3.2.1 What is (naturalistic) observation?

Observing is more than looking around, it is actively registering information along a number of dimensions, namely places (physical place or setting), persons (the actors involved) and activities (a series of acts) ⁸³. Observing means having attention for (1) the detail of the observation, (2) visual as well as auditory information, (3) the time dimension, (4) the interaction between people, and (5) making links with mental categories (Mortelmans, 2009).

Observing includes roughly three steps:

1. A descriptive step; the researcher enters the research setting and gets a general overview of the social setting.
2. A focused step; more focused observations are a step closer to the research question. The aim is to search for relationships or connections between several elements in his research question, for example X is a characteristic of Y, or X is the result of Y. More concrete, suppose a researcher wants to study the way emergency care is organized in Belgium, he would do some descriptive observations in the emergency department of hospitals to get an idea of the general structures and processes characteristic for emergency care. In a next step he turns to his research question which is about how cost-effectiveness of emergency care could be attained. Hence the focus of his observation will relate to all possible costs and which could be avoided.
3. Selective step ⁸³;. In this last phase, after the researcher may have analysed his data (field notes), he may have identified a lack of information of one specific category of costs, e.g. cleaning and housekeeping costs, and may therefore decide to do extra observations in function of this specific aspect.

3.2.2 When to use observations?

• To collect data on naturally occurring behaviors in their usual contexts⁵⁴. Observation also captures the whole social setting in which people function by recording the context in which they live⁸⁴.
• Unstructured observation illustrates the whole picture, captures context/process and informs about the influence of the physical environment⁸⁴.
• To check whether what people say they do is the same as what they actually do⁸⁴. Both what people perceive that they do and what they actually do are however valid in their own right and just represent different perspectives on the data⁸⁴.
• Observation is also an ongoing dynamic activity that is more likely than interviews to provide evidence for processes, things that are continually moving and evolving⁸⁴.
• To study the working of organisations and peoples’ roles and functioning within organisations²⁰.
• To uncover behaviours or routines of which the observed themselves are not aware of²⁰. What the researcher considers an important finding may belong to the self-evident nature of daily life from the participants’ point of view.
• To understand data collected through other methods (e.g. interviews) and also to design the right questions for those methods⁵⁴. 

3.2.3 What are the strengths and weaknesses of observations?

3.2.3.1        Strengths

A number of strenghts have already been described under “When to use observations?”. We could add that:

• Observation has the advantage of capturing data in more natural circumstances⁸⁴.
• The Hawthorne effect[1] is an obvious drawback but once the initial stages of entering the field are past most professionals are too busy to maintain behaviour that is radically different from normal⁸⁴

3.2.3.2        Weaknesses

• It can be very difficult to get access to the setting.: An observer is often experienced as a threat, especially if the setting is not asking for the research to take place. Observation (and especially participant observation) might lead to knowledge of informal procedures or rules, which people do not want to be uncovered. Also the researcher can be experienced or perceived as a barrier for the normal daily routine in the setting10. In direct observation, the researcher does not participate in the setting, hence is known as a stranger and gets only access to the public or formal layer of the social reality. He does not become an insider and will miss inside information because he is too distant from the actors he is observing10. “Access, then, is not a straightforward process of speaking to the person in charge and obtaining the approval of the ethics committee. It usually involves considerable time and effort and a constant endeavour to strive for ‘cultural acceptability’ with the gatekeepers and participants in research sites” (p. 310)84.
• Once inside the setting there is the problem of avoiding “going native”: This means “becoming so immersed in the group culture that the research agenda is lost or that it becomes extremely difficult or emotionally draining to exit the field and conclude the data collection” (p. 183)20.
• Observational data, are more than interview data, subject to interpretation by the researcher. Observers have a great degree of freedom and autonomy regarding what they choose to observe and how they filter the information84.
• Observations are time-consuming and hard work at every possible hour of the day.
• An observer can get emotionally involved in what he observes, and by consequence lose his neutrality.
• It is impossible to write down everything that is important while observing (and participating). The researcher must rely on his memory and have the discipline to write down and expand the field notes soon and as completely as possible54.

[1]           The Hawthorne effect is the process where human subjects of an experiment change their behavior, simply because they are being studied http://www.experiment-resources.com/hawthorne-effect.html.

3.2.4 How to plan the research design?

Often observations are carried out at the beginning of the data collection phase, but the method can also be used later on during the research process to address questions suggested by data collected though other methods ^{(Mack, 2005)}. Before starting the observations, the researcher should try to find out as much as possible about the site where he will be observing.

