Did You Say Flexibility? or Rickly's rules of rexibility??

Fellow researchers,

I now am the proud owner of a digital camcorder (very nice blue!) but alas, no one to video. As suspected by those more knowledgeable (i.e. Rickly and my PI, Koerber), the hospitalists do not seem open to being videoed. Undaunted, I have developed several ideas.

When I last posted, I was meeting with the hospitalist coordinator and looking forward to meeting most of the hospitalists at their daily exchange meeting (Wednesday was my day to meet with them). I knew my first challenge with this study was having to introduce myself and "win" over, so to speak, their trust. This challenge has met my expectations.

The hospitalist coordinator spent 1 1/2 hours with me and shared a wealth of information as well as some doubt as to what findings I will discover. Interesting.... He's also director of the ER so he'll bring a very different perspective to the study.

Several areas of research that I'm moving toward within the framework of my IRB:

Because I won't get to examine documentation practices as I had hoped with the "think out loud" protocol, while sitting in on their group one-hour session, I started making notes of topics they discussed and their specific duties within the team. For example, two of the females are hospitalist practitioners (one a general practitioner; one acute care practitioner); one of the hospitalists is the director and one is the quality director (I'm assuming quality control).

As I noted the topics they discussed, one topic discussed over and over centered around Spinuzzi's breakdowns. Using their terminology, the central topic covered interruptions in the practice of medicine as they treated patients. An example of one hospitalist: "I tried to call the cardiologist and keep getting his nurse - I need to talk with the cardiologist and not his nurse. Isn't that why we have their cell numbers?"

Hospitalists have to immediately be immersed with the patient, patient family, primary care physician, specialist, ER if the patient is admitted through the ER, and personnel within the hospital environment. So, my study is moving toward examining the communication between these groups but focusing on the breakdowns.

Also, after sitting in on their group session and listening as they exchanged information concerning 87 patients, I introduced myself to those who had arrived just before or just after the session began and also requested setting up individual interview times. Some hospitalists were on call and needed to immediately leave but handed me their email addresses. However, one hospitalist who is Hispanic introduced himself and said that he would like to visit with me about his challenges in dealing with Hispanic families. He said the culture is very unique. Of course, I wanted to hug him but didn't and am looking forward to our time together. Because I can only cover one project at a time, this conversation may lead to another study. I also realized that I will add some questions to my interviews specifically about cultural differences.

I begin my individual interviews next week.

To summarize, I had to reposition my focus for this study. The unexpected answer to the change came as I was able to observe the group dyamics in their environment (field methods). Also, Dr. Rickly was very instrumental in helping me sort through the process before a possible panic moment!

Debra B.