Pearls, Pith, and Provocation Qualitative Health Research XX(X) 1–9 © The Author(s) 2010 Reprints and permission: http://www. sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732310361243 http://qhr.sagepub.com The Problem of Time in Ethnographic Health Care Research Eileen M. Willis 1 Abstract Drawing on the ideas outlined by anthropologist Fabian and feminist scholars Halford, Savage, and Witz, in this article I make two arguments that challenge ethnography’s claim to theoretical inference and empirical generalization, particularly for research examining contemporary health care practices. For Fabian the dilemma arose out of ethnography’s origins in the secularization of time. Accounts of the subject’s experiences using present tense assume no progress; accounts using past tense freeze the subjects in the past. For Halford and her colleagues, the methodological problem was reversed. Their respondents were engaged in a battle with health systems in constant change that resulted in the loss of memory of a corporate past. The problem now for the ethnographer, as in many other research approaches, is one of verification of observations and reliability of interpretations. The ethnographer now becomes frozen in time as is his or her account of events in the field. Drawing on ethnographic research in hospital workplace change, in this article I examine these time-based implications for truth claims. Keywords anthropology; ethnography; health care; qualitative methods, general; time In this article I focus on the theoretical issues of “time and the Other” in ethnographic research. The first issue reiterates the arguments put forward by Fabian in his text, Time and the Other: How Anthropology Makes its Object (1983, 2002). For Fabian, the methodological problem was essentially one of how to situate the “Other” in a time that does not construct them as exotic. Methodologi- cally, this is about what tense the ethnographer should use in the written account of fieldwork. The use of past tense assumes the subjects of the study no longer live this way and their culture is a thing of the past, whereas the use of the present tense assumes their culture is frozen in the past and has miraculously resisted the rational logic of Western industrial and capitalist progress. The second theoretical dilemma, outlined by Halford, Savage, and Witz (1997) in Gender, Careers and Organisations: Cur- rent Developments in Banking, Nursing and Local Government, has its origins in hyper capitalism, in the ideologies of new public management, where change is the benchmark for continuous quality improvement (Mathews, 1992). Here, the methodological issue is one of reliability of theoretical interpretations. In this case it is the ethnographer who is frozen in time, while the sub- jects have moved on to a point where even memory no longer serves them well. In organizing the article I provide a brief overview of ethnography. This is followed by an outline of each of the issues raised by Fabian (2002) and Halford et al. (1997), drawing on my own ethnographic work. The focus of my own study, conducted between 1998 and 2002 in a large metropolitan hospital in South Australia, was to examine the impact of microeconomic heath reforms on the work of nurses and early career doctors (Willis 2001, 2002a, 2002b, 2004, 2009). These workplace reforms produced a flurry of changes inspired by rhetoric of the new public management (McLaughlin, Osborne and Ferlie 2002). The research proposal was submitted to the Adelaide University Social and Behavioural Science Ethics Com- mittee, and the ethics committee of the hospital where the study was conducted. Both committees granted ethics approval for a period of 6 years. In the final section, I discuss the implications of these findings for ethnogra- phers engaged in studying the culture of contemporary health care organizations. 1 Flinders University, Adelaide, South Australia, Australia Corresponding Author: Eileen Willis, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia 5001 Email: eileen.willis@flinders.edu.au