The Politics of Health Services Research: Health Professionals as Hired Hands in a Commissioned Research Project in England

By Simon Dyson (De Montford University) and Sue Dyson (Middlesex University)

Have you ever seen an early production line in action? Although these systems increased production, they did so at the expense of the quality of the experience of the workers, who were positioned at the bottom of the occupational ladder. The workers then had no say over the flow and pace of work. They had no voice in the organisation of work, nor any view of the overall wider picture into which their contribution fitted. Early studies in the sociology of work suggested that, in such circumstances, we should expect the following. Workers will do the minimum work possible to get by. They will not care about the quality of work they produce. They will not use initiative to solve any problems. Work will be undertaken resentfully, or else some will delight in finding creative ways to deliberately undermine the work processes.

 A US sociologist, Julius Roth, considered these ideas in the light of his experiences as a hired data collector on big research projects.  He suggested that research workers – whom he called “hired hands” – behaved in the same ways as disenchanted production line workers: they did not care about the quality of the data they produced, just so long as they did sufficient to stay out of trouble with their line-managers. When we were commissioned by the Department of Health to undertake a large health services research project we anticipated that the 300 or so midwives who would be collecting data would be put in this same “hired hands” position. From their point of view midwives had no say in the topic that was being researched, which concerned pregnant mothers being screened to see if they were genetic carriers of two inherited chronic illnesses, sickle cell anaemia or thalassaemia.  They had no voice in the design of the study, no say in the analysis of data, no role in how the study was written up and no influence on what policy might be implemented as a consequence of the findings.

Because we realized the invidious position the midwives were being placed in, we tried to ensure they could see what was at stake for them (briefly: complex and emotionally difficult work in probing the ethnic and family origins of a mother to ascertain if she was at risk of carrying genes associated with sickle cell or thalassaemia, emotional work that was far more difficult and time-consuming than either policy-makers or their managers were prepared to allow);  we also tried to ensure their time was fully paid for, and that they were given an overview of where their work in collecting data fitted into the overall policy issue being researched.

Despite our best efforts, the midwives collected only 25% of the data they were paid to collect. Managers and policy makers responded with naïve anger: “give me their names” said one.  Rather than blame midwives who were feeling overworked and put-upon, we tried to understand what was happening sociologically, using the sociological concept of ideal types. In the article, we refer to different styles of adapting to demand of data collection over which they had little say or formal control. These terms were Repairers (the demands for data collection disrupted their work but they adapted both processes to try to make it work as best they could in difficult circumstances); Refractors (as often as possible, they would creatively use adherence to formal rules of their usual work procedures as a basis not to collect data) and Resistors (those who actively opposed the research but could/would not directly challenge their managers, and so used appeals to broader contexts to avoid collecting data). Managers did not challenge this evasion as they feared that midwives would move jobs and leave the service even more short-staffed than they already were. Although we paid research funds to cover the work of the midwives, these monies were not always passed on by the health organizations concerned, and this lack of financial transparency was also used by the midwives to justify their resistance.

Some sociologists have tended to reject all large scale research because of this “hired hands” problem.  A current problem is that this model of research, in which ordinary nurses or midwives collect data for a project run by a medical researcher, is characteristic of much health services research. Put bluntly, much health services research would be of little value if it relies on data collected by workers who have no say over the process, no stake in the results, and who are denied any vision of where their efforts fit into an overall picture.

 In our report to the commissioners, rather than either hide these problems (the reaction of many medical studies we feel) or rejecting results outright (the reaction of some schools of thought within sociology) we characterised the practical consequences for the quality of data collected. To take just one example: midwives sometimes did not recruit white mothers into the study (wrongly presuming that sickle cell only affects ethnic minorities, when in fact 1 in every 450 white babies born carries a gene relevant to sickle cell). Rather than ignore this or discount the research entirely as flawed, we tried to use data to estimate how often this occurred and to assess the impact of this on the overall findings and policy recommendations.

The lessons for the hired hand concept in sociology is that it requires refinement to take account of how work hierarchies interact with gender hierarchies  and how contingencies of workplace organization may mean that some workers are required to be busier than others, so that extra work demands the impact upon them differently. The lesson for health services research is that it needs to take account of this phenomenon in the design of the study and in analysis of the results, but above all in the respect with which it treats health workers who collect data.  

 

This is based on Simon and Sue's article published in Sociological Research Online in August 2014. Read the full version here.

