At Xerox’s recent Innovation Day, scientist and user experience designer Ellen Isaacs gave a thoughtful and informative account of her career as a corporate ethnographer at PARC in California. Wholly owned and operated by Xerox since 2002, PARC is dedicated to providing services in open innovation, technology and R&D to organizations across the globe. As a principal scientist at PARC, Isaacs often employs corporate ethnography in order to reach new insights and to better grasp the needs of Xerox’s clients. HealthBiz Decoded spoke with Isaacs about corporate ethnography and her multi-faceted career at PARC.
You’re a self-ascribed ‘corporate ethnographer.’ Can you explain that term and tell us what you do?
Ellen Isaacs: Ethnography is the study of human behavior within a culture, so it’s about understanding how human practices are influenced by the culture people live in. As an ethnographer, I spend a lot of time in the field directly observing people in their natural environments to try to understand how they go about living their everyday lives. My focus is in understanding how they use technology as well as when and why they don’t use technology, with the goal of identifying opportunities for new types of technology that might enhance people’s lives.
How is the concept of corporate ethnography conducive to innovation, compared to old research processes and techniques – specifically, in the healthcare realm?
I think ethnography is especially appropriate for getting ideas for innovation because it helps you see the things that people can’t tell you directly. It would be nice if all we had to do is ask people: “What types of new technology would you like?” But people don’t think that way. People get set in their ways and take for granted that the world around them has to be that way, so they usually just ask for minor improvements on their existing tools and methods. By getting out and watching people, we as ethnographers are able to notice all the ways that people are working around their tools or solving problems without even noticing it. Those gaps or glitches that people work around represent our gateway to innovation because they suggest ways that we can make people’s environments better.
This applies to healthcare just as much as any other domain. That’s the wonderful thing about ethnography. It’s useful in every domain of human activity.
What are some of the most interesting things you’ve discovered about healthcare during your research?
One of the things that fascinated me, but sadly, didn’t surprise me, [about the project which focused on nurses] was how the electronic medical record (EMR) system, which is supposed to make healthcare more efficient, was not assisting the nurses nearly as well as it could. Although every step in these collaborative processes gets documented, the information is scattered all over this complex EMR application so the nurses have to dig around through dozens of screens that can scroll for many pages to uncover the information they need to know. And if they don’t realize there’s a problem, they don’t know to look. There was no one place to go to see the progress of a task so the nurses can see who had done what, and what more needed to be done.
Our contribution was to recommend a system that would visualize the progress of collaborative tasks. An easily accessible visual representation of task progress would relieve the nurses of the burden of keeping this information in their heads, and it would enable everyone involved to notice when a problem arises and take steps to unblock the process. The charge nurse we spoke with thought this would be especially helpful for her, because she could see when there was a problem with any of her nurses and step in to help.
What is the process of corporate ethnography like – do you start out with a hypothesis, or do you observe without prior prediction?
With ethnography, we don’t go in with a hypothesis but rather a domain of study. Usually someone has an idea for a technology solution or at least a potential problem to solve, and we go in to validate that the problem exists and to help figure out how to solve it. The big advantage of ethnography is that it lets you discover things you wouldn’t have thought to ask or look for. I try to go in with a naïve state of mind so I can see what’s really there and not what I’m expecting or hoping to see.
Our analysis is “bottom-up” in that the data drives the findings, not the questions we think to ask. In the case of the nurses I just described, this open-ended approach is what helped us see that we needed to focus on task coordination rather than planning and scheduling, which had been the original focus.
Are there any ‘downsides’ to this kind of ethnography in the healthcare realm? Do you ever find yourself with too much information, or focusing on problems outside of the realm you meant to hone in on?
There are several downsides to ethnography, which is why we complement it with other methods. One issue is that we can only observe a small number of people, so we have to be careful not to generalize too much from a small sample. This is why it is useful to follow up our findings with broader-scale, quantitative methods. Those methods are not as good at uncovering new opportunities but they can validate that a problem is widespread and worth solving. Also, in corporate ethnography, we don’t have as much time as we’d like to fully understand a domain, so again we have to recognize that we may not have captured all the nuances of the activity. To counteract this, we will often feed back our findings to the people we observed or experts in that field, again to validate our findings and refine our understanding.
As for having too much data, I would say there’s no such thing, but that’s because I love the process of digging into messy qualitative data and figuring out how to organize it in a systematic way that brings out the key insights. I would say it’s common for us to end up focusing on problems outside the expected area, which is one of the great things about ethnography. We do need to address the initial questions we were asked to explore, but we always tell clients ahead of time that we expect to uncover unanticipated findings outside the scope of the original focus area. We often get our best ideas for innovation this way.
What do you love best about working at PARC and specifically, in working with the healthcare innovations taking place at Xerox?
One of the things I love about my job at PARC is that it gives me the opportunity to learn about such a wide range of things. I love that I get to accompany people in their natural environments and see how people live. Basically, I love that I get to be a fly on the wall and see how people do what they do.
The healthcare project was one of my favorites because I got to take it all the way through the process — from observing nurses in their natural environment, to identifying a need, to designing a solution in collaboration with the nurses, to working with engineers to build the technology, and finally testing it with nurses again. It pained me to watch the nurses struggle to find information in the EMR and then blame themselves for not noticing what they felt they should have known. We can do better than that!