Research Note – Hospital ethnography and its application in interprofessional care research: A lay summary

By | 20th September 2024
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Authors:
Andreas Xyrichis1, Brianne Wenning2, Shannon Costello3
1Reader in Interprofessional Science, 2Research Associate in Interprofessional Science, 3Research Assistant in Interprofessional Science

Florence Nightingale Faculty of Nursing, Midwifery, & Palliative Care, King’s College London University, London, United Kingdom

Correspondence to andreas.xyrichis[at]kcl.ac.uk

Introduction

Imagine standing in a bustling emergency room, watching doctors, nurses, and other hospital workers rush past, hearing the beep of monitors, and feeling the palpable tension in the air. Now imagine being able to study this environment in-depth, uncovering the hidden patterns and unspoken rules that shape healthcare delivery and interprofessional collaboration. This is the world of hospital ethnography, a powerful research approach that offers unique insights into the complex ecosystem of hospitals and healthcare settings.

In the increasingly complex web of modern healthcare, where multiple professionals collaborate to provide patient care, understanding the nuances of interprofessional interactions is crucial. Hospital ethnography is a valuable tool for unravelling these complexities, allowing researchers to observe and analyse how different healthcare professionals—doctors, nurses, therapists, social workers, and many more—interact, collaborate, and navigate their shared workspace. This approach provides a rich, qualitative understanding of the human experiences and social dynamics that influence interprofessional care delivery, offering a window into healthcare environments that goes beyond statistics and clinical outcomes to reveal the heart of collaborative patient care. This blog post explores how hospital ethnography can inform and enhance interprofessional care research and practice.

What is Ethnography?

Before diving into hospital ethnography specifically, let’s understand what ethnography is. Ethnography is a research method rooted in anthropology that involves immersing oneself in a particular community or environment to study its culture, behaviours, and social interactions. Ethnographers aim to understand the world from the perspective of those they study, often spending extended periods observing and participating in the daily life of their subjects. Ethnography has been used to study various settings, from remote tribes to urban neighbourhoods. Its strength lies in its ability to uncover the nuances and complexities of human behaviour that other research methods might miss.

Hospital Ethnography and Interprofessional Care

Hospital ethnography applies the principles of ethnographic research to healthcare settings. It involves researchers spending time in hospitals, clinics, or other healthcare environments to observe and analyse the interactions, practices, and cultures that shape patient care and interprofessional healthcare delivery. Hospital ethnography allows researchers to observe and analyse how different healthcare professionals—doctors, nurses, therapists, social workers, and many more—interact, collaborate, and navigate their shared workspace. Unlike quantitative health research that might focus on statistics or clinical outcomes, hospital ethnography provides a rich, qualitative understanding of the human experiences and social dynamics within healthcare settings. It can reveal how organisational cultures, interprofessional power dynamics, and everyday routines impact patient and family care and outcomes.

Ethnographic Methods for Interprofessional Care Research

Researchers employing hospital ethnography to study interprofessional care use various methods:

  • Participant observation: Researchers spend time immersing themselves in the hospital environment, observing how different professionals interact during rounds, handovers, team meetings, and other daily activities.
  • Interviews: Both formal and informal conversations with healthcare professionals, patients, and family members offer insights into their perceptions of care organisation and delivery through interprofessional collaboration.
  • Document analysis: Studying team communication tools, care protocols, and policy documents reveals formal structures supporting or impeding interprofessional care.
  • Visual methods: Techniques like photography, illustration, and mapping of physical spaces where interprofessional interactions occur can uncover how aspects of the environment impact collaboration.

These methods allow researchers to capture the nuanced realities of interprofessional care that might be missed by quantitative approaches alone.

Areas of Focus in Ethnographic Interprofessional Care Research

Hospital ethnography is particularly valuable for exploring several critical aspects of interprofessional care:

  • Patient experiences: How do patients navigate the hospital system? What shapes their perceptions of care?
  • Team dynamics: How do different professionals negotiate their roles and responsibilities within care teams?
  • Communication patterns: What formal and informal communication channels exist between professions, and how effective are they?
  • Power relations: How do hierarchies and professional identities influence collaborative care practices?
  • Learning and knowledge sharing: How do professionals from different disciplines learn from and with each other in practice?
  • Patient involvement: How are patients and their families integrated into interprofessional care processes?
  • Organisational culture: What unwritten rules and norms govern interprofessional hospital life?
  • Impact of technology: How do medical technologies shape interprofessional practices and patient and family care?

Challenges and Ethical Considerations

While hospital ethnography offers valuable insights, it also presents unique challenges in the context of interprofessional care research:

  • Access and trust: Gaining permission to observe interprofessional care interactions in sensitive healthcare environments can be difficult.
  • Regulatory approvals: Researchers must navigate strict ethical guidelines and procedures to protect incidental overhearing and capturing of patient and family information.
  • Navigating multiple professional cultures: Researchers must build trust and rapport with various (sometimes competing) professional groups simultaneously.
  • Confidentiality in team settings: Protecting the privacy of individual professionals while studying team interactions requires careful consideration.
  • Reflexivity: Researchers must be aware of their own professional backgrounds and biases when interpreting interprofessional dynamics.

