Introduction
For over two decades, social scientists have been responding to calls to improve understandings of the role played by context and culture on clinical practice in acute care environments.1 2 Social scientists have also been identified as critical contributors to public health emergencies, adding value by assessing social, economic and political factors as these shape responses to emerging public health crises across low-income and middle-income country (LMIC) and high-income country (HIC) contexts.3 4 A Wellcome Trust report recently recommended ‘fully integrating social science into epidemic preparedness and response’,5 with the World Health Organization (WHO) describing this integration as both a method to ‘build institutional and Member States buy-in and capacity’6 for health emergencies, and an essential component of the current ongoing global response to COVID-19.7 This paper describes the theoretical foundations, deployment and outcomes of an interdisciplinary team of social scientists formed from Organisational Sociologist (OS) ethnographers and Human Factors (HF) experts, working with Infection Prevention and Control (IPC) specialists and other clinicians as part of a Canadian province’s COVID-19 response.
Working in HICs, organisational sociologists and other ethnographers have provided nuanced analyses of how quality and safety policy is generated,8 interpreted9 and implemented10 inside the organisations of acute care. Specifically, ethnography11 and HF12 have been broadly employed to support quality improvement (QI) and patient safety in HIC clinical environments. Where ethnography is a fully social scientific discipline pursuing ‘thick descriptions’ of social action,13 HF is a specialty with roots in engineering, design and psychology that concentrates on identifying and remediating human limitations and characteristics as they affect the performance of tasks, processes and systems.14 15 HF incorporates knowledge from the biological and social sciences, with specialists in HF employing these approaches not just to study how humans use ‘anything and everything’, but to ease and optimise that use.16
The 2014 Ebola outbreak in West Africa focused both the ethnography and HF community’s attention on integration as a potential benefit to affected communities, and to response organisations themselves.17 18 Although there was an initial lack of clarity as to what OS, anthropologists and other ethnographers could contribute, discussions eventually led to the creation of innovative research platforms, including the Ebola Response Anthropology Platform (ERAP).19 20 Focused on how culture shapes the uptake of, or resistance to, public health policy, this research has tended to focus on LMIC contexts, or vulnerable populations in HIC contexts. The Ebola response similarly stimulated HF research and optimisation work with strides made in the effective use of personal protective equipment (PPE) and improvement of organisational responses.21 This applied research in the context of an outbreak saw IPC specialists—physicians and nurses with backgrounds in infectious diseases (ID) and limiting the transmission of pathogens—working alongside HF experts and clinicians to deliver practical recommendations aimed at optimising ease of use, workflow and safety.
Despite this progress, the simultaneous integration of OS, HF and IPC insights into organisations involved in epidemic preparedness and response was limited until the arrival of COVID-19. More importantly, response organisations tended to ‘slot’ social scientists into the role of cultural brokers, rather than direct contributors to health system response processes. The case study we report here illustrates a novel trend towards positioning interdisciplinary teams of these experts as ‘situated intervenors’ embedded in and directly contributing to health system response processes.
In this paper, we describe early progress and contributions made by a team of OS ethnographers, HF specialists and IPC experts carrying out ‘situated interventions’, which is to say, studying and feeding findings back into the health system in the HIC context of Alberta, Canada.22 Recognising that a ‘disease outbreak is no place to begin to negotiate disciplinary differences’,3 this multidisciplinary group was in contact well in advance of COVID-19. Our QI-focused ethnographers knew and had worked with our IPC professionals in the past, and indeed co-wrote the grant that would fund the present work. Similarly, our ID specialists had spent considerable time during the Ebola outbreak working alongside our HF colleagues, and recognised the added value of integrating OS, HF and IPC perspectives into clinical practice—particularly during health emergencies.21 23
Our work is grounded in the Wellcome Trust report’s observation that a ‘key aspect of saving lives during an infectious disease epidemic is the effective generation and use of contextual information and knowledge that can guide adaptive planning, agile decision-making and more effective interventions’.5 In this way, we are using our ongoing work as a case study, to describe the specifics of how health systems and emergency responders might leverage social science to improve the quality and safety of their pandemic responses and communications. The design and execution of our work, then, is a pragmatic effort to merge the traditions of public health focused and acute care focused social science.