Research program
The communication of knowledge.
Ethnography of knowledge in diverse institutional and organizational settings
University Co-ordinator
Università degli Studi di TRENTO -
SOCIOLOGIA E RICERCA SOCIALE - TRENTO(TN)
Research Unit Leader
Giolo FELE
Description
The Trento unit will analyse the communication processes and forms of knowledge that structure work in health emergencies operations centres in various regional operation centres. At the moment, we have access to the operations centre of Trentino Emergenza 118, which has been in operation since 1993 in the province of Trento. The Trentino Emergenza 118 operations centre is located in Trento and has 48 emergency stations distributed around the province (which has a surface area of circa 6200 square kilometres, much of it mountainous, and circa 478 thousand inhabitants) and a helicopter rescue service based at the G. Caproni Airport in Mattarello, close to Trento. The centre operates around the clock, 365 days a year, and its personnel includes professional nurses and technicians who can be consulted at any moment for medical advice and on organizational and operational problems. In 2002, the operations centre handled 29,606 emergency situations, with an average of 81.1 per day. Other organizations in the country have been contacted. Negotiations are now at an advanced stage with the 118 Foligno – Umbria operations centre set up in March 1999, one of the three centres handling medical emergencies in the region of Umbria (8,450 square kilometres and 835 thousand inhabitants). Access to other organizations will depend on the resources available.What happens when a member of the public calls an emergency number? Who takes the call? What information is required for efficient intervention? How are the resources to deal with the emergency alerted? How are the resources distributed? Who organizes the work of emergency intervention? What is the role of technology in emergency management? What problems arise when organizing the response to the emergency? Can performance be improved? What contribution can the new technologies make to enhancing the efficiency of action? The project intends to answer these questions by examining the organization of work at medical emergency call centres in Italy. Rather than investigating the paper-based norms, protocols or standards on which the provision of emergency assistance is based, the aim of this research project is to examine the actual practices and concrete routines and operations that take place in real work settings. The research will centre on study of social interaction and communication processes in an operations centre. It will use naturalistic methods based on three elements: a broad-ranging ethnography of the setting; study of the communications (telephone and radio) that take place in the operations centre; extensive video recordings of everyday work in the centre. The purpose is to gather data and information which will enable description of good practices in the operators' work and the furnishing of suggestions on how to improve the service. The gathering of materials on the various contexts in which the emergency call centres operate and detailed study of interactions and communications processes will serve to investigate three particular knowledge-related aspects of emergency work.1. The relationship among different types of knowledge. We have said that at least three fundamental types of knowledge are involved in emergency responses to requests for medical assistance. The first type is medical knowledge, which is utilized by the operator during the conversation with the caller. This conversation is a vital part of the emergency because it must enable the operator to determine the urgency of the situation. The operator's knowledge is often in conflict with the ‘profane' knowledge of the caller. The operator must constantly mediate between different types of knowledge, articulating and balancing his/her competence with respect to the caller's. Consequently, the operator must use forms of interrogation shorn of technical aspects, avoid specific terminology, and match the knowledge possessed by the caller. To be noted is that all this takes place in an emotionally charged context in which the communication itself is influenced by factors and variables such as anxiety and agitation.The second type of knowledge is geographical. Knowing where the incident provoking the emergency call has occurred is as important as medical knowledge for the success of the response. To a large extent, this type of knowledge does not require specific technical expertise; but in many cases knowledge of the area, a kind of geographical common sense, is essential for determining where the incident has happened. The operator must constantly deal with a simple and unwieldy cartographic or linear type of knowledge which s/he must compare against first-hand knowledge of the territory in question. In order to identify the location of the incident, the operator can draw on numerous sources, the heterogeneity of which is one of the objects of the Trento unit's research; paper-based geographical maps, electronic maps on the computer screen, information obtained from colleagues and persons on the spot, information available from other institutional actors (the police, the fire brigade, traffic wardens, mountain rescue, etc.).The third type of knowledge concerns the position of the emergency assistance units on the ground and their ability to intervene. This too involves complex work of organizing and assessing information from disparate sources in constantly and rapidly changing circumstances (are other emergency operations simultaneously in progress? have unexpected difficulties arisen? are there exceptions due to the days and hours of the day in which the intervention takes place? etc.). 