Institutional ethnography as a unique tool for improving health systems.

Qualitative research in the health system has made tremendous developments in the last decade to better understand patient experiences. What is often overlooked, are the influences that the internal structures, policies and people have on the individuals that use health services. Institutional ethnography is a qualitative approach that aims to capture the social organization of "everyday life" at various system levels. An institutional ethnographic framework was applied to two research studies exploring how families experience care in neonatal intensive care units. Data were collected to develop a deep understanding of the social contexts that exist within institutional boundaries. This paper provides evidence that how care is organized and delivered can significantly influence patient experiences, perceptions and ultimately health outcomes. Adopting institutional ethnographic techniques as a common research method is a valuable tool for health leaders seeking to understand and develop recommendations for health system reform.

An assessment of women's knowledge of and views on the reporting of ultrasound soft markers during the routine anatomy ultrasound examination.

OBJECTIVE: To assess women's knowledge of and views on the evaluation and reporting of ultrasound soft markers. METHODS: A prospective survey of 263 women undergoing 18 to 20 week anatomy ultrasound examination at Mount Sinai Hospital, a level 3 perinatal referral centre for a multi-ethnic population of approximately 2.5 million. RESULTS: Prior to reading an information pamphlet provided in the context of this survey, 30% of women (79/263) reported having heard of the term soft marker and 59% of these women (47/79) had discussed soft markers with their caregiver. When asked their preferences about the reporting of ultrasound soft markers, 53% of women said that soft markers should be reported routinely, 20% said they should be reported when the caregiver thinks it necessary, and 23% preferred they be reported only when they have been discussed prior to the ultrasound examination. A minority of respondents (8%) had not participated in prenatal screening for aneuploidy. All of these women preferred that soft markers be reported only after pre-screening discussion. CONCLUSION: The study demonstrates that most women have little prior knowledge about routine examination for soft markers during the anatomy ultrasound examination and emphasizes the importance of expanding counselling and informed consent to include this aspect of prenatal screening.