Integrating cognitive ethnography and phenomenology: rethinking the study of patient safety in healthcare organisations

While the past decade has witnessed a proliferation of work in the intersection between phenomenology and empirical studies of cognition, the multitude of possible methodological connections between the two remains largely uncharted. In line with recent developments in enactivist ethnography, this article contributes to the methodological multitude by proposing an integration between phenomenological interviews and cognitive video ethnography. Starting from Schütz’s notion of the taken-for-granted (das Fraglos-gegeben), the article investigates a complex work environment through phenomenological interviews and Cognitive Event Analysis, drawing on distributed cognition and embodied cognitive science. The methodological integration is illustrated through the study of an adverse event in a highly specialised medical ward. Starting from a nurse’s task of administering medicine to a patient, the analysis tracks how a distributed cognitive system in the ward handles an adverse event where a pill becomes contaminated. The analysis demonstrates how complex decision-making processes depend on agents’ micro-scale embodied coordination, on their engagement with the material environment, and their anticipation of other agents’ intentions. It is concluded that ethnography can accommodate both cognitive and phenomenological research aims, while also contributing to the important mission of understanding successful responses to adverse events in healthcare. The article further contributes to patient safety studies by demonstrating how safe medicine administration itself can lead to increased risk, hereby pointing to a problem of incompatible safety logics as a source of medication errors in healthcare.