At the KCE, site visits are common to allow the researchers to become familiar with the research topic and setting. This is often combined with interviews or less formalized talks to key persons on the site. After a number of site visits the scope of the research project is determined and precise research questions are formulated.

3.2.5 Modalities of data collection

3.2.5.1        Participant versus direct observation

The role to adopt during observation and the extent to which participants are fully informed are somewhat intertwined⁸⁴. Typically researchers refer to Gold’s typology of research roles⁸⁵:

• The complete observer, who maintains some distance, does not interact and whose role is concealed;
• The observer as participant, who undertakes intermittent observation alongside interviewing, but whose role is known;
• The participant as observer, who undertakes prolonged observation, is involved in all the central activities of the organization and whose role is known;
• The complete participant, who interacts within the social situation, but again whose role is concealed.

Mack et al.⁵⁴ describe observing as remaining an “outsider” and simply observing and documenting events or behaviors being studied, while participating is taking part in the activity while also documenting it. Pure observing, without participating is a situations that in fact seldom occurs, because once you are present, you are visible, you influence the activities around you, you participate in some degree. There are two reasons for this participation, or to better understand the local perspective, or in order not to call attention to yourself⁵⁴.

3.2.5.2        Structured versus unstructured observation

• Structured observations are associated with the positivist paradigm and aim at recording physical and verbal behavior by means of a list of predetermined behaviours⁸⁴.
• Unstructured observations are not ‘unstructured’ in the sense of unsystematic or messy, “instead, observers using unstructured methods usually enter ‘the field’ with no predetermined notions as to the discrete behaviours that they might observe. They may have some ideas as to what to observe, but these may change over time as they gather data and gain experience in the particular setting. Moreover, in unstructured observation the researcher may adopt a number of roles from complete participant to complete observer, whereas in structured observation the intention is always to ‘stand apart’ from that which is being observed” (p307)⁸⁴.

3.2.5.3        Overt versus covert observation

Covert observation corresponds to two roles in Gold’s typology⁸⁵, i.e. complete observer and complete participant (see above). Most authors agree that covert observation is only legitimate in very specific circumstances and should be avoided. Mack et al. ⁵⁴ formulate the following ethical guideline regarding observations: “When conducting participant observation, you should be discreet enough about who you are and what you are doing that you do not disrupt normal activity, yet open enough that the people you observe and interact with do not feel that your presence compromises their privacy.”(p. 16) As with all qualitative research methods, researchers must also protect the identities of the people they observe or with whom they interact, even if informally. “Maintaining confidentiality means ensuring that particual individuals can never be linked to the data they provide”⁵⁴. 

3.2.6 Data collection tools

3.2.6.1        Checklists

Before you enter the setting and start observing, it might be a good idea to have some questions in mind. It may be helpful to carry a checklist in your pocket to help you remember what you are meant to observe⁵⁴.

3.2.6.2        Fieldnotes

“Fieldnotes are used by researchers to record observations and fragments of remembered speech. Although researchers may use other means of recording (such as video) and other form s of data (such as interview transcripts), fieldnotes remain one of the primary analytic materials used in ethnography.” (p. 82) ³⁵.

Depending on the research questions, the researcher is interested in other aspects of social reality. Mulhalls’ schema⁸⁴ includes the following types of field notes, each covering an aspect of social reality:

• Structural and organizational features – what the actual buildings and environment look like and how they are used
• People – how they behave, interact, dress, move.
• The daily process of activities.
• Special events – in a hospital ward this might be the consultant’s round or the multidisciplinary team meeting.
• Dialogue.
• An everyday diary of events as they occur chronologically – both in the field and before entering the field.
• A personal/reflective diary – this includes both my thoughts about going into the field and being there, and reflections on my own life experiences that might influence the way in which I filter what I observe.

It is particularly important to detail any contradictory or negative cases. Unusual things often reveal most about the setting or situation²⁰.

Documenting observations consists of the following steps^{54, 86}:

• Quick notes during the observation.,
• Once the researcher left the setting, he expands his notes into fieldnotes. This means he reads them through and adds other things he can remember, but has not yet written down. Note taking in the setting is not self-evident and it is impossible to write down everything you see. Therefore good note taking should trigger the memory by means of key words, symbols, drawings, etc.
• After expansion, the researcher “translates” his shorthand into sentences., and
• Together with the translation phase, a descriptive narrative can be composed. The researcher writes down a description of what happened and what he has learned about the setting. In this step the researcher should distinguish between describing what happened and interpreting.

