Watching me, watching you : interpreting findings from a realist evaluation study

This poster is a report of part of findings from an original research study in the area of realist evaluation which was designed to evaluate the role of the ‘intermediary’ in promoting best practice in infection prevention and control. In healthcare, intermediary roles have potential to support the translation of evidence into everyday practice (Chew et al, 2013), especially through the ways in which they act to “bridge the communities of research and clinical practice” (Milner et al, 2005: 900). However, understanding the effectiveness of intermediary interventions is challenging, given the complexity of the processes involved and the context-dependent, contingent nature of their work (Chew et al, 2013: 337). Study aim and objectives: The aim of the study was to seek the programme theories to show how intermediaries promote best practice in infection prevention and control; to determine what works, for whom, how, and in what respects. Methods: Realist evaluation was used to elicit a better understanding of the mechanisms and contexts that lead to outcomes (CMOs) for the role of intermediaries in infection prevention and control programmes. An essential element which separates realist evaluations from other types of outcome-focused evaluations is the focus on understanding how programmes or services, which offer different resources, have different effects for people (Timmins & Miller, 2007). In this study, a realist review led to case studies conducted consecutively within two NHS hospitals in the United Kingdom, with data comprising of interviews, non-participant observations, and documentation review. Findings: In infection control practice, intermediaries discussed “watching over” as an inherent part of their role. To consider the implication for future policy and practice, this finding was explored through a Foucaldian lens, to understand how surveillance of people who operate in organisations and institutions (such as hospitals), is historically drawn from knowledge of the impact of discipline in social systems. The concept of informal surveillance represents the idea that equilibrium within society is maintained through covert forms of discipline (Burrell, 1988). Informal surveillance is generally undertaken through different interactions with colleagues and co-workers, whilst more formal surveillance is usually undertaken through formal institutions (Henderson et al, 2010). In this study, formal surveillance formed part of the intermediary role and included carrying out tasks, such as data collection and audit, to meet the objectives within the organisation’s infection control strategy. However, the informal surveillance intermediaries undertook was described as a subconscious activity, in an enactment of their intermediary role. Subjecting individuals to surveillance acts as a vehicle to enhance self -awareness and influence behaviour (Henderson et al, 2010), and there is an argument for surveillance to become more humanised (Lyon, 2003). Whilst surveillance is not always intentional, it is, according to Foucaldian thinking, an integral part of humanity. It is argued that much more needs to be understood of how different forms of surveillance can be used to promote best practice, and in particular, how can human surveillance be integrated into organisational systems which are already established. This poster will illustrate how promoting self-surveillance can make a significant contribution to promoting best practice in healthcare.

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