Benefits for Interprofessional Care Research and Practice

Despite these challenges, hospital ethnography offers numerous benefits for advancing interprofessional care:

  • Identifying barriers to collaboration: Ethnographic observations can reveal subtle obstacles to effective teamwork that may not be apparent through other research methods.
  • Informing interprofessional education: Insights from hospital ethnography can guide the development of more effective interprofessional education programs by providing illustrative case studies and real-life examples.
  • Improving team-based care models: By understanding how interprofessional teams function in real-world settings, researchers can propose evidence-based improvements to care delivery models.
  • Informing health policy: Ethnographic insights can guide healthcare reforms and policy decisions around workforce planning and reorganisation of care.
  • Enhancing patient-centred care: Ethnographic approaches can illuminate how interprofessional dynamics impact patient experiences and outcomes.

Real-world Application

A classic hospital ethnography conducted by sociologist Charles L. Bosk examined how surgical residents learn to manage medical errors. His work revealed the complex social processes involved in error recognition and correction, influencing how hospitals approach patient safety and medical education.

An example of hospital ethnography in interprofessional care research is the work of Rick Iedema and colleagues, who used video-reflexive ethnography to study and improve team communication in emergency departments. Their research not only revealed communication patterns but also engaged healthcare professionals in collaborative analysis and improvement of their own practices.

In intensive care units (ICUs), Andreas Xyrichis and colleagues applied hospital ethnography to understand how doctors and nurses negotiate their professional roles in three intensive care units (ICUs) in the UK. The research reveals that in these high-pressure environments, the traditional boundaries between doctors and nurses can blur, particularly when senior nurses leverage their in-depth patient knowledge to influence medical decisions. The study found that while junior staff often adhered to conventional hierarchies, more experienced nurses and doctors worked collaboratively, especially during urgent situations. This dynamic reflects a more fluid division of labour, shaped by both the urgency of patient needs and the experience levels of the professionals involved, challenging the idea that each profession works within fixed, separate domains.

The Future of Hospital Ethnography in Interprofessional Care Research

As healthcare policy worldwide continues to emphasise team-based care approaches, hospital ethnography will play an increasingly important role in interprofessional care research. Emerging trends include:

  • Integration with improvement science: Combining ethnographic insights with quality improvement methodologies to enhance team performance.
  • Exploration of virtual care teams: Studying how telemedicine and digital health technologies are reshaping interprofessional collaboration.
  • Focus on patient and family engagement: Examining how patients and families can be more effectively integrated into interprofessional care teams.

Conclusion

Hospital ethnography offers a unique and valuable approach to understanding and improving interprofessional care. By illuminating the complex social worlds within healthcare settings, it helps researchers and practitioners see beyond surface-level interactions to the deeper dynamics that shape collaborative care.

For those engaged in interprofessional care research and practice, embracing ethnographic approaches can lead to richer insights and more effective strategies for enhancing team-based care. As we continue to strive for more integrated, patient-centred healthcare systems, hospital ethnography will undoubtedly play a crucial role in guiding our understanding and improvement of interprofessional care.

As patients, healthcare providers, family members, or simply concerned members of the public, we all have a stake in improving our healthcare systems. By supporting and engaging with hospital ethnography research, we can contribute to creating more effective, compassionate, and patient-centred healthcare environments.

Disclosure statement

No potential conflict of interest was reported by the authors.

Further Reading

For those interested in exploring hospital ethnography and its applications in interprofessional care research, consider these resources:

  • Goldman et al n interprofessional communication during discharge processes
    • Goldman, J., Reeves, S., Wu, R., Silver, I., MacMillan, K., & Kitto, S. (2015). Medical residents and interprofessional interactions in discharge: An ethnographic exploration of factors that affect negotiation. Journal of general internal medicine, 30, 1454-1460. Access Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579221/
  • Gurtner et al on interprofessional consultations, communication and interactions in a psychiatric hospital
    • Gurtner, C., Lohrmann, C., Schols, J. M., & Hahn, S. (2022). Shared decision making in the psychiatric inpatient setting: An ethnographic study about interprofessional psychiatric consultations. International Journal of Environmental Research and Public Health, 19(6), 3644. Access Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8954628/
  • Iedema & Xyrichis on video-reflexive ethnography
    • Iedema, R., & Xyrichis, A. (2021). Video-reflexive ethnography (VRE): A promising methodology for interprofessional collaborative practice research. Journal of Interprofessional Care, 35(4), 487-489. Access Link: https://doi.org/10.1080/13561820.2021.1943124
  • Leslie et al on how health information technology influences clinical relationships
    • Leslie, M., Paradis, E., Gropper, M. A., Kitto, S., Reeves, S., & Pronovost, P. (2017). An ethnographic study of health information technology use in three intensive care units. Health services research, 52(4), 1330-1348. Access Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517684/
  • Xyrichis, Lowton, Rafferty on accomplishing jurisdiction in ICU