Rapid Ethnography Research Articles

Influence of Context as a Key Ingredient for High Performance on Skilled Nursing Facility Readmissions

Improving hospital discharge processes and reducing adverse outcomes post discharge has become a topic of national importance, especially for older patients transitioning to skilled nursing facilities (SNFs). The substantial variation in rehospitalization outcomes suggests contextual factors may play a role in performance. We conducted rapid ethnography with opportunistic interviews (148 hours of observations, 30 clinicians) at hospitals that were high (n=2) or low (n=2)- performing in terms of their readmission rates from SNF, as well as 5 associated SNFs, to understand how contextual differences influenced performance variation. We used thematic analysis to categorize contextual factors and compare differences across high and low perfoming sites. We found three main contextual factors that differed across high- and low-performing hospitals and SNFs: team dynamics, patient characteristics, and organizational context. First, we observed high-quality communication, situational awareness, and shared mental models among team members in high-performing sites. Second, patients at high-performing hospitals had better insurance coverage that made it feasible for clinicians to place patients in SNFs based on their needs instead of financial abilities. Third, staff at high-performing hospitals were more engaged in the transitions process and rapport building with SNFs thereby facilitating smooth transitions of care from hospitals to SNFs. For example, clinicians at high- performing sites were actively engaged in directing the discharge process, but this was not observed in low-performing sites where a lack of clinician engagement lead to delays. Understanding how context affects transitions could be used to target organizational, policy, and staff level interventions to reduce adverse outcomes.

Uncharted waters of the entrepreneurial ecosystems research: Comparing Greater Istanbul and Reading ecosystems

AbstractThis study introduces the complementarity perspective to the entrepreneurial ecosystem (EE) research as a process to compare the two entrepreneurial ecosystems of Reading (United Kingdom) and Istanbul (Turkey). We apply the multiple‐case design methodology based on the rapid ethnography and the grounded theory to construct two entrepreneurial ecosystem models characterized by different EE taxonomy pillars and embedded in different local and institutional contexts. As a result of the study, two findings emerge. First, we find three distinct complementarities in both EEs: access to resources, effective use of resources, entrepreneurial orientation, and ecosystem awareness. Second, EE taxonomy pillars serve as mediators between ecosystem elements that drive entrepreneurial activity and complementarities. We argue that this approach could be applied to understand how EEs work and develop in regions with heterogeneous economic, geographical, and institutional contexts.

A conversation with Pat Armstrong about Creative Teamwork: Developing Rapid Site-Switching Ethnography

A conversation with Pat Armstrong about Creative Teamwork: Developing Rapid Site-Switching Ethnography

“That’s what I’m supposed to do at work”: gendered labor, self-care, and overdose risk among women who use drugs in Vancouver, Canada

ABSTRACT Through rapid ethnography undertaken in Vancouver, Canada’s Downtown Eastside – one of Canada’s overdose epicenters – this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations.

Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study

ObjectiveTo report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.Design and SettingThe Partnerships in Research to Implement and Disseminate Sustainable and Scalable...

PENGEMBANGAN DESAIN SEPEDA ANAK USIA 7-12 TAHUN MENGGUNAKAN METODE RAPID ETHNOGRAPHY DAN SCAMPER

Title: Design Development of Bike for Kids (7-12 y.o) using Rapid Ethnography and SCAMPER Method Children by nature growth relatively fast. Their body expand in a short time that demand many things that they wear or use to meet their body accordingly. This to include also the need for their bicycle. In order to fulfill the needs of children’s comfort in cycling, some bicycles which are suitable with anthropometry of children’s body are required. With the existence of bicycle’s design which has longer durability than children’s bicycles in general, hence the children’s bicycle which will be designed would have sustainable design concept. Clark et al. (2009) states that sustainable design is a design concept which integrates 3 kinds of elements (people, profit, planet) and not merely an environmental-friendly concept. Developing a product with sustainable concept is not only done with a manipulation on materials which are bio-degradable, but also could be done with extending the lifespan of the product. Respondents which are targeted on this planning are children aged from 7 until 12 with their parents, since the children on this age range experience rapid growth. Not only the interests of the children aged from 7-12 as primer users which are concerned, but also their parents as secondary users. This matter is resulted from how the parents also play a role in choosing and buying the bicycle which will be used by their children.

Social Participation in Long-term Residential Care: Case Studies from Canada, Norway, and Germany.

Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents' social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.

