Table 3.

Ethnographic methodology and its relevance to healthcare improvement

Ethnographic methodology used	Description	Example paper	Relevance to healthcare improvement
Video-reflexive ethnographic study	Collecting in-depth data on intimate or micro-interactions	Patients’ and families’ perspectives of patient safety at the end of life: a video-reflexive ethnography study. (Collier, Sorensen, Iedema, 2016) [32]	• Able to capture complexity in delivery of healthcare. • Irrefutable basis for improving healthcare delivery from the 'bottom up' • Video footage played back to participants. • Video footage challenges the taken for granted aspects of practice individuals may not be aware of
Peer ethnography	Peers collecting data from excluded or vulnerable populations	Using Peer Ethnography to address health disparities among young Black and Latino men who have sex with men. (Mutchler et al., 2013) [33]	• Improves access to marginalised groups • Data collection on healthcare topics that may only happen between peers (for example, discussions about substance use with men who have sex with men)
Focussed ethnography	Focus on a discrete community or organisation or social phenomena; problem-driven	Culture of Care for Infants with Neonatal Abstinence Syndrome: A Focused Ethnography. (Nelson, 2016) [34]	• Method often used in nursing research • Intense, short-term observation and interview data collection provides rich and thick description of culture of care • Rapid feedback loop into improvement through focus and insider status
Critical ethnography	Projects with vulnerable populations and/or political improvement agendas	Nursing casualization and communication: a critical ethnography. (Batch and Windsor, 2014) [35]	• Method gives focus to power, communicative distortions and context • 'Critical' element turned the focus to structures and situations of power and dominance that underpinned nursing culture
Institutional ethnography	Research studying complex social issues and projects that aim to achieve meaningful social change at the nexus of health professions education and other social systems	Homelessness, health, and literacy: an institutional ethnographic study of the social organization of health care in Ontario, Canada. (Hughes, 2018) [36]	• Insights to explicate the complex and invisible relations that exist being people, place, and things. • Powerful tool to explore the multi-layer entity of health care
Qualitative methodology incorporated into ethnographic studies
Grounded theory	Researcher co-constructs theories with the research participants, building the theory de novo from iterative data collection	Using an emic and etic ethnographic technique in a grounded theory study of information use by practice nurses in New Zealand. (Hoare et al., 2013) [37]	• Focus on theory generation supports generalisability of healthcare improvement recommendations • Incorporating of grounded theory techniques such as memoing heightens reflexivity [38] • Gives priority to the studied phenomena rather than the study setting
Thematic analysis	Flexible qualitative analysis method of deriving themes from data through systematic coding procedures	Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame. (Armstrong et al., 2018) [39]	• Findings are (potentially) accessible to different audiences due to thematic presentation • Allows analysis of observation and interview data from a diverse sample of organisations • Can thematically explore people's views as well as see what they did in practice