVE to gain an understanding of how women conceptualise continuity of maternity care. DESIGN a qualitative study involving in-depth semi-structured interviews and thematic analysis. SETTING a range of urban and rural public hospitals in New South Wales, Australia. PARTICIPANTS 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011-2012. FINDINGS responses from women suggested five concepts of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies and continuity across locations. These concepts of continuity differed by parity and location. CONCLUSION AND IMPLICATIONS FOR PRACTICE continuity of maternity care has a variety of meanings to women. If health care providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of womens experiences, and ensure that systems of care are flexible and appropriate to womens circumstances and needs.

Patient perceptions of carrying their own health information: approaches towards responsibility and playing an active role in their own health - implications for a patient-held health file

Objective  To elicit patients’ views on whether they could contribute to improvements in their care by carrying their own health information to clinician encounters; and to consider the implications for the development of a patient‐held health file (PHF).

Distance versus Dialogue: Modes of Engagement of Two Professional Groups Participating in a Hospital-based Video Ethnographic Study

Abstract This paper considers how video methodology creates a unique space to engage research participants in reflecting on and challenging their existing ways of working. A video ethnographic research project that investigated changes in the work practices of doctors and laboratory scientists at a metropolitan teaching hospital in Sydney Australia is used as an example to detail the way that the contrasting modes of engagement of the two participant groups led to a consideration of the role of the video camera in a research setting. The paper argues that the engagement of one participant group with the researcher led to the development of a dialogic relationship with the research process that enabled the formulation of greater insights for both the participants and researcher about the work practices under study. The other participant group who engaged in a more boundaried and distanced way with the research process provided an identifiable contrast with the group who took up the reflexive role. Providing participants with the opportunity to view their practices in a space separate from simultaneously performing their work leads them to understand their practices in a new way, a way that differs from them reading interview transcripts or other research data. By viewing everyday work practices, the participants are afforded space to re-examine this familiarity with the potential to improve their practices. The accessibility, coupled with the recent increases in the affordability and manipulability of video recordings, highlights the potential usefulness of this method for enabling practitioners themselves to redesign their work practices.

Decision Making in a Crowded Room The Relational Significance of Social Roles in Decisions to Proceed With Allogeneic Stem Cell Transplantation

Researchers studying health care decision making generally focus on the interaction that unfolds between patients and health professionals. Using the example of allogeneic bone marrow transplant, in this article we identify decision making to be a relational process concurrently underpinned by patients’ engagement with health professionals, their families, and broader social networks. We argue that the person undergoing a transplant simultaneously reconciles numerous social roles throughout treatment decision making, each of which encompasses a system of mutuality, reciprocity, and obligation. As individuals enter through the doorway of the consultation room and become “patients,” they do not leave their roles as parents, spouses, and citizens outside in the hallway. Rather, these roles and their relational counterpoints—family members, friends, and colleagues—continue to sit alongside the patient role during clinical interactions. As such, the places that doctors and patients discuss diagnosis and treatment become “crowded rooms” of decision making.

Medicine, the media and political interests

The news media is frequently criticised for failing to support the goals of government health campaigns. But is this necessarily the purpose of the media? We suggest that while the media has an important role in disseminating health messages, it is a mistake to assume that the media should serve the interests of government as it has its own professional ethics, norms, values, structures and roles that extend well beyond the interests of the health sector, and certainly beyond those of the government. While considerable attention has been given to the ways in which uncritical publication of industry perspectives by news media can negatively impact on public understandings of health and health behaviours, we would argue that it is equally important that journalists not become the ‘lapdogs’ of government interests. Further, we suggest that the interests of public health may be served more by supporting the ongoing existence of an independent media than by seeking to overdetermine its purpose or scope.

Rules of engagement: Journalists’ attitudes to industry influence in health news reporting

Health-related industries use a variety of methods to influence health news, including the formation and maintenance of direct relationships with journalists. These interactions have the potential to subvert news reporting such that it comes to serve the interests of industry in promoting their products, rather than the public interest in critical and accurate news and information. Here, we report the findings of qualitative interviews conducted in Sydney, Australia, in which we examined journalists’ experiences of, and attitudes towards, their relationships with health-related industries. Participants’ belief in their ability to manage industry influence and their perceptions of what it means to be unduly influenced by industry raise important concerns relating to the psychology of influence and the realities of power relationships between industry and journalists. The analysis also indicates ways in which concerned academics and working journalists might establish more fruitful dialogue regarding the role of industry in health-related news and the extent to which increased regulation of journalist–industry relationships might be needed.

Views of health journalists, industry employees and news consumers about disclosure and regulation of industry-journalist relationships: an empirical ethical study

Bioethicists and policymakers are increasingly concerned about the effects on health journalism of relationships between journalists and private corporations. The concern is that relationships between journalists and manufacturers of medicines, medical devices, complementary medicines and food can and do distort health reporting. This is a problem because health news is known to have a major impact on the publics health-related expectations and behaviour. Commentators have proposed two related approaches to protecting the public from potential harms arising from industry-journalist interactions: greater transparency and external regulation. To date, few empirical studies have examined stakeholders’ views of industry-journalist relationships and how these should be managed. We conducted interviews with 13 journalists and 12 industry employees, and 2 focus groups with consumers. Our findings, which are synthesised here, provide empirical support for the need for greater transparency and regulation of industry-journalist relationships. Our findings also highlight several likely barriers to instituting such measures, which will need to be overcome if transparency and regulation are to be accepted by stakeholders and have their intended effect on the quality of journalism and the actions of news consumers.