Mass Observation as Method

By Emma Casey, Fiona Courage and Nick Hubble

Founded in 1937, Mass Observation has played witness to eight decades of often dramatic social, political, economic and cultural change. It remains one of the most enduring and comprehensive archives to provide rich detail of the intimate and personal ebbs and flows of everyday life. The overwhelming importance of Mass Observation cannot be overemphasized, as Mike Savage remarks in Identities and Social Change in Britain Since 1940, ‘Mass Observation is the most studied, and arguably the most important, social research institution of the mid-twentieth century’ (2010: 57).

The founders of Mass Observation – Tom Harrisson, Humphrey Jennings and Charles Madge – were young radical intellectuals keen to record the hitherto ignored lives and experiences of the working classes. George Orwell in, for example, The Road to Wigan Pier was already producing prolific accounts of working class life that were noted for their focus on everyday and intimate frequently painful experiences of poverty. Mass Observation, as with Orwell’s accounts, became synonymous not only with political radicalism but also radical in the sense that the unrepresentative, qualitative and ‘thick’ description of working class practices stood in opposition to the deductive, statistical accounts and methods that tended to dominate the social sciences. Thus, although Mass Observation shared with early social scientists and critical theorists a commitment to revealing the hidden thoughts and dreams of the masses, Mass Observation dramatically differed in its methodological approach to achieving this. Today, this difference remains stark, with the ‘messy’ and unwieldy data of Mass Observation standing in direct contrast to sociological assumptions about methodological rigour. However, Mass Observation has long been of interest to sociologists, for example at the Birmingham School of Contemporary Cultural Studies whose dual interests in resistance and agency mirrored the approaches of Mass Observation. This is reflected in Stuart Hall’s The Social Eye of the Picture Post (1972) and in Tom Jeffrey’s A Short History of Mass Observation that was published as a CCCS occasional paper.

One of the distinctive facets of Mass Observation is the unique role of the observer both as researcher and researched, archivist and archived. That the observers are part of a collective project is a hugely important feature of Mass Observation particularly in terms of the type of data that is collected. Furthermore, the potential of Mass Observation to provide a reflection of ‘the past’ for future generations of scholars is a theme that runs through Mass Observers’ accounts. Ben Highmore notes the ‘thickly rendered’ and ‘temporal’ atmospheric nature of Mass Observation and remarks that:

‘Mortality, both the finitude of death and the mourning of passing time is a subterranean seam that runs through these documents as correspondents consider their (and others’) past and futures in the context of the ever-changing present.’ (2011, 92)

The papers in the special section of Sociological Research Online have been selected in an attempt to address some of the key methodological debates highlighted here. The papers fall into four key strands, the first of which examines the ‘big’, ‘messy’ and ‘awkwardness’ of the Mass Observation data. In The Materiality of Method: The Case ofthe Mass Observation Archive, Liz Moor and Emma Uprichard observe the peculiarly ‘sensory’ experience of ‘getting dirty with data’ and highlight the unique opportunities that Mass Observation offers social researchers in terms of the materiality of method and the sensuousness of the data.

The second theme is intimacies, the family and personal life. Anne-Marie Kramer’s paper explores the role and status of geneaology in exploring personal and family lives and Mark Bhatti’s paper also connects to this theme by focusing on Mass Observers’ accounts of gardens and gardening.

A third theme addressed by this collection centres around the distinctiveness of the relationship between observers and the data that they produce. Annebella Pollen’s paper considers the complex nature of Mass Observation material and how it is imagined and understood by researchers and contributors alike. In addition, Dana Wilson-Kovacs’ paper considers the use of Mass Observation as tool to aid accounts of the public understanding of science.

The fourth and final theme emerging from the collection relates to the opportunities that Mass Observation offers for producing historical and longitudinal accounts. Emma Casey’s paper traces the relationship of the Archive from its conception in 1937 to its present day incarnation.  Drawing on previously uncovered correspondence between the social researcher and reformer Seebohm Rowntree, his research assistant G.R. Lavers and Tom Harrisson at Mass Observation, Casey shows how this correspondence provides vital information about early debates and uncertainty about the sociological and particularly the methodological potential of Mass Observation. Rose Lindsey and Sarah Bulloch’s paper continues on the theme of Mass Observation as offering opportunities as well as challenges for historical and longitudinal research.

We are very grateful to the contributors to the collection for their hard work in meeting deadlines. We are also optimistic that the collection will continue to reinvigorate sociological interest in Mass Observation and that it will convince readers of Mass Observation’s capacity to permeate the everyday processes and practices through which the social and ‘history’ is continuously made and re-made.

References

Highmore, Ben (2011). Ordinary Lives: Studies in the Everyday. Abingdon, Oxon:

Routledge.

Savage, Mike (2010). Identities and Social Change in Britain since 1940. Oxford: Oxford University Press.