Opening the 'black box' of patient safety in UK general practice: the application of long-term and short-term multi-sited ethnography for understanding healthcare organisational complexity
(University of Dundee)
Paper short abstract:
This paper examines the application of both ‘long-term’ and ‘short-term’ multi-sited ethnographic methods to the exploration of high-volume, safety-critical routines in UK general practice, and the how ethnographic findings can best contribute to a wider body of ‘evidence’ for policy and practice.
Paper long abstract:
Ethnography is a well-established approach to conducting research within healthcare organisations. While ethnography is usually associated with a long-term research process involving extended periods of fieldwork, more 'rapid' (Bentley et al. 1988) or 'focused' (Knoblauch 2005) approaches are increasingly being sought by researchers and policymakers that are responsive to the short-term cycles of healthcare policy implementation and change. Healthcare organisations are increasingly described as 'complex systems' (Rowley & Waring 2011). Within the field of patient safety, there is increased recognition of the need to understand the 'black box' of organisational safety practices and processes over time through long-term ethnographic engagement (Dixon-Woods 2003). It is also recognised that the tacit knowledge, innovation and flexibility used by local actors in the creation of safety varies across organisational settings, and that a wider range of methodological, practical, and analytical entry points are required to provide a fuller understanding of change across different organisational contexts. The aim of this paper is to examine interprofessional safety practices across a range of high-volume organisational routines within UK general practice (e.g. repeat prescribing) through the application of both long-term and 'short-term' (Pink & Morgan 2013) multi-sited ethnographic methods. Drawing on findings from an ethnographic study conducted across 8 general practices (2010-14) and Pink's (2009) concept of 'ethnographic place', it explores how different 'types, qualities and temporalities of things and persons' come together through both long-term and short-term methodological approaches, and how ethnographic findings can best contribute to a wider body of 'evidence' for healthcare policymakers and practitioners.
Ethnography and evaluation: temporalities of complex systems and methodological complexity