Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery

BACKGROUND: The ability to capture the complexities of healthcare practices and the quick turnaround of findings make rapid ethnographies appealing to the healthcare sector, where changing organisational climates and priorities require actionable findings at strategic time points. Despite methodological advancement, there continue to be challenges in the implementation of rapid ethnographies concerning sampling, the interpretation of findings and management of field research. The purpose of this review was to explore the benefits and challenges of using rapid ethnographies to inform healthcare organisation and delivery and identify areas that require improvement. METHODS: This was a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Mixed Methods Appraisal Tool to assess the quality of the articles. We developed the search strategy using the Population, Intervention, Comparison, Outcomes, Settingframework and searched for peer-reviewed articles in MEDLINE, CINAHL PLUS, Web of Science and ProQuest Central. We included articles that reported findings from rapid ethnographies in healthcare contexts or addressing issues related to health service use. RESULTS: 26 articles were included in the review. We found an increase in the use of rapid ethnographies in the last 2‰years. We found variability in terminology and developed a typology to clarify conceptual differences. The studies generated findings that could be used to inform policy and practice. The main limitations of the studies were: the poor quality of reporting of study designs, mainly data analysis methods, and lack of reflexivity. CONCLUSIONS: Rapid ethnographies have the potential to generate findings that can inform changes in healthcare practices in a timely manner, but greater attention needs to be paid to the reflexive interpretation of findings and the description of research methods. TRIAL REGISTRATION NUMBER: CRD42017065874

What is not, but might be: The disnarrated in parents' stories of their child's cancer treatment

The study of illness narratives is based on the premise that stories are told for a reason and storytellers make narrative decisions on what to include and leave out of a story, the style of narration, the place where the story is told and the audience. Through this narrative work, they situate themselves in particular ways and make sense of the illness and the world around them. In this article, we explore the disnarrated, a style of narration that features events that do not happen, but are nonetheless referred to in the story. The aim of the article is to illustrate the additional layers of meaning that can be uncovered from illness stories when attention is paid to what did not happen, but, yet, is still part of the story. We draw from a qualitative study carried out with 17 parents whose children were diagnosed with cancer and were receiving medical care in Argentina. We carried out narrative interviews with the parents and participant-observation in hospital areas and the hotels where they resided during treatment. The analysis of the interview transcripts was carried out using a holistic understanding of the narratives and focusing on the identification of themes that appeared disnarrated. The fieldnotes from the observations were used to contextualize the narrative analysis. The disnarrated, in its many manifestations, produced a layer of analysis of parents' stories of treatment patterned by parents' desires, hopes and fears. The disnarrated was used by parents to discuss alternative care trajectories and express fears regarding what the future would bring for the child and family. The disnarrated is a useful analytical tool for examining illness stories as it points to storytellers’ views of what is acceptable or desirable in their world and their hopes and preferences for alternative realities.Fil: Vindrola Padros, Cecilia. University College London; Reino UnidoFil: Brage, Eugenia. Universidad de Buenos Aires. Facultad de Filosofía y Letras. Instituto de Ciencias Antropológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Can We Re-Imagine Research So It Is Timely, Relevant and Responsive?; Comment on “Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to ‘Re-Imagine’ Research”

Partnerships between academic institutions and healthcare organisations have been proposed as an effective way to integrate academic research findings into changes in health policy and practice. Bowen and colleagues explore these partnerships from a different angle, analysing them in relation to the experiences of health system leaders. The authors made a call to re-imagine research, rethinking how we train applied health researchers, fund health research and evaluation and design studies and collaborations with the health sector. In this paper, I respond to this call by discussing three strategies we can use to make sure our research is timely, relevant and responsive to the needs and context of healthcare organisations: the widespread use of rapid research approaches, the integration of scoping stages in all studies, and the training of applied health researchers to work in the health system and develop collaborative relationships with staff

A Cautionary Tale: The ‘New’ Medical Tourism Industry in Argentina

Argentina’s universal model of healthcare and open immigration policies make it a popular destination for people from neighbouring countries requiring free medical treatments. These medical tourists come from Bolivia, Peru, and Paraguay. They are often from low-income households and rural areas, and travel to Argentina seeking medical attention in public hospitals because they are unable to pay for services in their own countries. In addition to these patients, current governmental-private sector agreements are being put in place to attract patients from the US and Europe. This new initiative – called Medicina Argentina (Argentina Healthcare) – hopes to raise the number of foreign patients from 6000 per year to 100,000. In theory, this change in government policy seeks to: provide services to patients who might not be able to access them in their own countries (due to high cost, unavailability, or long waiting lists), increase Argentine tourism income, and improve the quality of the medical services available for local populations. However, in practice, it will mean that an already overburdened healthcare system will have to adapt to suit the needs of short-term, medical tourists. The flow of foreign patients will interact with local migrating patients to create a tiered system of medical tourism, posing ethical and legal challenges in the distribution of scarce resources and regulation of medical care. In this article, I explore the ethical and practical impact of this “new” medical tourism industry on the care provided to the local population

The Early Neolithic 'Broken World': The role of pottery breakage in south-eastern and central Europe

