Below are descriptions of my three major research projects.
Creating Learning Networks for Improved Care
If you are a participant in the Learning Networks study, please visit the LN Transformation Study page for more information.
Healthcare delivery reform is a pressing issue in the United States. Some of the most urgent needs include increasing transparency in healthcare costs, improving care quality and access, and accelerating the pace of clinical research and point-of-care implementation. One novel approach to addressing these challenges is the establishment of Learning Networks as a mechanism of achieving Learning Health Systems. In a Learning Network, providers, patients, families, health system administrators and researchers work together to improve outcomes by collaborating on quality improvement and clinical research projects. The results of clinical research can lead to targeted, effective treatments, lowering long-term cost and improving health outcomes. Preliminary research[i] has demonstrated that Learning Networks are an example of successful healthcare delivery reform.
Three primary attributes contribute to the success of Learning Networks as a healthcare model. First, Learning Networks change the relationship between clinical research and patient care by speeding up data collection, analysis and implementation. Second, the clinical research activity within Learning Networks is driven by patient concerns, and patient participation is incorporated at different stages in the process. This elevates the patient and family from relatively passive recipients of care to active participants in daily care and research agenda-setting. A Learning Network therefore contains the infrastructure to enable the co-production of clinical knowledge by Network participants. Third, Learning Networks, as a type of Learning Health System, have organizational mechanisms to promote continuous improvement and sustainability.
However, not much is yet known about the process of taking existing healthcare systems and changing them into Learning Networks. Existing research[ii] points to the complexity of this process, but without greater understanding of the organizational, cultural and structural transformations of healthcare systems into Learning Networks, our ability to scale this process will be hindered.
I propose to close these gaps in knowledge by performing a 2.5-year descriptive evaluation study of these four disease networks as they transform into Learning Networks. Specifically, I seek to conduct a longitudinal comparative field study to examine the process of organizational transformation across the four networks, identifying salient commonalities and differences across these disease-specific populations. A field study is a form of qualitative research that combines participant observation with semi-structured interviews. This method prioritizes in-depth interactions with stakeholders over time to gain a rich understanding of everyday life in each of these healthcare systems.
A deeper understanding of how healthcare systems make the transition to become Learning Networks is the first step in support of the long-term goal of replicating and scaling this model to the national level. In service of this aim, this study attends to organizational change, information technology infrastructures, and how the transition to a Learning Network impacts the daily work and health of those embedded in it.
[i] Crandall, W., M.D. Kappelman, R.B. Colletti, I. Leibowitz, J.E. Grunow, S. Ali, H.I. Baron, J.H. Berman, B. Boyle, S. Cohen, F. del Rosario, L.A. Denson, L. Duffy, M.J. Integlia, S.C. Kim, D. Milov, A.S. Patel, B.T. Schoen, D. Walkiewicz, P. Margolis (2011). “ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network.” Inflammatory Bowel Diseases, 17(1):450-7.
[ii] Kraft, S., W. Caplan, E. Trowbridge, S. Davis, S. Berkson, S. Kamnetz, N. Pandhi (2016). “Building the learning health system: Describing an organizational infrastructure to support continuous learning.” Learning Health Systems. DOI: 10.1002/lrh2/10034
Teaching the Work of Doctoring:
How the Medical Profession Adapts to Change
Foundational ethnographers of medical education investigated how medical students take up the social role of the physician by examining the professional norms and values students learn during training. Researchers in broader medical sociology, for their part, have focused on the macrosocial relationship of the medical profession to other stakeholders, such as government, insurance and consumers. While healthcare is shaped by evolving professional dynamics, the everyday work of healthcare occurs on the interactional level–in individual patient-provider encounters. I argue that the dominant sociological focus on the medical student in ethnographies of medical training has left the professional context of medical work, and the physicians who carry out medical teaching, unexamined. By conceptualizing the medical school as an institution populated by physicians who actively adapt their practice and teaching to new constraints in healthcare work, I present an analysis of medical education that situates professional socialization in the context of the ongoing social transformation of medicine.
This NSF-supported research (2010-2013) is based on a four-year ethnography of the training of medical students by teaching physicians and administrators at “West Coast Medical School” and “University Hospital.”
Learning Ethnographies of New Engineers
From 2015-2017 I worked with colleagues Reed Stevens & Pryce Davis on an NSF-funded study that investigated how undergraduate engineering majors transitioned from college to the workplace. We used ethnographic methods, including semi-structured interviewing and video-based interaction analysis, to understand changes in skills and identity as the engineers moved into full-time work. We also examined the role of mentors, curricula, early work experiences, parents, and other factors in shaping engineers’ workplace learning and career trajectories.
We carried out our research at five field sites: a large steel mill, a third-party medical device testing company, a supply chain management company, a product design/implementation team at an elevator manufacturer, and a small R&D company specializing in containerless processing.
Our findings speak to disciplinary concerns in sociology, STS, and learning sciences, as well as to engineering educators.
Vinson, Alexandra H., Pryce Davis & Reed Stevens (2017). “Problem Solving in Engineering Education & Professional Engineering Work.” Proceedings of the 2017 American Society for Engineering Education Annual Conference & Exposition. (Peer-reviewed)
Vinson, Alexandra H., Pryce Davis & Reed Stevens (2017). “Learning to Anticipate the User in Professional Engineering Work.” Proceedings of the 2017 American Society for Engineering Education Annual Conference & Exposition. (Peer-reviewed)
Davis, Pryce, Alexandra H. Vinson & Reed Stevens (2017). “Informal Mentorship of New Engineers in the Workplace.” Proceedings of the 2017 American Society for Engineering Education Annual Conference & Exposition. (Peer-reviewed)
Vinson, Alexandra H. & Reed Stevens (2016). “Staying In or Getting Out: The Relationship Between Undergraduate Work Exposure and Job Satisfaction After Graduation.” Proceedings of the 2016 American Society for Engineering Education Annual Conference & Exposition. (Peer-reviewed)
Stevens, Reed & Alexandra H. Vinson (2016). “Institutional Obstacles to Ethnographic Observation in Engineering Industry.” Proceedings of the 2016 American Society for Engineering Education Annual Conference & Exposition. (Peer-reviewed)