USING ETHNOGRAPHIC METHODS TO EVALUATE THE DEPARTMENT OF VETERANS AFFAIRS PATIENT SAFETY PROGRAM

The U.S. Government Accountability Office over the last 30 years has developed a rigorous process for conducting program evaluations on behalf of the U.S. Congress. In order to become accepted, ethnography has to fit into this process. GAO evaluators work in an environment that requires them to conduct investigations that (1) are objective, (2) are based on evidence, and (3) can be replicated. In addition, evaluators generally compare their data to identified criteria such as policies, regulations, guidance, and best practices. All good evaluation includes such ethnographic methods as interviewing and observation, much of which has historically been practiced at GAO. Our mission is to further strengthen the GAO evaluation methods "toolbox" by incorporating ethnographic techniques into it. For example, in a recently completed assignment we were evaluating Department of Veterans Affairs organizational culture. We are doing this in the context of a program evaluation that investigates (1) the status of implementation of a patient safety program in VA medical facilities, and (2) the obstacles and incentives to acceptance of this program. Our approach combines GAO's investigative audit techniques with ethnographic analysis of interviews and observations.