University: Towson University
Description of Work:
I have two projects underway right now: my book project and a new project. Both of these projects involve emergency communication in medicine.
In my book project, I examine the rhetorical work of emergency medical services (EMS) professionals. EMS professionals are responsible for gathering, remembering, and communicating a great amount of information while simultaneously making treatment decisions, treating patients, and transporting them to the hospital. From my 16-month study that used ethnographic research methods, I found that EMS professionals managed and facilitated their goal-directed activity using rhetorical work: “the process by which we create and shape our communication for specific audiences in specific contexts for specific purposes” (Andersen 2014, p. 118). As results suggest, rhetorical work in EMS includes two vital components: three types of memory (individual, collaborative, and professional) and a process I call “multisensory invention.” Multisensory invention refers to the ways in which participants used their senses—sight, hearing, smell, and touch—and their intuition to gather and interpret pertinent data during the initial stages of an EMS response. In this project, I also argue that different types of rhetorical work are involved in other activities: the professionalization of a field and the medical rhetoric research process.
In my newest project, my co-researcher, Christina Norwood, and I are answering this research question: How do web content developers manage and revise medical content for health professionals? We are working with the Johns Hopkins Medicine Ebola Crisis Communications Team. Made up of web content developers, public relations professionals, and physicians, the team was responsible for overseeing the revision of Centers for Disease Control and Prevention (CDC) documents about Ebola and personal protective equipment (PPE) in 2014. The team revised the CDC’s document and collaborated with many specialists to generate new content. We want to study how the team managed and shared knowledge to create usable, high stakes medical procedure content, which includes text documents and video.
With this study, we also are refining a new method that can help researchers examine unobservable writing practices. This study examines writing and decision-making that happened nearly a year ago. To account for this time lapse, we are using the modified Critical Decision Making Model, which I first used in my EMS study. The Critical Decision Making Model (Blandford & Wong 2004; Hoffman, Crandall, & Shadbolt 1998) asks participants to recall their action in critical situations. We modified this model to account for writing practices, thereby helping researchers study these practices without being able to observe them in action.
Assemblage Mapping: A Medical Rhetoric Research Methodology
The proposed presentation illustrates a methodology that may help medical rhetoric researchers collaborate with complex institutions, such as hospitals. Although medical rhetoric researchers use a variety of methods, the medical rhetoric field lacks methodologies that are unique to the discipline and that help researchers address related challenges, including accessing highly regulated research sites. The presented methodology is guided by assemblage theory (DeLanda 2006) and emerged as a model that helped the speaker overcome challenges during an empirical study. The study investigated the communication practices of emergency medical services (EMS) professionals. Before I could conduct research, I had to access EMS and its affiliated hospitals, which are traditionally difficult to approach. I used assemblage theory to study and map the institutions and their related components to complete the project. This methodology, which I call “assemblage mapping,” will support attendees as they look forward in their research efforts and investigate similar complex sites.
Institutional Research Challenges
Some workplace communication researchers have addressed research challenges with tracing methods, communication models, mapping techniques, and situated research practices (e.g., Porter et al. 2000; Simmons 2007; Slack, Miller, and Doak 1993; Spinuzzi 2003; Sullivan and Porter 1997). These approaches are valuable in understanding research processes as a whole, but a mapping method is best suited to help medical rhetoric researchers enter an institutional research site. Mapping provides a heuristic and graphical display for the beginning stages of research because they connect stakeholders and are associated with performance. Maps are non-linear and represent different points of action. As such, a map’s focal point can be re-centered so that researchers might re-focus a study; they then might better understand certain connections or roadblocks that influence stakeholder communication. As a mapping method, assemblage mapping illustrates a research site’s tangible and intangible components. This illustration is particularly useful for medical rhetoricians. We often work with human and nonhuman stakeholders when conducting research: patients, patients’ families, health professionals, policy makers, lawyers, technology, policies, and protocols. Assemblage mapping (outlined below) as a methodology can guide attendees in visually connecting various institutional elements and thereby assist them in entering an institution.
Assemblage theory builds on Deleuze and Guattari’s (1987) rhizome theory and adds to current network theories. Assemblages, or “wholes whose properties emerge from the interactions between parts,” facilitate networks, organizations, and, as I suggest, the medical rhetoric research process (DeLanda 2006, p. 5). Assemblage theory involves understanding the relations among components involved in an assemblage, like the research process. In my study, components included me, two hospitals, EMS professionals, the medical director, doctors, nurses, lawyers, the Health Insurance Portability and Accountability Act (HIPAA), health care reform, protected health information, two institutional review boards (IRB), a university, medical protocols, patients, and patient safety. These components interacted dynamically and influenced the research process assemblage.
In assemblage theory, written and spoken communication allows components to interact dynamically. Communication stabilizes an assemblage, and the communication among components influence and can dictate the direction of institutional research. For example, in the beginning stages of my EMS communication study, I encountered important roadblocks that shaped the project and my communication with the IRBs. I experienced significant challenges gaining the hospital’s IRB approval to observe ambulance responses, despite having EMS training. While I was waiting for approval, I learned that another EMS researcher worked directly with the EMS medical director. I created an assemblage map and then re-focused it by placing the medical director at the center. By visually understanding his position, I realized he was connected to and communicated with all but one of the study’s components. As such, he could help me understand and contact essential, often inaccessible, components, like hospital lawyers. We collaborated for the duration of the project, which was successful because of his assistance.
Assemblage mapping models the various tangible and intangible components and contexts that are involved with institutional research. One of assemblage mapping’s unique characteristics is its dynamic, shifting nature. Because it is difficult—if not impossible—for researchers to identify every component involved in the research process, they can modify the map as needed. Presentation attendees will learn the steps needed to create an assemblage map. First, in a table, researchers list the components involved in the whole process (the assemblage) and the concerns those components may have about the process (e.g., HIPAA). Next, researchers list the communication channels the components use (e.g., email, phone). After creating this table, researchers map the assemblage’s components by following these steps:
- On a piece of paper or Word/InDesign document, write a component’s title that you may be struggling with or want to better understand in the center (“medical director”). Circle it.
- Place the other components or related assemblages around the main one, grouping related parts and parts that have the same concerns.
- Enclose the grouped components together with a larger circle.
- List the components’ concerns in the larger circle to map the larger forces at work (“HIPAA”).
- Link the components together with arrows to indicate communication channels that are outlined in the table.
By seeing the connections among components, researchers can identify gaps in communication, and they can better understand the institutional contexts they need to access and research. Assemblage mapping helps scholars articulate how their research affects an institution and how components involved in the research process relate. Understanding where knowledge overlaps is especially important when working with institutions because these institutions and researchers may be in different discourse communities. For instance, researchers use terms like “institutional review board”; some components, such as hospital administrative assistants who answer researchers’ phone calls, may not be familiar with IRBs.
In this presentation, I explain assemblage mapping methodology that may guide researchers who work with complex institutions. Medical rhetoric researchers, instructors, and students may benefit from this presentation. Researchers may find it a useful heuristic when developing a project or working through research roadblocks. Instructors and students may find this presentation’s material appropriate for graduate classes in empirical research methods or institutional communication.