Friday, 25 October 2013

There's doing ethnography and then there's Doing Ethnography: Things I have learned from my time in the field. By Tim Banks

Over the last year, I have been conducting field work for my PhD. It has been an ethnography in two hospital settings in order to understand patient experiences of acquired brain injury in terms of identity and rehabilitation and how this matches up to the biomedical model of patient organisation. Well, that’s not quite true. I have actually observed several settings in two hospitals, often frantically writing down as much as I can, whether it is describing a complete ward evacuation or counting the number of pieces of masking tape attached to the floor (used for physio therapy sessions). I’ve observed patients, health care professionals, carers, people who I initially thought were professionals but were actually patients and people who…well I never found out exactly who they were.

Image of Brain from Wikipedia

Just before entering the setting, the usual blind panic of realising that I would be actually conducting the type of research that I had read and thought about doing for so long hit me. Initial anxieties were compounded by thoughts of how being known previously by some of the participants in the research (I used to work at one of the hospitals) impacted on my position to conduct meaningful research.

Having been required to obtain NHS ethical approval prior to beginning the study, it meant that I had plenty of waiting time in the 1st year of my PhD to reflect and (over)think this dilemma. When I finally entered the field it soon became clear that the experience was going to unfold in none of the ways that I had expected.

As I look to leave the field at the end of the year, I have begun to consider what I have learned from this experience. I have drawn up a short list of the things which I would like to have known (or would like to have remembered having been told), or things that I did not expect when I first started out. I’m not sure if these might be “hospital specific” or whether they are applicable to any large institution or workplace or just any place! In no particular order:

1)    Things take much longer than you expect!
I spent several days, even weeks, waiting on emails from various middle managers to get final permission for me to research their particular domain. After a week, I often rung to find out they are on annual leave for a fortnight. Then I would call two weeks later to discover they will be on night shifts for the next week and are unlikely to pick up messages. I would call again a week further on to find they have left their post or on long term sick leave and it will be a month before cover is found. (In one instance there were 3 people who left the position in 1 year!) This brings me to point 2.

2)    Official protocols are not always that official!

Once in the field, it was quite useful to see when things should be followed to the letter and when I could “try my luck” (a useful phrase to hide the term “cheeky”.) Having had the experience mentioned above in the first hospital, after a much shorter period, in the 2nd site, I popped to the office of the appropriate person on the off chance of catching them. In explaining who I was, it transpired that she had read my email and forgotten all about it. After a 10 minute chat, I started my research on the ward the following day!

3)    The important people are not always the most important people!
Or more accurately, it is those people who are perhaps deemed less important and less powerful who are often the most important. It was not the neuro-consultant who I needed to be in with (despite the official protocols), but her secretary who is in charge of arranging (and delaying) any meetings! She was also the person who was able to let you borrow the photocopier!

4)    It’s all about performance!
In keeping with the above (and in true Goffman style) the way I presented myself went a long way to getting results (or not!) This is a precarious activity and one false move could have isolated me altogether. However I did find that when I was going over and beyond the call of duty in regards to being accommodating and forgiving every time something wasn’t done, I became considered as someone that could be considered trivial.

After three consecutive weeks of catching two buses to get to a pre-arranged meeting, confirmed that morning, only to find it had been cancelled, I became very frustrated (though I did meet some lovely people on the bus.) Thus, when I began fieldwork in the new setting, I acted with more sense of purpose. I explained what had been agreed for the research and ensured it was adhered to throughout (within reason). As long as this was done politely and with tact (my research isn’t the most important thing gone on in an ABI acute ward!) people didn’t seem to mind. When all is said and done, I did have a right to be there and I had a rather lengthy NHS ethical approval form that said so!

5)    Don’t assume people care who you are!

Having gone to some lengths to gain access to the field setting, I could be forgiven for thinking that this rather exclusive, private sphere would continue to keep up the surveillance when I was actually in the field. In a hospital this might appear obvious. However, this idea soon disappeared when I arrived on the ward, sometimes having forgotten my ID card and no-one really questioned why I was walking around talking to numerous people and reading various files. As long as I wasn’t reading the file anyone else needed, or wasn’t sat in someone else’s seat, I was largely left alone. Maybe I was doing point 4 very well! This did however pose some problems. How long could I leave it till I did speak to the person I had seen every day for the last four weeks and how were they going to react when they realised I wasn’t the medical student/relative/neurosurgeon who they assumed I was?

6)    Don’t assume people don’t care who you are!
Similarly, I could turn up to the same setting 5-6 times in a row to find that I had to explain who I was, what my research was and (a particular favourite!) what I want to do for a career after, with the same professionals every time I saw them! Without fail, on every occasion my answers were met with the same look of genuine surprise!

7)    Seize every opportunity - even the ones that look pointless!

This rule is in the theoretical armoury of any good ethnographer. However when you have made concrete arrangements, you have particular ideas of how the research will be conducted and you are aware of the limited time available, and therefore it is all too easy to forget this. However, as time went on and I loosened up a bit, I found it easier to ask if I could “tag along” to various groups and session in the hospital. Some of my most useful data came from these sources. This is a combination of points 2 and 4 I suppose!

8)    You will never be able to log everything!
Doing ethnography is a very exhausting experience. Who would have thought that “looking at stuff” can be so demanding! I found that by having a two hours on/half hour off policy, I was able to really concentrate and then recharge the batteries to go again. I might always miss some golden nugget of information but hopefully this method reduces those chances. Even if I didn’t take a breather, so much goes on in a hospital that I would have had to focus on one particular aspect or conversation with the hope of catching another aspect on a different occasion. On-going analysis helps with this of course, as does experience whilst instinct and luck cannot be underestimated either!

9)    Know when you’ve looked at a certain setting for long enough!

Again, we are all aware of ideas about saturation etc. and I never thought I would be one of those who found it hard to leave a particular setting. However, when I look back, there are certain “comfortable” settings which I could probably have left far earlier but simply found myself enjoying it too much. As a result, now I am finding myself doing intense field work in certain settings that had been left under researched. Perhaps it’s human nature to veer towards pleasant experiences and avoid ones we find difficult!

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