1. © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 What is Ethnography? Qualitative Methods in Health Services Research Charles L. Bosk, PhD Ksenia O. Gorbenko, PhD Joanna V. Brooks, MBE, MA

2. 2 Armstrong Institute for Patient Safety and Quality This is what most people think ethnography is... 2 Originally, a study of peoples/ cultures in anthropology Greek ἔ θνος ethnos = folk/people γράφω grapho = to write

3. 3 Armstrong Institute for Patient Safety and Quality 3 Hospitals Nuclear powered aircraft carriers NASA shuttle operations Chemical manufacturing plants Nuclear power plants Post-disaster sites Ethnography has been conducted in high risk settings, including

4. 4 Armstrong Institute for Patient Safety and Quality Ethnography seeks to uncover How frontline workers make sense of their work world and create the patterns quantitative researchers discover. 4

5. 5 Armstrong Institute for Patient Safety and Quality Value of ethnographic research Way to address the tension between the ideal and the real, the plan and its implementation Way to capture stories about successes and failures at creating change Way to provide real-time feedback Way to discuss unexpected contingencies that arise in work 5

6. 6 Armstrong Institute for Patient Safety and Quality Product is a “thick description” “Not an experimental science in search of a law but an interpretive one in search of a meaning” (Geertz, 1973). 6

7. 7 Armstrong Institute for Patient Safety and Quality 4 Basic Questions: Who are the stakeholders in SUSP? What do they think they are doing? How and why are they doing what they are doing? Within what frames of meaning does all this activity make sense? 7

8. 8 Armstrong Institute for Patient Safety and Quality Specifically, we will ask teams: How did coordinating entities and participating hospitals decide to become part of SUSP? How are teams formed? How do SUSP teams work? How does frontline understanding of what is being done converge and diverge from the national team? 8

9. 9 Armstrong Institute for Patient Safety and Quality And produce detail-drenched stories about: What makes the project work? What creates barriers to success? What strategies overcome barriers? What barriers introduce hard limits on quality improvement? 9

10. 10 Armstrong Institute for Patient Safety and Quality Benefits of participation in ethnographic study Allow recognition of structural factors that inhibit change Share knowledge about attempts to improve quality Provide understanding of how collaboratives work Create social networks that promote shared wisdom based on recent successes and failures 10

11. 11 Armstrong Institute for Patient Safety and Quality Level of exposure We take confidentiality of our sites and participants very seriously. All data, whether gathered through observation or transcribed interviews, will be de-identified in reports and publications. We will to the best of our ability and using all the resources at our disposal present findings so that they will not be traceable to particular states, sites, or individuals. Bosk, CL 2008 What Would you do? 11

12. 12 Armstrong Institute for Patient Safety and Quality Why Do Qualitative Research? A Tonic: It’s humbling to see the unexpected contingencies that can interfere with our attempts to control the world rationally. A Reality Check: There are no sensible limits to self-delusion and human folly. A Corrective: A way to provide real-time suggestions for improving delivery of program. 12

13. 13 Armstrong Institute for Patient Safety and Quality How do teams participate? Volunteer for a site visit: Funds limit participation to 2 visits to 5 states 1-2 day site visit per hospital, once yearly for 2 years Observations in OR, Prep and PACU, SUSP meetings Interviews with SUSP team, clinicians, administrators Contact us for a brief memo outlining the details of site visitsContact us 13