One of the most materially evident yet socially obscured aspects of modern consumer society has been the increasing accumulation of broken objects considered as ‘waste’ or ‘rubbish’. During the Neolithic period, central and south-eastern Europe were also to witness an unprecedented explosion of material remains, mostly pottery fragments, that would affect the social lives of local inhabitants, referred to as the Linearbandkeramik (LBK) and Starčevo-Körös-Criş (SKC) groups respectively. However, because of our modern tendency to write (pre)history in stages of technological development, the Neolithic is conventionally characterized as the moment where humans became masters over nature. Thus, it is emphasised that sedentism, agricultural production, and economic innovations like pottery were introduced. In contrast, the redefinition of the Neolithic as a 'thing-heavy world' (Robb 2013) allows envisioning the Neolithic as a world charged with broken objects. As such, this period can inform us of a unique form of knowledge on what people do when objects break. Determining how they were broken and deposited represent a fundamental way to understand this social knowledge. Through the study of the breakage and alteration of pottery fragments by a combination of wear, morphometric and failure analysis I show how breakage actions and broken objects shaped social practices in SKC sites from the Upper Tisza/Tisa Basin (NW Romania, NE Hungary and SW Ukraine), and LBK sites from the Northern Harz Foreland (northern Germany). Results indicate there was a significant variation in social responses to breakage in both regions resulting from the ubiquitous presence, continued exposure and movement of fragments through daily life, as well as from the paradoxical resilience and extensive cracking behaviour of their organic-tempered ceramics. This knowledge brought by living with broken objects marks a stark contrast to present lifestyles, and it becomes clear then that the modern waste crisis signals an epistemological crisis

Perceptual experience and degrees of belief

According to the recent Perceptual Confidence view, perceptual experiences possess not only a representational content, but also a degree of confidence in that content. The motivations for this view are partly phenomenological and partly epistemic. We discuss both the phenomenological and epistemic motivations for the view, and the resulting account of the interface between perceptual experiences and degrees of belief. We conclude that, in their present state of development, orthodox accounts of perceptual experience are still to be favoured over the perceptual confidence view

Advocating for carers: a qualitative study exploring the needs of UK carers of patients with an acoustic neuroma

Research on the impact of caring for patients with an acoustic neuroma is scarce. Findings from 12 interviews with primary carers of this patient population highlight six key themes: life disruption, support, well-being, the carer role, lessons learned and the impact of COVID-19. Carers need more practical information and emotional support, starting from the diagnosis stage through to recovery. Recommendations include routine carer assessments, early signposting to auxiliary services and information materials about recovery. This study contributes to the UK literature gap of this under-studied population and demonstrates the importance of carer assessments, as set out in the Carers Act 2014

Destruction and abandonment practices at La Rinconada, Ambato Valley (Catamarca, Argentina)

Occupation of the Ambato Valley in north-western Argentina ended abruptly in around AD 1200, with destructive abandonment resulting in burnt and collapsed buildings. Analysis of broken pottery sherds from La Rinconada suggests that this may have been the outcome of a deliberate ‘closing’ activity. Re-fitted vessels were found to be largely complete despite extensive fragmentation; two portions of one vessel were 10m apart with a wall in between. Conjoining fragments of other vessels exhibited contrasting effects of thermal alteration, or were associated with lithic objects that may have been used to destroy them, or appeared to have been deliberately arranged. The evidence is altogether indicative of the intentional destruction and deposition of this material immediately prior to the burning of the site

Gender Matters: A Gender Analysis of Healthcare Workers’ Experiences during the First COVID-19 Pandemic Peak in England

The coronavirus (COVID-19) arrived in the United Kingdom (UK) in February 2020, placing an unprecedented burden on the National Health Service (NHS). Literature from past epidemics and the COVID-19 pandemic underscores the importance of using a gender lens when considering policy, experiences, and impacts of the disease. Researchers are increasingly examining the experiences of healthcare workers (HCWs), yet there is a dearth of research considering how gender shapes HCWs’ personal experiences. As the majority of HCWs in the UK and worldwide are women, research that investigates gender and focuses on women’s experiences is urgently needed. We conducted an analysis of 41 qualitative interviews with HCWs in the British NHS during the first peak of the COVID-19 pandemic in the Spring of 2020. Our findings demonstrate that gender is significant when understanding the experiences of HCWs during COVID-19 as it illuminates ingrained inequalities and asymmetrical power relations, gendered organizational structures and norms, and individual gendered bodies that interact to shape experiences of healthcare workers. These findings point to important steps to improve gender equality, the wellbeing of healthcare workers, and the overall strength of the NHS

What does 'learning' and 'organisational learning' mean in the context of patient safety? Protocol for a systematic hermeneutic conceptual review

Introduction: Learning is essential for improving patient safety and is often cited as necessary following a patient safety incident (PSI). Both individual and organisational learning are needed to enable improvements in health systems. However, there is no clear consensus on what ‘learning’ or ‘organisational learning’ actually means in the context of a PSI. Learning theories can be applied to healthcare in order to improve patient safety interventions. In this systematic hermeneutic conceptual review, we aim to define learning and organisational learning in the context of patient safety and to identify the theoretical approaches to learning and interventions utilised. / Methods and analysis: This review will be undertaken in two phases, utilising a systematic hermeneutic approach. Phase one will focus on ascertaining taxonomy domains through identification of the concept and theoretical frameworks of ‘learning’ and ‘organisational learning’ from the literature. These taxonomy domains and the World Health Organisation’s World Alliance for Patient Safety International Classification for Patient Safety will inform a thematic framework for phase two. Phase two will be a more detailed search and focus on learning and related applied interventions in the context of patient safety incidents utilising the thematic framework from phase one. Data will be analysed using framework method analysis. / Ethics and dissemination: This review does not require ethical approval. The results will be published in a peer-reviewed journal