Ethnographic study of ICT-supported collaborative work routines in general practice

Deborah Swinglehurst,Jill Russell,Trisha Greenhalgh,Michelle Myall

doi:10.1186/1472-6963-10-348

Deborah Swinglehurst, Jill Russell + Show 2 more

Open Access

https://doi.org/10.1186/1472-6963-10-348

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Abstract

BackgroundHealth informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations.Methods/designFollowing Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations.DiscussionOur study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice.

Highlights

Health informatics research has traditionally been dominated by experimental and quasiexperimental designs
Our study offers the potential to identify potential quality failures in collaborative work routines and to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in electronic patient records (EPRs) technologies and via which “automated” safety features have an impact in practice
Our study seeks to contribute to a body of knowledge which lies at the interface between health services research and organisational sociology

Summary

Introduction

Health informatics research has traditionally been dominated by experimental and quasiexperimental designs. Research has focused predominantly on experimental, quantitative and (often) behaviourist study designs oriented to developing interventions, testing hypotheses and measuring the relationship between inputs (e.g. training), processes (e.g. following a guideline) and outcomes (e.g. morbidity). These empirically-driven (’positivist’) approaches resonate strongly with medicine’s methodological hierarchy of evidence in which the controlled experiment counts highly [1]. Important though such research is, there is a need for in-depth qualitative research (’interpretivist’ approaches) oriented to developing theories and explanations of how innovation and change happens - and in particular, how new ideas, practices and collective behaviours become routinised as business-as-usual. A recent systematic review on implementation of electronic patient records (EPRs) in organisations revealed a preponderance of experimental and quasi-experimental studies and a much smaller qualitative literature describing the social processes and contextual influences on EPR adoption and use [7]

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