Introducing the Pictor technique: A method for exploring collaborative working in health care

Collaborative working between different professionals is a crucial part of contemporary health and social care and essential to the provision of good quality care for patients and their families. However, given the complexities of many cases, researching the experiences of those involved – be they professionals, patients or carers – can be challenging. In our experience, whilst health and social care staff are generally very aware of the rhetoric around the importance of good collaboration, when asked about their own involvement in and understanding of collaborative working, they can sometimes present an “official” explanation or ideal version, rather than an account of their own direct lived experience of the phenomenon (Ross et al., 2005). Often, for experienced professionals, the way they work with others (professional or lay) has become so habitual and taken for granted that it is quite difficult to reflect on in any depth whenquestioned by an interviewer.

The Pictor technique developed in direct response to these challenges. Pictor is a simple yet effective technique which is able to successfully address some of the significant methodological challenges presented in the exploration of collaborative working in health care settings. The Pictor technique has its intellectual origins in phenomenological readings of personal construct theory by more recent scholars such as Butt (2003). PCT suggests that as human beings we are essentially meaning-makers, formulating our own personal hypotheses or “constructs” to explain our world. This meaning making process (referred to in PCT as ‘construing’)
Involves the whole person, and happens not “inside” the person but through his or her actions and interactions in and with the world.

Put briefly, the Pictor technique requires the research interviewee to choose a case of collaborative working in which they are, or have been, involved. They are provided with a set of arrow-shaped ‘Post It’ notes and asked to lay them out on a large sheet of paper in a manner that helps them tell the story of their case, with the arrows representing people and/or agencies involved in the case. The interviewer uses the “chart” so produced to probe the participant on their experiences.

We used Pictor in a large scale qualitative research project exploring how different professionals collaborate in the care of patients with cancer and other long term conditions. We conducted 78 Pictor interviews with a wide variety of stakeholders including different nursing professionals, a wide range of professionals with whom they interact, patients themselves and their close others. There were important differences in the ways in which different professional groups represented cases using Pictor, which can be understood in terms of role perceptions, aspects of service organisation and also wider societal perceptions of different types of illness. We discuss how the use of Pictor facilitated description of and reflection on complex cases across our different participant types.