VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, IA, USA.
VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System (152), 601 Highway 6 West, Iowa City, IA, 52246, USA.
BMC Med Res Methodol. 2021 Feb 5;21(1):27. doi: 10.1186/s12874-021-01215-y.
Ethnographic approaches offer a method and a way of thinking about implementation. This manuscript applies a specific case study method to describe the impact of the longitudinal interplay between implementation stakeholders. Growing out of science and technology studies (STS) and drawing on the latent archaeological sensibilities implied by ethnographic methods, the STS case-study is a tool for implementors to use when a piece of material culture is an essential component of an innovation.
We conducted an ethnographic process evaluation of the clinical implementation of tele-critical care (Tele-CC) services in the Department of Veterans Affairs. We collected fieldnotes and conducted participant observation at virtual and in-person education and planning events (n = 101 h). At Go-Live and 6-months post-implementation, we conducted site visits to the Tele-CC hub and 3 partnered ICUs. We led semi-structured interviews with ICU staff at Go-Live (43 interviews with 65 participants) and with ICU and Tele-CC staff 6-months post-implementation (44 interviews with 67 participants). We used verification strategies, including methodological coherence, appropriate sampling, collecting and analyzing data concurrently, and thinking theoretically, to ensure the reliability and validity of our data collection and analysis process.
The STS case-study helped us realize that we must think differently about how a Tele-CC clinician could be noticed moving from communal to intimate space. To understand how perceptions of surveillance impacted staff acceptance, we mapped the materials through which surveillance came to matter in the stories staff told about cameras, buttons, chimes, motors, curtains, and doorbells.
STS case-studies contribute to the literature on longitudinal qualitive research (LQR) in implementation science, including pen portraits and periodic reflections. Anchored by the material, the heterogeneity of an STS case-study generates questions and encourages exploring differences. Begun early enough, the STS case-study method, like periodic reflections, can serve to iteratively inform data collection for researchers and implementors. The next step is to determine systematically how material culture can reveal implementation barriers and direct attention to potential solutions that address tacit, deeply rooted challenges to innovations in practice and technology.
民族志方法提供了一种实施的方法和思维方式。本文应用特定的案例研究方法来描述实施利益相关者之间纵向相互作用的影响。这种民族志方法源自科学技术研究（STS），并借鉴了民族志方法所隐含的潜在考古敏感性，STS 案例研究是实施者在一件物质文化是创新的重要组成部分时使用的工具。
我们对退伍军人事务部远程关键护理（Tele-CC）服务的临床实施进行了民族志过程评估。我们在虚拟和现场教育和规划活动（n=101 小时）中收集了实地记录并进行了参与者观察。在实施和实施后 6 个月，我们参观了 Tele-CC 中心和 3 个合作 ICU。我们对实施时 ICU 工作人员（43 次采访，65 名参与者）和实施后 6 个月 ICU 和 Tele-CC 工作人员（44 次采访，67 名参与者）进行了半结构化访谈。我们使用验证策略，包括方法学一致性、适当的抽样、同时收集和分析数据以及理论思考，以确保我们的数据收集和分析过程的可靠性和有效性。
STS 案例研究帮助我们意识到，我们必须以不同的方式思考 Tele-CC 临床医生如何从公共空间进入私人空间。为了了解对监控的看法如何影响员工的接受度，我们通过员工讲述摄像头、按钮、钟声、电机、窗帘和门铃的故事，映射了监控产生影响的材料。
STS 案例研究为实施科学中的纵向定性研究（LQR）文献做出了贡献，包括人物素描和定期反思。STS 案例研究以物质为基础，生成问题并鼓励探索差异，这增加了文献的多样性。如果足够早开始，STS 案例研究方法（如定期反思）可以为研究人员和实施者提供信息，以迭代方式为数据收集提供信息。下一步是系统地确定物质文化如何揭示实施障碍，并将注意力引向潜在的解决方案，以解决实践和技术创新中潜在的、根深蒂固的挑战。