The researcher should be well aware of the difference between describing what he observes versus interpreting what he observed. It should be avoided to report interpretations rather than an objective account of the observations⁵⁴. For example, an interpretive description of a patient could be “he was in terrible pain”. An objective description would be “he was screaming and his face turned pale while grimacing”. “To interpret is to impose your own judgment on what you see” (Mack, 2005⁵⁴, p23). The danger is that interpretations can turn out to be wrong. Therefore the researcher should ask her/himself “what is my evidence for this claim?”⁵⁴. One way of separating descriptions and interpretations is by separating them visually on paper or screen.

3.2.6.3        Draw a map of the setting or settings you observe.

Maps might support your memory and are a tool to reconstruct interactions and movements of people in a room.

3.2.6.4        Audio or video

Audio or video recordings of observations are generally not permissible unless all ethical requirements are fulfilled and informed consent has been obtained.

3.2.7 Sampling

As outlined in the general principles of the chapter on interviewing, sampling in qualitative research is seldom statistically based. Also samples of settings or groups to observe are purposive.

Specifically for observation the sampling units are places, locations, and blocks of time, but usually not individuals. The aim is to select ‘information-rich’ cases, but in practice site selection is often a pragmatic decision based on existing networks and accessibility. Ideally however, sites are chosen because they typify some larger population of sites (such as clinics) or perhaps because they are exceptional in some way. Observation methods may be used across multiple sites and one could select the ones representing a range of typical settings (Green et al, 2009). 

3.2.8 Human resources necessary

Observations can be the work of one researcher, a pair of researcher, or a whole team. Which arrangement is most appropriate depends on the research questions and the features of the setting. Also members of a team can disperse to different locations individually, or in pairs or groups, in order to construct a more complete picture of the issues being studied.

One of the advantages of team work is that field notes can be compared and that team members can question each other about assertions being made. “Taking another perspective on validity Graneheim et al. (2001) used multiple data collectors with different perspectives (insider or outsider) to observe the same situation. This may not accord with the idea that every researcher may produce a unique account of a situation that is valid in its own right. But with extensive mutual reflection, as undertaken by Graneheim and colleagues, these combined observations may have consensual validity. However, from a practical standpoint few projects are afforded the luxury of multiple data collectors.” (Mulhall, 2003⁸⁴, p. 309).

3.2.9 Practical aspects

• Try to be “invisible” as an observator. Adapt to the setting in which you will do the observations, in terms of dress code, the way of behaving, and what is expected from you by the other actors in the setting.
• Start with short observations to explore the field and to get yourself used to your role as observer.
• First you should get an idea of “the normal” way of life in a setting, before you are able to identify unusual or abnormal situations.
• Circumstances may make it difficult or unacceptable to make fieldnotes, hence the researcher has to write down his observations afterwards. This can lead to a memory bias.
• Field notes should not contain interpretations, but merely descriptions.
• There is also the practical problem of how, especially in large and busy social settings, like an emergency department, to inform and obtain consent from everyone who might ‘enter’ the field of observation⁸⁴.
• Note that once inside the setting it might be difficult to get out again: Ending the fieldwork should not happen abruptly. The researcher must take time to “ease out”. In the ‘easing out’ phase the researcher is more and more absent from the setting. This means more time to analyse the data. When present in the setting, the researcher can confront his preliminary analysis with new observations in the setting¹⁰. In the literature the advice is to keep in contact with the setting until the final report is written⁸⁷.

3.2.10 Analysis

Field notes contain a lot of detail and are highly descriptive. In order to find explanations or answers to the research questions, the researcher should develop categories and test them against hypotheses, and refine them. This is an iterative process that starts during the data collection phase. 

3.2.11 Reporting of findings

As with other qualitative research methods it is important that evidence from the data is presented to support the conclusions of the researcher, by means of examples or quotations. The main principles have already been mentioned in (see  “How to report qualitative research findings”).

3.2.12 Quality criteria

The quality of observational studies depends largely on the quality of the descriptions of data collection and analysis provided by the researcher. Details about how the research was conducted are crucial and should be well documented. For example, how much time was spent in the field, how typical were the events recorded, description of the attempts to verify the observations made, etc.

The general criteria to assess the quality of qualitative research are described here and also apply to observational methods.

3.2.13 Examples of KCE reports using the method

So far no observational studies have been carried out at the KCE.