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Integrating cognitive ethnography and phenomenology: rethinking the study of patient safety in healthcare organisations

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Abstract

While the past decade has witnessed a proliferation of work in the intersection between phenomenology and empirical studies of cognition, the multitude of possible methodological connections between the two remains largely uncharted. In line with recent developments in enactivist ethnography, this article contributes to the methodological multitude by proposing an integration between phenomenological interviews and cognitive video ethnography. Starting from Schütz’s notion of the taken-for-granted (das Fraglos-gegeben), the article investigates a complex work environment through phenomenological interviews and Cognitive Event Analysis, drawing on distributed cognition and embodied cognitive science. The methodological integration is illustrated through the study of an adverse event in a highly specialised medical ward. Starting from a nurse’s task of administering medicine to a patient, the analysis tracks how a distributed cognitive system in the ward handles an adverse event where a pill becomes contaminated. The analysis demonstrates how complex decision-making processes depend on agents’ micro-scale embodied coordination, on their engagement with the material environment, and their anticipation of other agents’ intentions. It is concluded that ethnography can accommodate both cognitive and phenomenological research aims, while also contributing to the important mission of understanding successful responses to adverse events in healthcare. The article further contributes to patient safety studies by demonstrating how safe medicine administration itself can lead to increased risk, hereby pointing to a problem of incompatible safety logics as a source of medication errors in healthcare.

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Notes

  1. In Høffding and Martiny (2016), the first tier of the phenomenological interview is the generation of interviewee descriptions of lived experience. In the second tier, the descriptions are analysed using phenomenological methods (Gallagher and Zahavi 2012, chap. 2) to produce generalized knowledge of subjectivity as such.

  2. In the selection process, Ryan consults Alba multiple times, thereby creating a closed-loop between the selection and the validation because Alba falsifies candidate pills during the selection. For reasons of length, we do not analyse this specific dynamic in detail.

  3. This is well-known from optical illusions that use distortions in the background to trick the perceiver into seeing something as bigger or smaller than it is.

  4. We are grateful to two anonymous reviewers for pointing out these issues of cost-benefit.

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Acknowledgements

This research is part of the SimLEARN project that investigates adverse events in two Danish hospitals and experiments with simulation training of human factors to avoid error. The project is funded by Hospital Sønderjylland Aabenraa, the Free Research Fund at Odense University Hospital, and the University of Southern Denmark. Data management infrastructure is provided by OPEN (Open Patient data Explorative Network) at the University of Southern Denmark.

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Authors and Affiliations

  1. Centre for Human Interactivity, Department of Language and Communication, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Malte Lebahn-Hadidi, Lotte Abildgren & Sune Vork Steffensen

  2. Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark

    Malte Lebahn-Hadidi & Lotte Abildgren

  3. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Lotte Abildgren & Lise Hounsgaard

  4. Danish Institute for Advanced Study, Odense, Denmark

    Sune Vork Steffensen

  5. Center for Ecolinguistics, South China Agricultural University, Guangzhou, People’s Republic of China

    Sune Vork Steffensen

  6. College of International Studies, Southwest University, Chongqing, People’s Republic of China

    Sune Vork Steffensen

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  1. Malte Lebahn-Hadidi
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Contributions

All authors contributed to the study conception and design. Data collection was prepared by all authors and performed by Malte Lebahn and Lotte Abildgren. The first draft of the manuscript was written by Malte Lebahn and all authors has commented on and edited versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Malte Lebahn-Hadidi.

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Lebahn-Hadidi, M., Abildgren, L., Hounsgaard, L. et al. Integrating cognitive ethnography and phenomenology: rethinking the study of patient safety in healthcare organisations. Phenom Cogn Sci 22, 193–215 (2023). https://doi.org/10.1007/s11097-021-09780-9

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