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We read with interest the debate around the use, and representation, of ethnography in the journal following the publication of Lamba et al's article on the identification of patient safety problems during ward rounds.1 In correspondence, Tanisha Jowsey saw the study, which involved observational methods to catalogue safety issues and then applied descriptive statistics as a method of analysis, as misappropriating the ethnographic tradition.2

We share with Jowsey her concerns about the way ethnography can sometimes be used as a label to describe observational studies where, in broad terms, a researcher counts or categorizes clinical activities. It is our view that ethnography is much more than observing. Rather, it is about the type of questions we ask of the social world. We wonder whether such methodological slippage would be tolerated, for example, with trial methodologies where issues of randomisation, power calculations and analytical rigor are heavily scrutinized.

The journal's editors, Dixon-Woods and Shojania, acknowledge Jowsey's critique, and suggest that the methods of ethnography are evolving to reflect the changing demands of health research; where expectations of ‘time in the field’, methods of data collection, and analytical procedure are more pluralistic or ‘loose’.3 We agree entirely with their view that ethnography is not necessarily tied with a given method, such as participant observation, nor a single analytical technique, such as grounded theory; and, like them, we also caution against separating the methodology and methods of ethnography, where ethnographic-like methods are used without consideration of the wider methodological principles. We add to their editorial response by extending the argument for the necessity of maintaining a unified understanding of ethnography as a methodology, a range of field methods, and ultimately an account of the social world.

Thinking about ethnography as a methodology draws attention to the underlying concepts, principles and theories of enquiry, including ontological and epistemological assumptions.4 In its broadest terms, ethnography is concerned with richly describing and, more importantly, explaining the social and cultural organization of ‘everyday life’ for a given community. The concept of culture is especially important where ethnography is usually concerned with the shared meanings, beliefs, practices, rituals, ceremonies, stories and material artifacts that are represented in, and are reproduced by, social life.5 In attending to the social and cultural field of a given community, ethnography is associated with naturalistic and emic enquiry; that is, developing an in-depth, insider's perspective of how local people think, act and organize their lives. At the same time, the researcher's ethnographic ‘sensibility’ or ‘imagination’ is integral to asking questions, exploring possibilities and developing explanations.6 Through these enquiries, ethnography engages with and, in due course, develops relevant social science theory as a basis of explaining the observed patterns of social activity.4

In line with such methodological considerations, ethnographic field methods must be capable of bringing to light the social and cultural organization of everyday life. This is often associated with sustained periods of participant or non-participant observation, where the researcher develops a ‘rich description’ of how local people make sense of and order their lives. Often, it may involve use of other qualitative methods, such as interviews or documentary analysis, but as the journal editors indicate, the ethnographic toolkit is not confined to qualitative methods (or even observations), and can draw on a diverse range of sources.5 Importantly, however, the methods of ethnographic research should not be de-coupled from the underlying methodological principles. The use of observational methods, even over a sustained period of time, does not necessarily mean that a study is ethnographic if, for example, it does not seek to understand how local meanings and practices reflect and reproduce the wider social and cultural field.

Finally, ethnography can also be seen as an account or analysis of a given community at a particular time and place.7 This account must succeed in detailing the local meanings and practices and the cultural field and aspects of social organization from which more conceptual or theoretical explanations might be developed. It is important to acknowledge that the representation of ethnography is not fixed or prescribed, and often the large volume of field data is difficult to communicate in journal papers, leading to selective use of illustrative data. Although the sensibilities and position of the researcher are central to all aspects of the research process, it is especially critical during the process of writing, where the author's decisions and viewpoint should become clear to provide the reader with greater confidence in the account being developed.8

From our perspective, it is important not to separate the methodology and methods of ethnography, or indeed to undermine the ultimate goal of developing an ethnographic account. We are sympathetic to the debates emerging within the journal and highlight a tension between ‘purists’ and ‘pragmatists’, but we emphasise that the use of ethnographic-like methods, such as observations, does not necessarily qualify a study as ‘ethnographic’ or that they produce an ‘ethnography’. Increasingly health services research requires timely, multi-site, mixed method studies, where the more traditional expectations of sustained period of participant observation may be unrealistic. We see nothing necessarily problematic with using ethnographic methods in more focused or narrow forms, such as ‘deep dive’ observations across multiple organizational sites, but it remains important that the underlying ethnographic methodology and the concern with the social and cultural organization of ‘everyday’ life remain guiding principles of enquiry.