Things don’t work out as planned

 

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According to my proposal timeline, December is when I am working with my participants back and forth with their written transcripts. The idea was to co-create something based on their continued reaction to the discussions we had, to build on the original chats over coffee and tea, in offices and borrowed spaces, to merge our four perspectives into a unique representation of an often-unrecognised issue in the workplace.

It hasn’t worked out like that.

Our discussions were amazing, rich and full of detail. I felt like I had space to tell my stories as well as hear theirs, and many of the threads naturally connected. Our past histories were sometimes shared ones. I also heard some things that surprised me, made me doubtful, made me sad. The typed-up transcripts are lengthy, and I sent them back with the request for my participants to “engage with them”. What happened shouldn’t have surprised me. There were very few changes, a few typos or misspellings were pointed out. A couple of nice comments (I really enjoyed this process, thank you) but I was left with the feeling that this wasn’t going as planned.

Panic! I looked at my consent, at the emails I had sent to my participants, at the messages we’d exchanged on Facebook. I thought I had been really clear – I’d taken time to talk about how this wasn’t a typical interview, we were creating something together, it would be a commitment – take time and energy? Are you sure you are up for that? They’d all agreed!

I looked at my proposal. I’d been (deliberately) unclear about how this next part was going to go. I am used to thematic analysis in qualitative work. I had vaguely thought I’d sort the “data” into themes, maybe write some kind of story per theme? I had hoped that one of my participants would maybe volunteer to write a sonnet, even a haiku? When I teach or talk about qualitative research I always joke that the sections on analysis in text books refer to themes “emerging” – like mushrooms overnight. When in reality it’s a slog that taxes your brain and patience. Less art, sometimes, than persistence and rereading until you can quote your transcripts by heart. Anyway, nothing was emerging here unless it was a creeping sense of dread.

So I went back to the books and articles about authoethnography. HOW exactly is this supposed to work? There is a lot about the craft of writing, characterisation, action, context and resolution (or perhaps a point or moral as not all stories can be resolved). I am told that narrative is always unfinished, there is a “back and forthing” and a constant negotiation of relationships, transactions, truth and ethics. How I use other people’s words and stories is flexible, as long as I am respectful of their truths, and we negotiate the narrative together.

I am also instructed to go off and read, because we write what we love. So I pack up my short stories, my Wintersons, my Atwoods, my Munros for a long plane ride. Remember that I love feminist women, brave women who write from the heart. Rediscover the skill and clarity in good short fiction. This was enjoyable, but not getting it done (I think), not solving my problem.

Then one morning on the long drive to work I turned off the radio and let my mind mull it over. I realised a few things. It took me two years to grasp the idea of writing fiction as research, joining my own voice with the participants, having a conversation and not a one-way interview where I said as little as possible. Adding a paragraph to a consent form – and my own passionate, but possibly less than clear, explanations – probably won’t do the same job no matter how well meaning the participants are. What did I expect? I’d written about how much people had accommodated me and how much as this work they had done in the spaces of their busy lives. If I was living in the same city it might be different, or not. But regardless I needed a new way forward.

So – I decided to write a book (a short one!), that is embedded in my dissertation. I’d like to have illustrations, intersperse short stories with some poetry, maybe a graphic section. I see a cover, a preface, a contents page. I’d like it to be removable, stand-alone – so it could be read for its own merit and hopefully shine a light into the world of the four of us whose stories are told. I’ll share the writing as I go with my participants, but I am also going to meet with them as a group next year and read it with them. See how they respond, gather their ideas and perhaps reshape it. The book will be my results section, perhaps my discussion if I add the “whys and hows” of each piece into the text.

So things aren’t quite going as planned. But that’s what happens. I love my new idea and hope I have the literary skill (and patience) to pull it off. I also love that this doctorate allows me to stretch, to explore part of myself that perhaps would never have been able to unfold. In the middle of all the self-doubt and life-demands I try to remember that.

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Some autoethnography references:

Behar, R. (1997). The Vulnerable Observer: Anthropology That Breaks Your Heart. Boston, MA: Beacon Press

Clandinin, D. J., & Connelly, F. M. (2000). Narrative Inquiry: Experience, Story in Qualitative Research. San Francisco, US: Jossey-Bass.