2. Socialization to knowledge in the management of emergencies. The intention is to analyse the various levels of socialization in emergency work. A first ‘improper' level is that of the relationship between the operator and the caller. The interrogation procedure that the operator uses with the caller can be seen as a form of immediate socialization to knowledge: on the one hand there is a person who knows the medical aspects of the situation, on the other a person who must be instructed during the telephone call in the medical aspects of the case, without the former's specialist knowledge being perceived as a barrier against ascertaining the facts. This is a highly specific form of socialization which serves to establish a common basis on which communication is possible.The second level of socialization is that of the transmission and sharing of important information about the emergency and all other case handled by the operators. The public and collective access to the facts, the decisions taken, the movements of vehicles, the difficulties of the operation, etc., are distinctive features of operations centres. In fact, work settings of this kind are extremely complex, and coordination is essential for the success of emergency operations: coordination of the personnel, coordination between the personnel and the technologies used for their work, coordination between the work group responsible for handling an emergency and the various components of the emergency itself.The third level of socialization is the most common and obvious one of the induction of novices, independently of their formal educations, into the workplace by means of practical apprenticeship in action. This point takes us to the next aspect to be investigated.3. Knowledge in practice. The Trento unit intends to analyse in particular the process of practical apprenticeship undergone by a new operator after the period of formal learning. The novice will be followed step by step through his/her practical learning of routines and knowledge which are only very vaguely related to what s/he has studied in theory. The novice must learn how to operate in practice, in real time, in the actual performance of the action, without being able to stop and start again if s/he commits an error. The settings that we intend to examine are of great interest as regards their practical features because every error, snag or difficulty may be an even serious danger for persons (even a large number of them) and things. Because this is a complex system of management and control of interactions in ceaseless movement, it is susceptible to various kinds of unforeseen problems. The position of the novice will enable the researchers to identify and bring out the body of practical knowledge that the expert operator uses and dispenses without being aware of it, automatically and creatively at the same time, when performing his/her normal everyday work.The Trento research unit will have four main tasks. 1. Undertake close ethnographic observation of the settings where authorization has already been granted, and where problems of privacy had already been discussed and dealt with (signing of a consent form, confidentiality of all sensitive information, etc.). Ethnographic methods will be used to collect materials documenting the actual work in its normal, real-life setting. The researchers will engage in a lengthy period of ethnography in order to gain familiarity with the workplace being studied and obtain suggestions for analysis. 2. Collection of materials. The second phase of the research will involve the use of audiovisual equipment to record routine activities in the settings studied. The intention is to collect 120 hours of video recordings of work in the emergency control centres, considering different hours during the day, different days during the week, and different periods of the year. Besides these video recordings, the intention is also to acquire audio recordings of all communications (by radio or telephone) from and to the operations centre (these communications are already recorded for legal reasons). 3. Prepare the materials for analysis. The phase of the project devoted to analysis will make ample use of the information and insights obtained from the ethnography and will concentrate in particular on the interaction as it emerges from the video-recorded materials. The analytical method used will be derived from conversational analysis and context analysis. When the materials have been collected and collated (digitalized, indexed, etc.), all the data will be transcribed. After transcription, the analysis phase proper will begin. 4. Defining the results. The Trento unit will produce a final research report. Three articles will be written for submission to national and international journals, as well as a contribution to a collected volume published by the national research group. Finally, the materials collected and the tools developed will be used in a subsequent phase to draw up a training and awareness programme for the personnel involved in the research. This will be an important practical pay-off from the project.
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