From the Macro to the Micro and Back Again: Advancing Comparative International Ethnography through Conceptually Comparable Samples

This paper examines the way transferable concepts and data points can render qualitative samples comparable across national boundaries. It does so through a study of the organizational work in six purposively sampled emergency departments (EDs) in Australia, the Netherlands and the US. Ethnography, and, in particular, the social action theories than underpin it, has been criticized for being too locally-specific on account of its intense interest in local action and interaction. The study aimed to examine the extent to which, or how, conceptually comparable concepts and data points could render international samples comparable. The study draws on the equivalent of 24 months of deep and immersed observation in the EDs of large, well-known metropolitan teaching hospitals in the above three countries. Through thematic analysis of transcripts and policy documents, we found comparable associations between the dimensions of macro, meso and micro social life. In the US, where the primary care system was relatively weak and EM a well-established and respected sub-discipline, EDs had the power to admit patients to the hospital and dictate the terms of patient transfer. Emergency personnel in the Netherlands, with a relatively strong, publically-supported primary health care system, and only informal EM training, struggled for legitimacy and influence in interactions with in-patient clinicians. Australia occupied the middle ground between these positions on all dimensions. Far from being astructural, this study maximized the macro features inherent and observable in the micro of everyday interaction. The ability to account for macro-level differences in interactional data depended on conceptual comparison of criteria in the integration of theory and data. The paper advances the conceptual and methodological tools for learning lessons across national systems. Furthermore, the application of “conceptually comparable” criteria for data collection and analysis raises new possibilities and questions about the “reliability” and “validity” of qualitative research.