Ethnography and the evaluation of change in complex adaptive clinical cultures: understanding staff and managers' experiences of implementing accelerated co-produced service improvement
Annette Boaz (St Georges, University of London and Kington University)
Paper short abstract:
Considerations for documenting adaptation and temporal complexity in clinical settings will be discussed using examples from of an ethnographic evaluation of accelerated experience-based co-design in two intensive care units and two lung cancer pathways in English hospitals.
Paper long abstract:
An ethnographic process evaluation was used to understand the contribution of accelerated patient-led action research to patient outcomes and local clinical cultures in two intensive care units and two lung cancer pathways in English hospitals. We found that patient-led co-produced service improvement was embraced differently by managers, doctors and nurses and was enacted according to local organisational culture and a variable understanding of salient discourses on patient-centred design. Through participation in the project, different actors mobilised and acted upon their existing knowledge of service delivery and also incorporated new knowledge and non-hierarchical ways of working which involved diverse members of different clinical teams and patients. The flexibility that ethnographic insights provided throughout the research process, enabled documentation of the intricate and highly personalised facets of participatory health service design within four very different complex adaptive clinical environments. As this type of ethnographic evaluation occurred within highly medicalised knowledge-enfranchised settings, we will discuss the methodological and theoretical considerations for documenting adaptation and temporal complexity in organisational and focused ethnographies of clinical and patient communities.
Ethnography and evaluation: temporalities of complex systems and methodological complexity