Long-Term Care in Rural Alberta: Exploring Autonomy and Capacity for Action

Context: Since the 1990s, Alberta, Canada has seen considerable restructuring to health and long-term care (LTC) services. Most LTC research is conducted in urban centres. As a result, little is known about the effects that restructuring has had on rural LTC homes. Objective(s): In this article, we outline our findings related to autonomy and capacity for action in rural LTC homes. Method(s): We conducted a multi-site comparative case study. Using rapid ethnography, we conducted weeklong site visits at three rural LTC homes. This involved two types of data collection: semi-structured qualitative interviews and field observations. We used a feminist political economy lens to analyze the data. Findings: Our findings offer insights into how rural LTC staff are empowered to create change and/or constrained from doing so. We outline these findings at macro, meso, and micro levels of analysis and conclude that a combination of site-level and systemic factors contribute to a LTC home’s level of autonomy and capacity for action. Limitations: Our findings reflect experiences and observations at three LTC homes at three distinct points in time. Though the data provide rich descriptions, they do not provide an exhaustive account of the strengths and challenges of rural LTC. Implications: Community resources, local industries, and other socioeconomic and organizational factors contribute to a community’s response to LTC restructuring and their ability to make change and ruralize their LTC provision. These factors, and the heterogeneity of rural communities, should be taken into consideration during decision-making about rural health policy and service provision.

Development of an implementation and evaluation strategy for the Australian 'Zero Childhood Cancer' (Zero) Program: a study protocol.

IntroductionEffective implementation of a research Program requires an actionable plan to guide execution. To assess the actionability and success of that plan, both scientific and implementation elements must be taken into account. The aim of this study is to assess the ‘Zero Childhood Cancer Personalised Medicine Program’ (the Zero Program), an Australian first-ever and most comprehensive personalised medicine programme for children with high-risk or relapsed cancer, in terms of its structure, process and implementational effect.Methods and analysisWe will assess Program delivery mechanisms. The development of the implementation and evaluation strategy will concentrate on the work of the Zero Program as a complex whole. This includes the structure of collaborative links across stakeholder groups involved in Program development and delivery, changes to collaborative relationships over time and the impact of group working on Program outcomes. We are applying a mixed-methods design including: a rapid ethnography (observations of stakeholder interactions and informal conversations), Program professionals’ completion of a rapid health implementation proforma and a social network analysis. Formative evaluations of the implementation science effects, applying feedback techniques, for example, Formative Evaluation Feedback Loops and the Zero Program professionals’ feedback, will determine where Program tailoring may be needed. A repeat of the social network analysis downstream will examine network changes over time, followed by an expert panel using the expert recommendations for implementing change to assess the integration of implementation strategies into the Program structure. A summative evaluation of the Program will bring the research elements together, leading to comprehensive data triangulation and determining the sustainability and implementational effects of Program delivery.Ethics and disseminationEthical approval for this study has been granted by Hunter New England Research Ethics Committee, New South Wales, Australia (approval ref: 2019/ETH12025). Knowledge translation will be achieved through publications, reports and conference presentations to healthcare professionals, patients, families and researchers.Trial RegistrationNCT03336931; Pre-results.

Using Rapid Ethnography to Unpack Performances of Community Authenticity: An Art Festival Case from Victoria, British Columbia

Planning often tries to shape human behavior for public benefit. Planning also seeks to implement broad constructs, like livability and sustainability. In response to both tasks, qualitative explanatory research can help build crucial understanding. Still, qualitative approaches are often underused and undertheorized due to misconceptions about their resource and time-demands. This paper explores how rapid ethnography, already used in health and other disciplines, could help planning researchers improve their understanding of human behavior and of broad constructs. It then illustrates the methodology through a case study exploring performances of authentic community at an arts festival in Victoria, BC, Canada.

The gendered dimensions of informal institutions in the Australian construction industry

The construction industry is the most male‐dominated in Australia, despite companies implementing formal policies and initiatives to address this. While previous research has examined the role of workplace culture as a barrier to women in the industry, our research investigates the role informal institutions play in obstructing gender equity in construction. We examine the gendered dimension of informal institutions (practices, narratives and norms) in two multinational Australian construction companies using feminist institutional (FI) theory and rapid ethnography. The findings show that informal gendered institutions obstruct women’s recruitment, retention and progression in construction. Recruitment into and within the industry is framed by male sponsorship, cultural fit and traditional education pipelines. Retention is compromised by poor parental leave practices and norms, which tolerate sexism and gender stereotypes, as well as unsustainable work practices. Progression is impaired by the need for strategic alliances with powerful men and a lack of transparency around promotion opportunities.

