health

Attaining Humanity

DANNY MILLERThank you very much, indeed. I’m really delighted to be here and to meet this community. I hope that this will be the start of an engagement. As I think it’s sort of clear, I am a pretty academic anthropologist. That makes me a bit anxious, because I do remember going to something a bit like this a long time ago, and the keynote was this kind of academic anthropologist. It was very much this sense of they were standing there and it was like what they had done was so important and so kind of profound. Yes, there were these people doing this kind of more applied work. Well, I suppose you’ve got to do something for a living, but with all of these theories, you know, we can help you do this kind of thing.And when you actually look, I think these days the work of the kind of people who stand up and say that, I would actually say that they’re the kind of theoretical academic work going on in the social sciences today—it is actually increasingly problematic. I think an awful lot of it is very pretentious; it’s very...

What We Talk about When We Talk Data: Valences and the Social Performance of Multiple Metrics in Digital Health

BRITTANY FIORE-SILFVAST and GINA NEFF Data as a discursive concept in and around data-intensive health and wellness communities evokes multiple social values and social lives for data. Drawing on two years of qualitative, ethnographic observations, participation, and interviews in these communities, our work explores the gap between discourses of data, the practices with and around data, and the contexts in which data “live.” Across the communities of technology designers, “e-health” providers and advocates, and users of health and wellness data, we find that tensions emerge not around the meaning or legitimacy of particular data points, but rather around how data is expected to perform socially, organizationally and institutionally, what we term data valences. Our paper identifies data valences in health and wellness data, shows how these valences are mediated, and demonstrates that distinct data valences are more apparent in the interstitial interactions occurring in the spaces between institutions or among powerful stakeholder...

Human API as a Research Source in Health Care

KNOWL BAEK, KYLE DUKE, ROY LUO, MONICA LEE and ANIJO MATHEW This paper illustrates how the concept of “Human API” can help cancer post-treatment cancer patients with challenges they face once they are released from the hospital. The results and implications of this semester long graduate project will help illuminate how the Human API through its various data collection methods could potentially play a larger role in extended cancer care. The research will also attempt to determine if hyper-connected networks of individual patients could become effective sources of information for health institutions to engage and connect with patients after treatment or surgery....

Implementing EMRs: Learnings from a Video Ethnography

ERIK VINKHUYZEN, LUKE PLURKOWSKI and GARY DAVID This yearlong video ethnography of a healthcare clinic that transitioned from a paper process to a scanning solution documents in detail how the new technology impacted different groups in the clinic. While the scanning solution reduced the retrieving, filing, and paper-processing work for the Medical Record clerks, the ethnographic analysis showed that it also eliminated some of that work’s tangible benefits for providers. Ultimately, the scanning solution resulted in a shift in the division of labor in the clinic from Medical Records to the healthcare providers who were burdened with additional administrative tasks. Indeed, the scanning technology did not make the clinic more efficient overall, as the number of patient visits per day remained the same....

Opting Out Of Stasis: Using Integrated Techniques to Create Sustainable Change and Renewal in Healthcare Organizations

LINDSEY MESSERVY and BETH WERNER In recent times, hospitals and healthcare organizations have become more accepting of using human-centered approaches, including ethnography, to lend insight on how to prevent risk, increase efficiency, improve staff experience, and advance delivery of care. But often times, these approaches lack the tools and techniques needed to carry these insights to implementation. This paper identifies and reflects on the hurdles that make change and innovation difficult and how the integration of practices, such as quantitative, co-creative, and change management, with ethnographic methods can help facilitate responsive and sustainable transformation in healthcare organizations....

Mobility is More than a Device: Understanding Complexity in Health Care with Ethnography

TODD S. HARPLE, GINA LUCIA TAHA, NANCY VUCKOVIC and ANNA WOJNAROWSKA This case study on mobility in health care demonstrates how ethnography and design research helped Intel meet the business challenge of redressing market share. Ethnography enabled the team to assess the interplay between mobile devices and other hospital technologies, understand how they fit within or subverted existing practices, and document positive and negative features of the technology. Our deliverables not only answered the direct business question, but also expanded the scope of possible solutions....

