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Fieldwork for Healthcare: Building community, building guidance

Key points

  • Fieldwork for healthcare is a very challenging research area, for which there was little support, a gap we have filled.

  • We have made it easier for new researchers and practitioners to do healthcare fieldwork studies by

    • collecting case studies and experiences from international experts, sharing these through a published graduate guidebook;

    • identifying guidance and strategies for overcoming the problems doing fieldwork for healthcare, writing a second graduate guidebook on this.

  • We have also fostered a supportive international research community in fieldwork for healthcare.

Background
Fieldwork in healthcare involves observing and interviewing clinicians and their patients in often stressful and emotionally charged situations. It involves doing studies in busy hospitals or surgeries, and with ill people in their homes, or as they try to continue normal lives. It is more challenging than fieldwork in other contexts. There are much stricter ethics checks in place, gaining access to hospitals and patients is administratively complex, networking with medical professionals is difficult, and there are challenges in being with vulnerable patients in often very sensitive situations. Researchers face a very steep and frustrating learning curve when trying to engage in this area. Few resources described the challenges or gave support in how to do this kind of research, however, a gap we have now filled.

Sharing the challenges and successful strategies
From our own field studies in healthcare we gained experience of the problems and learned how to overcome many of the challenges. Rather than only focusing on our own experiences, we brought together a team of international experts. In doing so we identified complementary stories, broadened our perspective and showed the lessons could be generalised. For example, we found interviews extremely hard to schedule with nurses in intensive care, but this was similar to other clinicians in other areas of the hospital, so adaptations included noting down questions you could not ask immediately and interviewing clinicians between tasks. Also, researchers would adapt their methodology to avoid lengthy ethical approval processes - in the UK you do not need ethical approval through the healthcare system if you are interviewing staff outside of NHS premises. Excited by our shared experiences, we decided to share our findings with the wider community, so that other researchers can benefit, making the area easier to engage with, and ultimately we hope leading to more and better research in the area.  

With the wider group we first collaborated on a paper and organised a workshop to develop a graduate guidebook on doing fieldwork in healthcare. We edited 12 workshop papers into a set of case studies in the first book. A second book giving specific guidance, was then also co-authored by the workshop participants. One, an associate professor in the US, has said that it was the best workshop she has participated in. We created a website hcihealthcarefieldwork.wordpress.com/ for the workshops and books. To promote them and connect with more people interested in fieldwork for healthcare, we invited people to follow our blog posts from the website for a chance to win one of the books. Over 150 interested people now follow the blog.

The books are starting to be used in practice. As of March 2015, we know that a lecturer from a Computer Science and Engineering department in California has added the books to his class’ reading material, as has a lecturer in Health Informatics from UCL. The 2014 case studies book has been downloaded over 270 times and the 2015 guidance book over 160 times (see the latest figures here). Feedback about the books has been positive. For example, a clinical researcher from Sweden, who was not involved in the workshops, has said they found the books “really clear, helpful and accessible.”

A follow-up workshop, focusing on the role of theory when conducting situated studies, led by Kate Sellen (OCAD University, Toronto) was held in 2014. Members of CHI+MED were both on the organising committee and participated. The work also led to Furniss hosting an American Medical Informatics Association Evaluation Webinar in March 2015 with 23 attendees. One attendee then invited him to co-author a chapter on frameworks for evaluating health information technology. CHI+MED has also hosted visitors from Penn State, Johns Hopkins, University of Maryland at Baltimore and UHN Toronto with a shared interest in conducting situated studies in healthcare.

This work has, thus, led to both useful resources and CHI+MED nurturing a supportive network and wider research community in fieldwork for healthcare.

Publications
Blandford, A., Berndt, E., Catchpole, K., Furniss, D., Mayer, A., Mentis, H., O’Kane, A., Owen, T., Rajkomar, A. & Randell, R. (online first). Strategies for conducting situated studies of technology use in hospitals. Cognition, Technology & Work.

Furniss, D., O’Kane, A., Randell, R., Taneva, S., Mentis, H. & Blandford, A. (Eds.).  (2014). Fieldwork for Heathcare: Case studies investigating human factors in computing systems [Volume1]  Morgan & Claypool Publishers.

Furniss, D., Randell, R., O’Kane, A., Taneva, S., Mentis, H. & Blandford, A. (Eds.).  (2015). Fieldwork for Healthcare: Guidance for investigating human factors in computing systems [Volume2]  Morgan & Claypool Publishers.