Experiences and Insights from the Early US COVID-19 Epicenter: A Rapid Assessment Procedure Informed Clinical Ethnography Case Series

Objective The Coronavirus disease (COVID-19) outbreak has evolved into a pandemic crisis, with King County in Washington State emerging as the early US epicenter. A literature review revealed few reports providing front-line clinical and research teams guidance related to multilevel, rapidly evolving COVID-19 directives. Method The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method was used to develop a clinical case series and conduct participant observation during an ongoing comparative effectiveness trial of peer-integrated, patient-centered interventions after traumatic injury. Participants were patients enrolled in the intervention arm of the ongoing trial, as well as front-line clinicians, patient peer interventionists, and clinical research team members implementing the trial. All participants were exposed to the Washington State COVID-19 outbreak. Results Primary and secondary COVID-19 prevention strategies were feasibly integrated into ongoing care coordination and behavioral interventions for at-risk patients. Beyond the compilation of case studies, as an iterative method, RAPICE data collection naturalistically evolved to include observations of intervention team activity occurring within the larger pandemic epicenter context. A daily clinical research team huddle that flexibly accommodated virtual participation was also feasibly implemented. Conclusions Primary and secondary COVID-19 prevention strategies can be feasibly integrated into ongoing clinical interventions during the pandemic. Routine, proactive clinical and research team communication that transparently addresses ethical tensions and health-sustaining activities may promote well-being for providers grappling with rapidly evolving pandemic directives. Proactive assessments of individual provider vulnerabilities for severe COVID-19 related respiratory illness may also be a crucial element of the health care system pandemic responses.

School climate, an enabling factor in an effective peer education environment: Lessons from schools in South Africa

Globally, peer education and school climate are important topics for educators. Peer education has been shown to improve young people’s decision-making and knowledge about healthy and prosocial behaviour, while a positive school climate contributes to positive learning outcomes in general. In this article we explore the role of school climate in enabling the success of peer education outcomes. We do so by considering 8 geographically and socially distinct schools in the Western Cape province of South Africa where the peer education programme, Listen Up, was implemented, and for which measures of peer education quality exist. We then report a qualitative assessment of each school’s climate characteristics (student-interpersonal relations, student-teacher relations, order and discipline, school leadership, and achievement motivation), conducted through a rapid ethnography drawing on work by Bronfenbrenner (1977) and Haynes, Emmons and Ben-Avie (1997). Finally, we conclude that school climate can enhance learning and positive peer education outcomes. Keywords: learning environments; peer education; rapid ethnography; school climate; Western Cape

'Spending the day with your Family Health Team': rapid ethnography of a patient-centred quality improvement event.

BackgroundPrimary care practices have started to explore different methods of engaging with patients to advance quality improvement. This approach leverages the strengths of citizen engagement; however, there has been a lack of empirical research to understand the impact of such an approach from the patient perspective.AimTo understand how citizen engagement can inform quality improvement in family practice.Design & settingA single-centre, rapid ethnographic evaluation of a patient engagement event.MethodTen thousand email invitations were sent and posters put up in Family Health Team (FHT) waiting rooms, resulting in 350 patient responses and the purposive recruitment of 36 participants. Observation and key informant interviews were used to collect data. The data corpus was analysed according to ethnographically-informed thematic analysis techniques.ResultsAnalysis of the full set of field notes, patient interviews, and informal conversations with the FHT staff revealed three factors that impacted on the success of the patient engagement event: setting the stage, the power of storytelling, and the value of reframing the patient role.ConclusionThe present study highlights three components of patient and public engagement approaches — the importance of setting the proper stage, storytelling as a tool, and reframing the patient role in healthcare delivery — which may provide useful guidance to those considering similar patient and public engagement events.

Rejection and Resilience in a “Safe Space”: Exploratory Rapid Ethnography of Asian-Canadian and Asian-American Men’s Experiences on a Gay Cruise

Similar to other leisure spaces, gay cruises allow for self-expression and development of community, but in potentially sexualized environments over comparatively prolonged periods. Understanding racialized gay men’s resiliency in these spaces is important to leisure theory and practice, yet it has received little empirical attention, with an existing gap regarding resilience strategies of racialized gay men. Informed by minority stress theory and resilience theory, I use rapid ethnography to explore experiences of Asian-Canadian and Asian-American cisgender gay men (n = 7) on a gay cruise. Thematic analysis highlighted the cruise as a “safe space” where participants felt liberated. However, participants discussed rejection based on race and body size in this “safe space.” To cope, participants drew on existing resources rather than creating new ones, speaking to their resources as “my friends are my oasis.” Findings contribute to understanding Asian gay men’s resiliency in leisure spaces, highlighting the importance of social resources.

Tornado warning: Understanding the National Weather Service’s communication strategies

This study explores the National Weather Service’s communication through a multi-sited rapid ethnography that extends the fully functioning society theory. National Weather Service field offices do not employ public information officers. Instead, forecasters predict the weather, craft messages, and build relationships with their publics. Scholars have called for public relations research that examines messages, including how crisis communication can help publics cope. Additionally, scholars have noted that all organizations need public relations, even if they do not employ formal public relations personnel. In our study, forecasters emphasized the need to build their publics’ tornado threat awareness and provided strategies to make weather science accessible. Forecasters discussed a variety of message strategies including avoiding fear appeals, humanizing the organization, and visualizing risks. Forecasters also built relationships with active publics through soliciting weather spotters and empowering them to prepare others for severe weather. Overall, findings expand knowledge about how organizations can employ strategic public relations to benefit society, thereby extending fully functioning society theory.

