By Dr Maria Quinlan, Research Lead, ARCH
Over the past several years much of my research at ARCH has focused on the people and culture aspects of successfully scaling digital health within healthcare organisations. As I touched on in a previous blog post, the importance of positive staff morale within healthcare is recognised as a key factor in spreading best practice innovation and has been found to be positively correlated with patient outcomes.
There is broad agreement within the improvement science and implementation science literature that the organisational context is key to the sustainable adoption and scaling of connected healthcare processes and technologies. There is also agreement that the assessment of so-called ‘cultural-readiness’ for digital health is therefore a vital first step in any implementation. So how do we do this? – one potential approach which I have been testing out recently is the use of a method called photovoice.
As the name suggests photovoice uses photography as a means of giving voice to people’s experience. It is a relatively simple method, whereby we work with a group of people whose experiences we want to understand at a more nuanced level. We provide them with cameras and ask them to take and caption photographs related to a particular issue we want to explore. It is a method which has its roots in social activism and traditionally has been used to give voice to those who are disempowered, marginalized, unheard in society. It has been used widely as a method to explore the experiences of healthcare service users, but rarely as a tool to capture the experiences of those providing care.
In describing the philosophy behind the method, the creators Dr Mary Ann Burris and Dr Caroline Wang say that photovoice;
“..does not entrust cameras to health specialists, policymakers, or professional photographers, but puts them in the hands of children, rural women, grassroots workers, and other constituents with little access to those who make decisions over their lives”
However one only has to listen to Dr Paddy Barrett’s Doctor Paradox podcast, read the Irish Times ‘A Nurses’ World column’ or follow ‘Faceless Junior Doctor’ on twitter (@IRE_FJD) to realise that clinicians can feel disempowered too. In my own research, observing and talking with clinical hospital-based staff, I’ve found it be a consistent theme – particularly when it comes to large scale transformation projects which they often have little control over, but which have the potential to change fundamentally how they do their jobs.
As the health services move towards more patient-centred models of care which include significant eHealth-related transformations to how services are delivered, we need to understand the cultural context within which these changes are taking place. We also need to understand how clinicians, and non-clinical administrative staff, view and feel about these changes.
Participatory methods such as photovoice serve a two-fold purpose – firstly they allow us to explore and assess the organisational cultural context while secondly giving power and voice to those expected to innovate and/or change. Participatory research methods by their nature seek to empower and engage participants and thus I believe they can be used as a key tool in engaging health care employees in the sustainable adoption of connected healthcare processes and technologies.
There is a growing movement towards using photovoice as a tool at an organisational level to investigate phenomenon such as culture, climate and engagement. For example it has been used to explore health care employees’ perceptions of patient-centred care within the US Veteran Affairs health care system. This study found photovoice to be perceived very positively by participants as a tool for exploring their experiences and satisfaction within their workplace.
Creating space for health care professionals to share their stories, fears, concerns, and hopes is key to achieving healthcare innovation and transformation. Photovoice gives us a potential method to do this – capturing invaluable clinical-user insights and engaging clinicians in the process of change.
 For example, the Institute for Healthcare Improvement’s ‘Joy in Work’ initiative http://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx; Barsade, S. and O’Neill, O. (2014) ‘What’s love got to do with it? A longitudinal study of the culture of companionate love and employee and client outcomes in a long-term care setting’ Administrative Science Quarterly Vol. 59(4): 551-598
 Wang, C. Burris, M. (1997) ‘Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment’ Health, Education and Behaviour Vol. 24 (3)
 Catalani, C., & Minkler, M. (2010). Photovoice: A review of the literature in health and public health. Health Education & Behavior, 37(3), 424-451. Han, C., and Oliffe, J. (2016) Photovoice in mental illness research: A review and recommendations. Health Vol. 20(2) 110-126
 Day, D. Ed. (2014) The Oxford Handbook of Leadership and Organizations. OUP, New York
 Balbale, S., Turcios, B., LaVela, S. (2015) Health care employee perceptions of patient-centred care – a photovoice project. Quality Health Research, 25(3): 417-425