An ever existing issue in relation to conducting (good) qualitative research is the question of how to gain access. It is a question of how to get access to organizations, people and thus ultimately access to data. The question that is always on the
researchers’ mind is how to get into the “engine room” and study “real” people, processes, interactions, practices etc. in the natural setting and preferably not to influence too much on the situation in question.
Hastrup (1992) writes that in the world of science reflexivity has in term been seen as a problem and at times as the solution to solving scientific dilemmas, and when working in the field, as an anthropologist reflexivity is an unavoidable/inevitable part of the praxis.
"It is a condition embedded in the anthropological project" (Hastrup, 1992, p. 53) Even though this dissertation is not officially termed an anthropological project the active participation of the writer and the demand for ongoing reflexivity vis-a-vis colleagues
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and the organization as such, de-facto creates a chain of anthropological moments that it could well be described as such.
The gathering of data through open interviews is by its very nature anthropological in approach. It is not just a matter of obtaining factual data from an informant, but rather an opportunity together with the interviewee to work through a slice of reality to create a coherent and joint understanding. In this process the reflexivity is essential.
"Reflexivity requires attention to place of both subject and object, and in addition one’s own place in the communication. Reflexivity in anthropology is in other words not a question of examining how 'I' am, but about how the interaction between the
anthropologist and the others influence the empirics of which both are a part.", (Hastrup, 1992, p.54)
My entire stay at Sundhedsplatformen has been characterized by the reflexivity described above. In the beginning I saw it as a problem. I asked myself how this could ever become proper science with myself right in the middle of things? However, by acknowledging the inevitability of reflexivity in scientific process it has become clear that the periods where I was ‘just’ working in the team - as one of the guys - in fact has provided me with invaluable insights and understanding of the world of clinicians that I could not have obtained in any other way. I have become an insider and gradually became one of the experienced colleagues. Someone to go to with questions that required an extended, historical knowledge of the project and the project organization.
Researchers influence on the situation they study. No matter if it is the doctor’s
consultation (Silverman) or the humble huts of North-Atlantic islanders (Goffman). The presence of a researcher and of any other actant influences a situation. Kirsten Hastrup addresses this sublimely in “Det antropologiske project”.
Unlike many other researchers, ‘getting access’ was a negligible problem in my case. By the very nature of the agreement made between the researcher, CBS and the two regions access was de-facto granted from the start and I was given largely free hands to design my research while acting as communication consultant in the project.
The agreement between CBS and the two co-funding regions identified two main areas of responsibility to be handled in duration of the PhD. On the one hand I was assigned as the in-house communication consultant for Sundhedsplatformen. This job consisted of
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supporting the organization with all communication related tasks, including text writing, analysis and general communication consulting / advising in the program. Gradually this part of the job came to include a wide range of general organizational function including e.g. practicalities in connection with events and meetings. As a result of this position, learning about doctors, nurses and secretaries to a lesser degree became a matter of studying them, but rather a matter doing work with them and produce materials directed at them. I would not sit a distance and observe them doing their work and subsequently try to decipher meanings. I was colleague and work in the project as a communication consultant required quick development of a sensibility to characteristics of clinicians. An example of the required sensitivity dates back to 2013 and early 2014 when a number documents were published from the region talking about the
‘Production’ of the hospitals, meaning e.g. the number patients handled during a specific period. Many clinicians reacted negatively to the concept of ‘Production’ when
articulating what happens at hospitals. In their view the work involved curing and caring for patients and it seemed like a degradation if it was simply seen and talked about as
‘production’. In contrast to the view of the clinicians, talking about ‘production’ makes good sense to administrators. On higher levels of administration, hospitals are
organization to be managed by non-clinicians like any other organization. Coming from a non-clinical background – perhaps a business school - talking about ‘Production’ is not laden with negative or inhuman connotation. It is simply what large organizations do. It is a good example of the importance of choosing concepts, metaphors and images of organizations (Morgan, 1986) carefully in order to convey messages as intended and not e.g. invoke negative responses.
During the entire three years I have been an integrated member of the organization and in time becoming one of the ‘old’ team members with extended organizational memory.
As such I have enjoyed the organizational status of an insider, quite similar to the
position of full-fledged organizational member, described by Gioia and Chittipeddi in the classic 1991 study. My position as an insider “provided formal legitimacy as well as access to informants and information that enriched the ethnographic effort” (Gioia &
Chittipeddi, 1991, p. 437). In the case of this dissertation the appointments were made in advance and were de-facto in effect when I stepped into the organization. While at the same time I have been able to venture into the field wearing the ‘researchers hat’
and thus only to a lesser extend been seen as the errand boy of top management. A
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continuous effort has been made not misuse this dual position. It has been essential not to betray the confidence of the interviewees, which is e.g. done by never disclosing names of interviewees to the management of the project. While conducting interviews I have always informed the interviewees of the dual role and asked for permission to record interviews.
The special status of Sundhedsplatformen as a strategic regional project in Capital region has also made it reasonable and perhaps even expectable that some kind of research is conducted in order to examine organizational readiness and implications of the project.
The sheer size of the project and implication in the health sector in the region it could be considered negligent not to have a research dimension included. As an interviewee explained my participation in the project – as a researcher – was an indication of the significance of the project and how things were different in this project (Doctor 1 [41]).
It was however in the role as communication specialist that many organizational members came to know me. I was e.g. on stage representing the communication
strategies of Sundhedsplatformen. Many organizational members probably did not know of my PhD-role. To sum up I have on the one hand I have acted as the researcher from CBS. There has been no secrecy about this but it has on the other hand not been advertised widely. On the other hand, I have been the in-house communication specialist.
An inherent ethical concern of the dissertation is related to situations where I have had casual conversations with colleagues and only later realized the significance of what was said. At the time it may just have been lunch-time talk that the time appeared to be irrelevant to my research. When the episode late in the research was recalled and documented in a memo, the ethical concerns related to using knowledge obtained without prior agreement was handled by anonymizing the interviewee, department and other aspects that might compromise the interviewee.