Leveraging integrative research for inclusive innovation: urine diversion and re-use in agriculture

This report describes the evolution of a qualitative research design used in a study that integrated academic and non-academic expertise and involved multiple stakeholders concerned with the diversion of human urine from the waste stream for its re-use in agriculture. The study took place in two regions of the U.S., New England and the Upper Midwest (most specifically Vermont and Michigan) and suggests the importance of ethnographic perspectives in a participatory action research framework going forward. This manuscript presents a novel mix of researchers, from a grassroots organization to R1 University teams, and explores the perspectives of a wide range of research participants with whom we conferred to understand whether and how fertilizers made from nutrients recovered from diverted urine might be accepted, adapted, and scaled in agricultural use. Our manuscript thus articulates new territory for such interpretive social science work (focus groups, interviews and participant observations) neither within basic ethnographic research, nor within the kind of “rapid ethnography” widely used in business, engineering and international development fields. We describe how our research process entailed the modifications of our methods, and we consider the overlapping and sometimes opposed knowledges and attitudes of multiple stakeholders who are crucial to the uptake and scale of such new technologies for closing loops in our waste and water processing infrastructures and our food production systems. To best leverage these diverse knowledges, we suggest incremental steps for teams like ours towards an inclusive research process.

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study.

Coercive practices, such as physical restraint, are used globally to respond to violent, aggressive and other behaviours displayed by mental health service users.1 A number of approaches have been designed to aid staff working within services to minimise the use of restraint and other restrictive practices. One such approach, the 'REsTRAIN Yourself' (RYS) initiative, has been evaluated in the UK. Rapid ethnography was used to explore the aspects of organisational culture and staff behaviour exhibited by teams of staff working within 14 acute admission mental health wards in the North West region of the English NHS. Findings comprise four core themes of space and place; legitimation; meaningful activity; and, therapeutic engagement that represent characteristics of daily life on the wards before and after implementation of the RYS intervention. Tensions between staff commitments to therapeutic relations and constraining factors were revealed in demarcations of ward space and limitations on availability of meaningful activities. The physical, relational and discursive means by which ward spaces are segregated prompts attention to the observed materialities of routine care. Legitimation was identified as a crucial discursive practice in the context of staff reliance upon coercion. Trauma-informed care represents a potentially alternative legitimacy.

Mayo Clinic Registry of Operational Tasks (ROOT): A Paradigm Shift in Electronic Health Reco Implementation Evaluation.

ObjectiveTo systematically examine clinical workflows before and after a major electronic health record (EHR) implementation, we performed this study. EHR implementation and/or conversion are associated with many challenges, which are barriers to optimal care. Clinical workflows may be significantly affected by EHR implementations and conversions, resulting in provider frustration and reduced efficiency.Patients and MethodsOur institution completed a large EHR conversion and workflow standardization converting from 3 EHRs (GE Centricity and 2 versions of Cerner) to a system-wide Epic platform. To study this quantitatively and qualitatively, we collected and curated clinical workflows through rapid ethnography, workflow observation, video ethnography, and log-file analyses of hundreds of providers, patients, and more than 100,000 log files. The study included 5 geographic sites in 4 states (Arizona, Minnesota, Florida, and Wisconsin). This project began in April 2016, and will be completed by December 2019. Our study began on May 1, 2016, and is ongoing.ResultsSalient themes include the importance of prioritizing clinical areas with the most intensive EHR use, the value of tools to identify bottlenecks in workflow that cause delays, and desire for additional training to optimize navigation. Video microanalyses identified marked differences in patterns of workflow and EHR navigation patterns across sites. Log-file analyses and social network analyses identified differences in personnel roles, which led to differences in patient–clinician interaction, time spent using the EHR, and paper-based artifacts.ConclusionAssessing and curating workflow data before and after EHR conversion may provide opportunities for unexpected efficiencies in workflow optimization and information-system redesign. This project may be a model for capturing significant new knowledge in using EHRs to improve patient care, workflow efficiency, and outcomes.

Exploring museum service experience using gamification-based personas with distinct motivations

In the context of museums facing challenges from the cultural and leisure market, a desirable experience that can be tailor-made for different type of visitors can serve as an indicator to measure brand equity. To explore the museum service experiences, the Bartle Test of Gamer Psychology was introduced for identifying personas representing different visitors’ motivations to visit the museum. With the personas being recruited, this study will employ the adapted rapid ethnography as the research approach to gain in-depth and detailed insights into the perceptions from the user’s perspective.