• Medical education
• Social sciences
• Hospital medicine

As a medical anthropologist who has worked in primary healthcare research and medical education for many years, I was delighted to come across a recent article by Lamba et al,1 entitled ‘Identifying patient safety problems during team rounds: an ethnographic study.’ I am currently working on several research projects that involve observing healthcare practitioners in various settings—the clinic, wards, surgical theatres—with a view to applying anthropological methods to understanding the phenomena under observation. It is the term ‘ethnography’ in the title that first captured my attention. Eager to see how other social scientists in the clinical setting had applied ethnographic methods and appropriate theoretical positionings, I began to read. Having reached the end of this short article, I was perplexed. The data collection was observational. The data analysis was descriptive statistics. What is it that makes this piece of research ethnographic? On what grounds might we consider it to be any different from a generic descriptive approach to an observational study? Are all observational studies necessarily ethnographic? By publishing this article that claims to present ethnography, is the BMJ Quality & Safety promoting an idea of ethnography to its readers that is not entirely accurate? There need to be specific parameters met when we profess to using a particular methodology. It is not, in my view, enough to state that an ethnographic approach—or indeed any approach—has been taken without following it up with evidence of such.

Bronislaw Malinowski is a name that features frequently in anthropological education as the father of modern ethnographic methods. He is well known for five ethnographies he published between 1922 and 1935 that each offer a close and in-depth investigation of people's lives as they play out in specific cultural settings (in relation to other people and their environments). Ethnographic methods, as outlined by Malinowski, involve a single researcher documenting people's lived worlds, their meaning-making, their productions and categorisations of knowledge and their interactions with one another. Ethnographic ‘documentation’ may include written, auditory, visual and tactile forms, such as letters, film footage and paraphernalia. Documentation is used to support the meaning-making of the ethnographer about the meaning-making of the people under observation. Woods2 notes that the ethnographic method lends itself to observing the immediacy of people's experiences and ‘seeing into the life of things’. In the last century, ethnography has moved in a few directions. While the normal expectation for ethnographic research remains around 2 years,3 some ethnographers have suggested that ethnography can still be useful when undertaken for shorter periods; that it is not how much time spent but the quality of that time and the intensity of observation that matters.4 Ethnography has also moved into new spaces as anthropologists and ethnographers have revisited how we define culture and how we explore its reach. Where ethnography originated in exploration of the exotic and unknown ‘other’, it can now be used in local spaces, and indeed, in auto-ethnographic modes to understand the self as subject.5 But what is the difference between writing an autobiography or a descriptive piece and something ethnographic? Ortner6 explains that ethnography ‘has always meant the attempt to understand another life world using the self—as much of it as possible—as the instrument of knowing’. Yet it is more than this. It is thick description coupled with theoretical interrogation. Ortner writes, ‘…the ethnographic stance (as we may call it) is as much an intellectual (and moral) positionality—a constructive and interpretive mode—as it is a bodily process in space and time’.6

Lamba et al write that two of the three authors (ARL and KL) had special training in quality and safety but in this article no mention is made of the ethnographic training, or the ethnographic methods or any ethnographic theoretical stance. On these grounds, I suggest that while they may have conducted ethnographic research they have not demonstrated this in their article. The article as it stands, therefore misrepresents ethnography and we the readers miss out on what could have been an exciting, even illuminating, read. By way of comparison, I was delighted to come across Hägg-Martinell et al's7 recent ethnographic study of students on an acute medical ward, which manages to tick all the right ethnographic boxes that I've outlined here.