Changing practice in a hospital setting can be difficult – fraught with a list of barriers that are uncovered throughout the process. Solving the barriers of today simply reveals the new barriers of tomorrow. A new research methodology, PRECESS, developed by a team of researchers from the US Healthy Children Project, and piloted by Healthy Children Project (USA), Karolinska Intitutet (Sweden), Karolinska Hospital (Sweden) and the Egyptian Lactation Consultant Association (Egypt), uses ethnographic methods combined with hands-on expertise to drive lasting change. PRECESS stands for Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success.
The PRECESS methodology expects sustainable change in a short period of time, only five days. The PRECESS methodology provides an opportunity for clinicians who are experts in the new technique to work in a practical manner side-by-side with the staff of the changing hospital for a limited amount of time. The hospital staff at the changing hospital then have the responsibility to continue the new process. During the time together, the PRECESS team uses video ethnography and interaction analysis, combined with expert education and practical application of the new knowledge, to document the work practice in the hospital, and to assist the staff in seeing their own work via interaction analysis, and to identify the barriers and solutions that, by necessity, would be unique to their situation.
A key component of this method is the basic assumption that the members of the site are the experts of their environment – not the outside experts who are brought in. Although these external experts have vital information about research, experience and practice, as well as all aspects of the PRECESS method, it is the hospital staff that are the experts in their hospital – it’s practice, history and people. The change needs to grow from within the already existing environment in order to succeed. External experts can offer information, but in order for that information to be integrated into the hospital’s practice for long term success, the grounding of the material needs to be integrated by the staff. This was achieved through the use of practical education combined with ethnography, video and workshops.
Ethnographic Research in Maternal and Child Health – Chapter 3 – Work Practice Ethnography: Video Ethnography in Maternity Settings
written by Kajsa Brimdyr