Surprises in Research - Field Methods

We had great discussion last night about field methods. I realize that some are conducting research through online mediums; however, in my research world I think of field methods as going to the person's world and observing them in that world. I've noticed more than just what they say; I've noticed interactions with others, non-verbal signals. Example, today the hospitalists and practitioners were issues new pagers. These pagers will enable the nurse especially to text the doctor instead of only being able to leave a phone number as in the past. So, the text might say, "results are back for Mrs. Smith" or "family needs to see you" or "cardiologist requests meeting." Sometimes the text allows the physician to not have to call back - they get all the information they need from the text. [more on field methods later]

This week we have had a holiday (today) where I teach which allowed me to get in an extra observation this morning. This is my fifth session with the group. Just to recap--I'm observing the morning group sessions of the hospitalists and one case manager while they review every patient who is a patient of the hospitalist group (approximately 80-100 patients).

Brief history: When I met with the group and introduced myself, I asked to conduct individual interviews with each physician/practicitioner. Many talked to me after the session concluded and gave me their personal email addresses as the preferred method of communication to set up the interview times. Some were interested but have not responded to my email request. I have met with three of the eight.

So, the surprise. After the last two group sessions, I have physicians approach me (I sit at a side table with my laptop and feverishly take notes) telling me that they would like to meet with me and giving examples of why communication is important, what it means to their field, etc. In short, I guess the light bulb is turning on that they see I am passioniate about the field and committed due to the time they see I am spending.

I'm also learning to work within their time constraints. With another study I conducted two years ago, several hospitalists preferred to meet with me after the morning session if they were going off duty. While they were tired, they preferred the morning time slot. This group prefers meeting late afternoon or night because everyone in the session is going on duty. So, they quickly leave to go on rounds as soon as the meeting is over. However, some stay around a few minutes to consult with other physicians and I've been able to ask quick follow-up questions. During these group sessions, I'm taking notes but I don't always understand the full message they are sharing with the group. I'm able to use 1-2 minutes to ask the physician if they can further explain what they mentioned in the session.

As I'm more and more accepted in the group, many are more willing to answer those types of questions. I've noticed this mostly through their body language. At first, I might ask a physician to clarify a statement and they would hold the door open [ready to leave mode] and briefly give me minimal information. Today, the physician pulled up a chair, sat down beside me, and shared more than I needed to know!

Like Rob mentioned in his posting, I'm needing a break from my data collection and will move to literature review and then come back.

Debra

Gathering Data....The Many Challenges

This morning I completed my third observation session of the hospitalists' routine morning group meeting. The purpose of the group sessions is for each physician to hear/share a brief summary of each patient's status. The sessions cover anywhere from 80-100 patients. (according to the medical director). The doctors sit around a huge conference table, each has a copy of the list of patients. I found a place to sit at a side table where I can also use my laptop. I realized early on that there was no way to hand write the information. Of course, some docs are more animated than others; some share their feelings for all to see, whereas some are very soft spoken and it seems these docs goal is to communicate with the least amount of words (mostly acronyms!).

In our jargon, I'm taking field notes - observations - of communication between doctor/doctor; reports of doctor/patient and doctor/specialist and sometimes doctor/family. The doctors are also slowly accepting me. While there has never been any hostility, at first I was invisible. Now, some are coming by my area and talking, asking questions, explaining statements made. In short, I'm not having to ask them for their time, they're giving me short segments of time (30-60 sec) that have been invaluable. (I'm not timing them - just want you to know that the discussion isn't lengthly by any means.)

My challenge is:

• until I pull out the right info from the notes, the info isn't valuable - what that information is at this point is still unknown
• medical terms are difficult and they share them so quickly that I don't want to miss the point of their stories because I don't "get" the medical connection
• tying in what I've gathered to a create/write a paper - I'm still see fragments of information

Last--I took Spinuzzi's advice and started transcribing after our session last week. I had let three 45 minute sessions accumulate, so it was time to transcribe. I've had some humorous moments while transcribing. The medical director has a very soft, quiet voice. I kept pushing the recorder closer and closer to him during the interview. So, I usually don't transcribe using earphones, but I've had to with his tape. I have it turned up so loud to hear his voice that when I transcribed my question I was so loud that it may have caused hearing loss :) The really funny moment was when his pager went off during the interview - on the tape, it was so loud that my dog started barking (keep in mind that I was listening with earphones and he heard it that loud.) Oh my - where's my grant money so that someone else can do this fun job?

Debra

Research Journey continued....influences of Spinuzzi

I have attended one morning patient information session and conducted two interviews. I am waiting on two more hospitalists to determine an interview time.

As I mentioned in an earlier post, my intention was to divide my research into two parts: interview session and observation session (this one video taped using a think out loud protocol). The observation session isn't going to happen on this project because the coordinator is very hesitant about my videotaping anything. So, making the most of the situation, I'm conducting interviews but also decided to explore the breakdowns in communication. I would gather this data from observing their group sessions as the hospitalists discuss each hospitalized patient and what has happened in their care in the last 24 hours.

My second interview (on Friday) was with the medical director of the Hospitalist Program and this interview was incredibly rich in information, largely because he was very open, honest in the interview. (I would add VERY soft spoken and so transcribing the interview is not going to be enjoyable.) In my encounters with physicians, their number one concern is how much time will I need - how much time will they have to set aside. One of the goals of the interview time with the director was to ask if I could sit in on multiple group sessions in order to research breakdowns. His question back to me: "Will this involved additional time on the part of the hospitalists?" When he found out that I would be able to observe them and not take up any additional time, he said he would definitely consider the request. I'll be following up with him next week.

For my project, I may only be able to focus on information gained from personal interviews. I hope to begin observing the group sessions but will continue those for several months. The hospitalists who are present are the ones on call, so I want to observe multiple times with multiple hospitalists (not the same hospitalists each time I observe). Each session discusses 85-100 patients, which is the number I was given as the lowest and highest number typically hospitalized in any given day.

After Spinuzzi (sounds like life before and after reading his book :), I realized that I will need to document the history and context of each breakdown. As a researcher entering the medical world, I'm also keeping in mind that asking about history, context are sometimes very sensitive issues because they bring to the forefront egos, lack of patient concern, etc. that the profession typically doesn't like to talk about.

The two phrases that both hospitalists shared - a hospital needs physicians who are willing to "play well together" - the good 'ole sandbox analogy!

Debra