Connelly, F. M., & Clandinin, D. J. (1990). Stories of experience and narrative inquiry. Educational Researcher, 19(5), 2–14. https://doi.org/10.3102/0013189X019005002

Ellis, C. (2004). The Ethnographic I: A Methodological Novel about Autoethnography. New York, NY: AltaMira Press

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Signals of safety: LGBT visibility at work

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My blog inspiration today comes from an exchange this morning on Twitter. The original tweet was from @radiographerben who posted a poll asking if people would be comfortable wearing a pin “advertising” their sexual identity and/or gender orientation like staff at Marks and Spencer in the UK are able to do.  There were a few options from “sure” to “er, no”! Comments varied from my straight out “hell yes” to more cautious responses, including @SophiaEThom’s concern about dealing with possible reactions from patients. The badge in question identifies the wearer as a member of the LGBT+ at M&S employee network and supports Stonewall’s amazing Come Out for LGBT campaign which encourages visibility in all areas of life.

Stonewall (a UK group who support LGBT people) also run a Diversity Champions program for workplaces.  They cite that LGB employees who are comfortable being out at work are 67% more likely to be satisfied with their sense of achievement and trans employees 77% more likely to be satisfied with job security.  While this type of initiative and workplace training is becoming more common in the private sector, healthcare workplaces are slower to catch up. Often the focus is on improving LGBT patient experiences, and there is a lot of work to do in this area. When we look at LGBT staff, the picture is less clear. Being out at work is important, but how out are we when we work with patients? Do we think, like one physician participant in a UK study that:

 The hospital is not ready…for a camp acting doctor…because it brings sexuality into the public eye, and is the workplace the right place to do that? I think the answer is no because it’s at the expense of the patients.

LGBT staff routinely manage their identities at work, in a way that some other marginalised groups aren’t able to. We have the choice (usually) to come out or not – to pass or tone down our sexual identity. The idea of wearing a badge or other signifier bypasses that choice and makes our identity visible, which can sometimes feel uncomfortable.

So, why bother? If we set aside the evidence that being open about who we are makes for a better work experience – why should we be open around and with patients?  As Sophia said, this brings an element of risk. Why open ourselves up to the possibility of a negative reaction, despite all our equality policies, diversity mission statements and the general feeling that it’s 2017 – and OK to be whoever we want to be? One reason might be that it makes it a little bit easier for our LGBT patients.

The 2011 Institute of Medicine report suggests that the barriers to equitable health care that LGB people face can “profoundly affect their overall well-being”. Our LGBT patients often feel invisible in a system that doesn’t see them for who they are.  We know there are steps we can take to make this better; one is having visible LGBT staff to care for them.  A nice example is this blog post by Roger Newman, a gay man living with cancer, discussing his experience in hospital:

I hardly dared mention a partner and I even found myself begging him not to kiss me when he visited me. His response, as expected, was ‘bollocks to ‘em, I love you’, but on his visits I could see the eyes taking it all in; sorting and codifying the resulting information. I found myself telling him that it was OK for him because he could take our lifestyle back home with him whereas I was left to deal with the consequences. I was profoundly disturbed by having these feelings and I felt guilty about them, but the fact was that there I felt and believed myself to be different. I pondered how much I would have loved to have had some ‘out’ LGBT staff around me, so that I didn’t feel so isolated and had more confidence to be me. Just someone with a ‘Me Too’ badge on them, would have helped.

I’ve also written about this before, and in talks I have used a clip from the Macmillan “LGBTQ experiences of cancer care” video series where Lesley (a lesbian living with ovarian cancer) discusses her discomfort with knowing some of her nurses were lesbian but closeted, when she could have used the support.

My research is about how the identity disclosure decisions we make at work might affect relationships, with our colleagues and also (perhaps more importantly) with our patients.  As I read through my interview transcripts, the daily (and often unrecognized) work we do to tone down our queerness is a common theme.  But my participants realize that our difference can make, well, a difference.  In an older post I quoted a paper by Riordan who wrote that LGB healthcare professionals may use their identity as a “signal of safety” to flag to LGBT patients that they are understood – in my opinion the use of a badge or lanyard is just that.

