Vougioukalou Sofia, Boaz Annette, Gager Melanie, Locock Louise
a School of Healthcare Sciences, Cardiff University , Cardiff , UK.
b Centre for Health and Social Care Research, Faculty of Health, Social Care and Education , Kingston University and St. George's, University of London , Kingston Upon Thames , UK.
Anthropol Med. 2019 Apr;26(1):18-32. doi: 10.1080/13648470.2018.1507104.
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 straightforward 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.
人种志越来越多地被用于评估医疗环境中的质量改进和变革举措，尤其是以“聚焦式”和“快速”人种志的形式。这种新的人种志类型是为适应临床路径中更狭窄的调查而量身定制的。然而，将人种志应用于质量改进评估并非易事，也难免存在简化论偏见，特别是在医院环境中，干预措施在有限的时间段内进行，并在繁忙且敏感的环境中引发变革。本文讨论了在对英格兰两家医院的肺癌和重症监护病房服务中的共同设计项目进行人种志过程评估时所涉及的问题及新出现的解决方案。这种混合方法的人种志评估包括对共同设计过程的观察，以及通过访谈、问卷调查、参与者反思日记和服务改进日志对研究结果进行三角互证。通过充分利用事件前后的观察期、将质量改进置于更广泛的临床实践背景中、与当地临床文化相契合以及让参与者共同指导观察和访谈设计，克服了观察时间和与“实地”距离的限制。这种方法促成了一次聚焦式人种志评估，尽管存在时间框架短和医院环境的限制，但仍能遵循人种志原则，深入了解质量改进过程。
