Hospital Experience

Exploring the experience of hospital patients and staff.

Summary

When: September 2013 - August 2014

Where: King's College Hospital, London

Research Tools: Ethnography, Interviews

As part of my PhD thesis, I conducted exploratory interviews with patients and staff to find out about their experiences at King's College hospital creating an ethnographic account of the intersection of the hospital experience in people's daily lives. This exploration opened up a user-centered understanding of public health provision in London which informed the research design of the final project.

Background

When London hosted the Olympic games in 2012, the opening ceremony included a lengthy segment about the National Health Service (NHS). This is evidence that the NHS is more than just a health service. For British people, the NHS is also a significant part of British culture and a source of national pride. I wanted to discover how people experience this powerful national and cultural symbol on a daily basis, both as patients and staff.

Exploring the hospital

"Meaning is what makes experiences valuable. Constructions of shared meaning include artifacts that embody meaning and rituals that transmit meaning." - Natalie Nixon

Unlike most research on healthcare which is focused on the provision of public health, I was interested in the NHS as a place that creates meaning in people's daily lives. In order to explore this, I deployed two research techniques: indepth interveiws and ethnography. Becasue the NHS is such a huge institution, I selected a single location, King's College Hospital, as my site for exploring the NHS

Interviews

I solicited interviews through contacts and by placing flyers around the hospital. I recieve responses from a variety of types of people associated with the hospital, inlcuding:

  • Patients
  • Doctors
  • Nurses
  • Administrative staff

The interviews were loosley structured. I asked people to relate a story about their visit to the hospital. The loose, general nature of the interviews prompted interviewees to choose experiences that had been meaningful for them. I recorded the interviews, typed transcripts, and then highlighted themes common to interviewees.

What I found was the boundaries of the hospital were very fluid. The stories I heard often wove in and out of the hospital at several points. For patients, the hospital site became an extension of their domestic and personal lives. For staff, the hospital was part of a longer story of learning and professional development. For both patients and staff, the hospital was a site where rituals of caring are performed.

Ethnography

In order to get a deeper understanding of these rituals, I approached the hospital ethnographically by volunteering to work in a clinic assisting patients. While volunteering, I took notes about the interactions of patients and staff as they waited for appointments paying particular attention to sources of stress, anxiety, and conflict. I also recorded my own interactions and the moments I found painful or challenging.

I found:

  • An elaborate administrative system
  • The system was not explained to patients
  • The system was not understood by patients
  • Waiting patients recive little regular information

Hospital staff are very busy dealing with a high volume of patients and do not have the time to explain the system to every patient. This, coupled with a lack of information updates tends to make patients anxious.

Conclusion

Interviews and ethnography showed me both the important role that the hospital can play in daily life, but also the anxiety that it can produce. It was clear that much of this anxiety was because of the 'ritual' of administration itself. This led to an obvious question: could the ritual be improved?

In order to understand this question, it was necessary to design a new research tool, one that makes the link between artefacts and ritual more apparent. An account of this research tool is given here.

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