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After the interviews

Can.jpgThe feeling I brought back from my initial interviews was how much of grad work is done in the spaces between our normal lives. My cohort knows the reality of taking on a full time doctorate on top of …well, life I suppose. We’ve struggled with deadlines, negotiated our inevitable absences for family commitments and furtively checked work emails during lectures. We are all tired, maxed out and scraping by–it’s normal. Doing the actual research bit, talking to other busy humans and relying on their friendship and generosity as I asked them nosy and intrusive questions, that was a whole other level!

I had badgered my participants with emails, consent forms and FaceBook messages ahead of time – trying to explain that this wouldn’t just be one meeting and done. At a very conservative guestimate I told them it would take up at least 10 hours of their time. Two face to face discussions, reviewing the transcripts, commenting on the transcripts, looking at my interim texts and working with me to shape a coherent and (hopefully) engaging story from their three individual narratives.

To further complicate things, I’ve never done this before. I feel like I am making it up as I go. It’s hard to project a feeling of authority and confidence when I really have no idea what I will expect of them two months from now, nine months from now? More emails? Phone calls? Skype? Individually? Together? My results section will be this co-joint narrative – but as I slog through the hours of transcription I still have no solid idea what that will involve.

So, I was working in the spaces that are left, full of the uncertainty that I have –at the coffee shop interview at the end of the shift, the room found at the busy conference just behind the registration desk with the loud air conditioning, the friend’s house with the borrowed tea and cookies and more. My friends, my participants, made space for me – they drove miles to talk to me, rearranged meetings to spend an hour sharing coming out stories and arranged child care. I was acutely aware of their lives outside the coffee shop or the living room – they were all juggling prosaic day to day appointments with emotionally demanding major life events. Before the tape was turned on, and lingering after we had finished, we reflected on how young we had been when we first met and we shared our battle scars.

It is always an honour and a responsibility to hear and share stories doing research, but a humbling realisation to begin to confront the issues that enrich and complicate working with friends. Lisa Tillmann-Healy (2003) places relational ethics and “friendship as method” as a feminist practice with its belief that “the personal is political” and commitment to empowerment and social change. Friendship as method involves hope, caring, respect and justice. This kind of research is intensely personal, done with love, I didn’t really understand that before but I realise it now.

Image: Church Street (Toronto) cross walk

Getting messy: ethics and reconnecting

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There is a lot going on at the moment. My life is messy. It’s crowded with personal upheavals, work issues, family trips, kid stuff – the usual and then a bit more. We’ve had wildfires in British Columbia, the sun was hidden in an orange shroud, and the air smelled like smoke. It seemed apocalyptic.

In the middle of this I am working on my research ethics application and reconnecting with my participants before meeting them in person in September. I am doing this in another province, with limited time.  In the past when I have done interviews I have sent an invitation, an email, advert, sometimes used a personal connection – followed by the arranging of a place and time. Somewhere in there I would send a consent form, to be read before we talk. The interaction would be approached as the interviewer trying to find the “truth” by extracting it from the empty vessel of the participant*. To avoid bias, I would strive to stay as neutral as possible – making noncommittal noises of encouragement, smiling (being careful not to lead) but not contaminating the pure data with my personal thoughts and feelings.

This time is different.  My participants and I are friends, we have histories. The shared stories we hold in common are the heart of the co-created research endeavour. Among the chaos of everyday life I am picking up the threads of our past. But it isn’t as easy as sending an email and arranging a date. Time must be taken to weave our lives back together. Most of the many exchanges so far are catching up, how are the kids? Did you hear what happened to so-and-so? Still at the same house, oh, thinking of a move? It feels like getting back to the place where we are comfortable with each other, reactivating memories that have been dormant – in some cases for many years.

My ethics application is focused on obtaining consent, storing the data, issues of confidentiality and so on.  Often we think of ‘getting ethics’ as a onetime hurdle to surmount, but my research plan doesn’t fit well with that. In autoethnography,  ethics are ongoing and pervasive and the concept of anonymity is a slippery one. These so-called relational ethics require us to “act from our hearts and minds, acknowledge our interpersonal bonds to others, and take responsibility for actions and their consequence”**.  Participants are friends, not subjects/objects to plunder for information and leave hollowed out. We have a duty to tread lightly, to be honest with each other and to work with love and respect.