A Case for Ethnography in the Study of Corporate Competencies

CHRISTIAN MADSBJERG, MIKKEL KRENCHEL, MORGAN RAMSEY-ELLIOT and GITTE HESSELHOLT In business thinking, ‘core competencies’ have long been seen as the critical factor that distinguishes great from good. Great companies have strong core competencies that they constantly leverage and develop. On the other hand, companies who do not understand their own strengths and weaknesses cannot execute at the highest proficiency. Their growth initiatives fail, not because they lack commercial potential, but because they fail to apply the same due diligence to their competencies they so naturally apply to their finances. Understanding competencies entails understanding culture, and few companies know how to approach this topic beyond the gut feel analyses of executives or the rare employee survey. In this paper, we use a large-scale study for the medico company Coloplast as a case for how to use ethnography to rigorously study competencies and leverage growth. We show how understanding the effects of culture and competence on market performance...

Limitations of Online Medical Care: Interpersonal Resistance and Cultural Hurdles in the Face of Technological Advances

PENSRI HO In 2009, a health care service organization in Hawaii launched a online medical consultation program intent to serve the needs of clients in rural Oahu and the neighboring islands, which faced increasing shortages of primary care clinicians. Patients could go online for medical advice from on-call Hawaii based clinicians. However, physicians and statewide medical agencies were critical of the program due to ethical concerns, medical licensure and insurance coverage, and deviation from socio-cultural practices specific to Hawaii. This empirical paper traces and examines the legal and medical ethics of telemedicine in the face of Hawaii's socio-cultural orthodoxy of interpersonal engagement and obligation called the ohana (Native Hawaiian for “family”), and the implications for telemedicine as a medical care resource for the state and nationally....

“Out of the Labs”: The Role for Ethnography in Guiding Clinical Trials

YOSHA GARGEYA and MADS HOLME Ethnography and clinical research appear fundamentally disparate, even conflicting. Their very objectives are dichotomous – the latter moves molecules ‘from the lab to consumer market’ in controlled environments, while the former studies the uncontrolled environment of everyday life. However, with the new reality of pharmaceutical research and development, companies are urged to look into new ways of delivering impact and value to payers, prescribers, and users. This paper explores how ethnographic research can fill that role in early stages of pharmaceutical clinical trials, challenging current paradigms of method as well as parameters for success – and how bridging methodologies can open new avenues for ethnographic practice in business....

Putting Mobility on the Map: Researching Journeys and the Research Journey

SIMON ROBERTS This paper, based on a fieldwork conducted with community transport projects in rural Ireland, examines the place of mobility in the lives of older people. It uses the idea of journey to explore what mobility means to older people, what the research made visible to a diverse range of project stakeholders and to reflect on the nature of ethnographic projects in industry settings. For passengers, the journeying is often as important as the destination – travelling creates visibility of countryside, community and communion with others. For project stakeholders, the research encouraged a view of mobility that transcends travel because it highlighted the world beyond the bus. For researchers, the project created challenges to the dominant view of technology for ageing-in-place within their own organization. Finally, reflections are made on industry ethnography as a journey with often unknown destinations....

The Secret Life of Medical Records: A Study of Medical Records and the People Who Manage Them

NATHANIEL MARTIN and PATRICIA WALL A study of the practices surrounding paper medical records captured key aspects of the work necessary to support this crucial element of health care. It uncovered work that was invisible to the nurses and physicians who use the records. This invisible work comprises tasks necessary to find and deliver the records as well as those necessary to ensure that the records are accurate and up to date. This study was undertaken because medical records are undergoing a transition from paper to digital systems, which will impact the practices of users of these systems at all levels, including clerical and medical staff. This is an area of particular interest to our organization as we look to provide technologies and services that enable seamless integration of paper and digital worlds. New technologies and practices will need to be developed to accomplish what is now being done invisibly....

The Invisible Work of Being a Patient and Implications for Health Care: “[The Doctor Is] My Business Partner in the Most Important Business in My Life, Staying Alive”

KENTON T. UNRUH and WANDA PRATT In a distributed system of care, patients shuffle among many clinicians and spend the majority of their time away from the treatment center. Although we see the results of patients’ work (e.g., medication taken, arrived at appointment) we do not see the work itself. By failing to see this work, industry overlooks issues with vital implications for their business. To lift the veil of invisibility from patients’ work, we conducted a longitudinal field study to uncover the invisible work breast cancer patients do to obtain information, bridge inter-institutional care, manage dependencies and resolve inconsistent recommendations. In this paper we provide detailed examples of this work and explore the impact on patients and health-care operations; identify patterns of work with implications for patient-centered research and design; and propose common information spaces to improve patients’ work through designs that highlight dependencies, preserve state information, link recommendations to justifications,...