Paper short abstract:

Tensions between ethnography and evaluation play out in notions of size, scale and perspective, raising questions about the relevance and connection of individual lives to wider changes. Exploration of these tensions is needed when trying to bring individuals’ experience to bear on service improvement.

Paper long abstract:

In this paper I explore ideas of size, scale and perspective in turning from an ethnographic to an evaluative approach; from fieldwork to generating ideas for service improvement. My ethnographic fieldwork is part of a multi-level case study of integrated care, focusing on people's experiences of living with multiple long-term health conditions. My dual role within the study site as researcher and NHS commissioner raises questions about the links between ethnography, evaluation and service improvement. Here I explore responses to the data generated by fieldwork; the data is seen as both too "big", in terms of quantity and detail, and too "small", in terms of generalizability. Scale is also of concern, as tensions between ethnography and evaluation play out in questions of relevance. Ethnography foregrounds embodied, day-to-day lived experience, bringing the minutiae of daily life into sharp focus. Evaluators, however, need a wider angle to foreground larger objects of interest; organisations, teams, services. The discrepancy between these two viewpoints raises questions about their relevance to each other, and the connections between "big" changes and individuals. A further source of tension between ethnography and evaluation emerges in defining interventions as distinct from "context", when the conceptual boundary required to distinguish the shape of the intervention within a social world, blurs and dissolves under the close gaze of an immersed ethnographer, rendering attempts to inform causation impossible. Exploring these tensions and aspects of complexity (Strathern 2004) is important in attempting to bring individuals' experiences to bear on improving services.