As I begin this I also realize I am bringing my participants back into focus, as people with autonomy and lives as messy as my own.  One is deep in a work project, our meetings will have to fit around that, but their project is part of my work reality as well – I want to help it succeed.  Another has family issues and there are multiple responsibilities, anticipating next month is hard as everything is in flux. My Type-A self has to take a back seat, chill out, wait my turn. It’s hard! Although I haven’t even downloaded the recording app on my iPad this is getting messy. But messy is where the good stuff is.

*Holstein and Gubrium, 1995

**Ellis, 2007 (p.3)

What is doctoral impact?

During the “trying to find a supervisor” period of my early EdD I met a few UBC professors for “bad academic first dates”. One of whom was a well known LGBTQ researcher who has done some wonderful and creative work in cancer care, and has written/blogged about their own cancer experiences. I was steered in their direction by several people who told me, “you must have heard of XXX, you would love their work”.  We did meet, but I wasn’t sure at that point exactly what I wanted to do and certainly didn’t really know what to ask of a potential supervisor. I was also worried that I came across as a stumbling imbecile! Apart from this blog, I hadn’t really written or spoken about (what would become) my research subject and was still wondering if I would be able to tackle it at all.

The development of learning through a professional doctorate (although for me incomplete and in progress) is partly gaining confidence to use your voice. A lot of us (women, people in traditionally marginalised populations) are used to being either ignored or actively silenced. Finding the courage (and having the support) to speak up was, for me, a huge part of my growth. I don’t think I would have been ready to do this work before now and certainly not without the framework offered by the program. I was asked the other day why I was doing the EdD. Would I get a teaching job, a better position? I usually say something neutral, as I am pretty sure those weren’t my motivations – but as I opened my mouth I suddenly realised why. I have wanted to do this research since I finished my Masters 15 years ago. There have been a couple of aborted attempts. One as a survey (not the right fit) and one with a colleague as a series of interviews (we were both too busy with other things, and nervous about the subject matter). I always felt it was too niche, too personal. I was doing it for the wrong reasons. Because I had struggled at times with being a lesbian and being a radiation therapist didn’t mean it was an issue that affected others. It was just me.

It took 6 courses, 2 electives, numerous papers and a lot of reflection for me to realize that just because it is personal, doesn’t mean it isn’t important. Just because it is difficult, doesn’t mean it shouldn’t be done. Part of the ongoing work is related to my own identity, which is relevant and enriches both process and product.  And (as my comps exam chair reminded me) it isn’t bias, it’s positionality!

So, apart from personal growth, confidence and the ability to speak openly (and, some would say, endlessly) about sexual identify and being out in the world – what has been the impact? Academically I could cite one publication, and a four keynotes/invited talks (Australia, UK, Canada) and this blog which has had more than a thousand visits. But is that the spirit of the EdD where the intent is to intensively study and (hopefully) affect/improve a problem or set of circumstances in practice?

I was at work last week writing an email to the same UBC professor I met almost two years ago. I was writing on behalf of a group looking to improve the experience of underserved populations. A few months ago, when there was a call for suggestions regarding what “underserved” populations should be looked at first, I had the knowledge and confidence to step into the silence and tell the group how some LGBTQ people have a hard time in cancer care. I said that I had written an article, did they want to see it? Also done a few talks and I had some good resources I could share.  The group agreed and we went ahead, steered by evidence and passion. We’re a new group, and it is early days. The first step is to ask how LGBTQ people have experienced us/the agency and how we could do better. I am convinced that this community outreach (including looping back to UBC) will make a difference and change how we care for LGBTQ patients – most importantly that they will finally be seen in our system. I had a moment of fierce pride as I sent the email. To me THIS is what impact looks like!

 

 

 

 

 

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*This blog was inspired by Janice St. John Matthew’s recent series “The impact of my doctorate” . Thanks Janice!