Table 3 Ethnographic methodology and its relevance to healthcare improvement
Ethnographic methodology used | Description | Example paper | Relevance to healthcare improvement |
|---|---|---|---|
Video-reflexive ethnographic study | Collecting in-depth data on intimate or micro-interactions | Patients’ and families’ perspectives of patient safety at the end of life: a video-reflexive ethnography study. (Collier, Sorensen, Iedema, 2016) [32] | • Able to capture complexity in delivery of healthcare. • Irrefutable basis for improving healthcare delivery from the 'bottom up' • Video footage played back to participants. • Video footage challenges the taken for granted aspects of practice individuals may not be aware of |
Peer ethnography | Peers collecting data from excluded or vulnerable populations | Using Peer Ethnography to address health disparities among young Black and Latino men who have sex with men. (Mutchler et al., 2013) [33] | • Improves access to marginalised groups • Data collection on healthcare topics that may only happen between peers (for example, discussions about substance use with men who have sex with men) |
Focussed ethnography | Focus on a discrete community or organisation or social phenomena; problem-driven | Culture of Care for Infants with Neonatal Abstinence Syndrome: A Focused Ethnography. (Nelson, 2016) [34] | • Method often used in nursing research • Intense, short-term observation and interview data collection provides rich and thick description of culture of care • Rapid feedback loop into improvement through focus and insider status |
Critical ethnography | Projects with vulnerable populations and/or political improvement agendas | Nursing casualization and communication: a critical ethnography. (Batch and Windsor, 2014) [35] | • Method gives focus to power, communicative distortions and context • 'Critical' element turned the focus to structures and situations of power and dominance that underpinned nursing culture |
Institutional ethnography | Research studying complex social issues and projects that aim to achieve meaningful social change at the nexus of health professions education and other social systems | Homelessness, health, and literacy: an institutional ethnographic study of the social organization of health care in Ontario, Canada. (Hughes, 2018) [36] | • Insights to explicate the complex and invisible relations that exist being people, place, and things. • Powerful tool to explore the multi-layer entity of health care |
Qualitative methodology incorporated into ethnographic studies | |||
Grounded theory | Researcher co-constructs theories with the research participants, building the theory de novo from iterative data collection | Using an emic and etic ethnographic technique in a grounded theory study of information use by practice nurses in New Zealand. (Hoare et al., 2013) [37] | • Focus on theory generation supports generalisability of healthcare improvement recommendations • Incorporating of grounded theory techniques such as memoing heightens reflexivity [38] • Gives priority to the studied phenomena rather than the study setting |
Thematic analysis | Flexible qualitative analysis method of deriving themes from data through systematic coding procedures | Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame. (Armstrong et al., 2018) [39] | • Findings are (potentially) accessible to different audiences due to thematic presentation • Allows analysis of observation and interview data from a diverse sample of organisations • Can thematically explore people's views as well as see what they did in practice |