Studying technology use as social practice: the untapped potential of ethnography
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Studying technology use as social practice: the untapped potential of ethnography Trisha Greenhalgh* and Deborah Swinglehurst
Abstract Information and communications technologies (ICTs) in healthcare are often introduced with expectations of higher-quality, more efficient, and safer care. Many fail to meet these expectations. We argue here that the well-documented failures of ICTs in healthcare are partly attributable to the philosophical foundations of much health informatics research. Positivistic assumptions underpinning the design, implementation and evaluation of ICTs (in particular the notion that technology X has an impact which can be measured and reproduced in new settings), and the deterministic experimental and quasi-experimental study designs which follow from these assumptions, have inherent limitations when ICTs are part of complex social practices involving multiple human actors. We suggest that while experimental and quasi-experimental studies have an important place in health informatics research overall, ethnography is the preferred methodological approach for studying ICTs introduced into complex social systems. But for ethnographic approaches to be accepted and used to their full potential, many in the health informatics community will need to revisit their philosophical assumptions about what counts as research rigor. Background ’The existence of the experimental method makes us think we have the means of solving the problems which trouble us, but problem and method pass one another by.’ - Ludwig Wittgenstein, Philosophical Investigations, para 230 [1]. Health informatics - the study of information and communications technologies (ICTs) in healthcare - is a * Correspondence: [email protected] Healthcare Innovation and Policy Unit, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London E1 2AT, UK
rapidly expanding field of research strongly influenced by (though extending beyond) doctors with an interest in computers. It emerged at around the same time as evidence-based medicine (EBM) and overlapped with the latter in several areas of work, notably the development of ICT systems to support large-scale epidemiological surveys and clinical trials; routinization of the use of Medline and other electronic databases; standardization of clinical practice via guidelines and automated decision support; and innovations such as computerized physician order entry (CPOE) aimed at reducing medical error [2-4]. Overall, the health informatics literature is hopeful and technophilic [5]. In this literature, ICTs are typically portrayed as potentially able to [a] incorporate (and thereby drive uptake of) evidence-based protocols and decision support; [b] overcome human failures and idiosyncracies; [c] ensure that clinical information is more complete, accurate and accessible; and [d] improve efficiency of healthcare transactions [6]. Health informatics is built largely though not exclusively on a positivist philosophy, determinist assumptions (that
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