They called her "the Doctor", and there is a difference of opinion about why that was so. "She looks like a doctor", was the rationale often heard among persons she met at work. She was NOT a Doctor! Her hair was greying over her ears, and she carried herself with a quiet, distinguished air. She also wore a lab coat, though she did not need the mark of the ancient guild - she had said she needed the "Captain Kangaroo" pockets in the coat to carry her stuff! She may need washable markers, and a penlight, and tongue depressors, and an applesauce container, And she had made a point, when her job started at the building, to meet and greet everyone who lived within and NOT just people on the clinical caseload. She had a method to her madness; really!
For example, when there was a new referral for service she might interact with the newest person served in a group setting (eating a meal, or participating in a leisure activity). Persons directly AND INDIRECTLY connected to the person served, often would volunteer their observations during or after the visit. Those observers may also, at times, help interpret the experience for the person served. Some of these observers are followers in the culture, but others are leaders - leaders on the playground, in the gardening session, or at weekly worship services. The Doctor learned the processes and agents that made the culture work: who had nominal power that made the culture run, and who in fact wielded actual power and influence. Some of the movers and shakers (who controlled the conversation at the big table at lunch; who could get you an extra dessert; who had been in therapy previously and could help the newest person served, adjust) - they might have insights into what the person needs, and might be open to an occasional interview.
The Doctor made certain that, from the beginning of her tenure at the facility, that most people knew who she was and what she did. It made clinical encounters in a group less anxious for the members (Who's that woman? What is she doing here? Is she going to talk to ME? You talking to me??), and made the culture - the community - more a circle of friends and supporters for the new person served. As the Doctor used to say, "One day you'll be rid of me; that is when you must rely on the support of all you spend time with here each day". It was the Doctor's intent to sketch in as clear detail as possible, that skilled intervention to help persons increase their function for cognition, communication and swallowing - it is finite, and the degree of change that comes about through clinical intervention can be sustained to some degree, by the processes of the culture.
The Doctor composed her ethnography of her work site, during the first month of her tenure at that facility. At the end of the process, there were explicit and implicit rules known. Hierarchies of control for persons, and for resources were more easily understood. How would a successful therapy outcome dovetail with the goals of the culture? She could predict that outcome much more easily now. Over the years, she knows that the study of her work 'culture' will have to be re examined, revised and rejudged for its validity. That is pittance little work on top of her clinical responsibilities, for it - the ethnography - can be a major road map to superior clinical outcomes.
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