Video-Ethnography and Video-Reflexive Ethnography: Investigating and Expanding Learning About Complex Realities

The chapter provides an overview of both video-ethnography and video-reflexive ethnography. It relates these two orientations as providing complementary perspectives on socio-organizational complexity, and on enabling learning about that complexity. The first section provides background to the video-ethnographic and video-reflexive endeavours that have been published in the last decade or so. The second section provides two examples; one from the domain of gall bladder surgery, and one from ward-based infection control. The chapter’s discussion offers some generalisations and delves into the links between visuality, complexity and pedagogy, before concluding with the assertion that visualization will grow in scholarly significance given the rising emphasis in contemporary civilizations on increasingly attuned, more multimodal, and more flexible ways of seeing and doing

Social research at a time of fast feedback and rapid change: The case for ‘slow science’

This contribution offers a reflection on the shift in social science towards participative enquiry and collaborative research practices. In doing so, the paper challenges the common conception that the methodological indeterminacy that participatory research may occasion undermines its scientific credentials by rendering its processes and outcomes vulnerable to idiosyncratic events, subjective interpretations, local variability and chancy outcomes. The focus of the article is not just that participatory processes require research flexibility to enhance the pragmatic outcomes of research, but that the researcher’s theory and methodology may need to be recalibrated from discipline-controlled givens to publicly-negotiable points of departure. This latter point expands the paper’s argument to advocate for research that has “the power to be affected” (Hardt 2007, x) by the views, feelings and experiences of those it targets, and of those affected by its processes and conclusions. Using video-reflexive ethnography to illustrate this point, the article exemplifies what it means for the researcher(s) to be affected by the constraints inherent in their own research approach and disciplinary priorities (Iedema 2021). &nbsp

Introducing the new Editorial Team

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93531/1/hex12001.pd

Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients - a feasibility study protocol

Background Intravenous (IV) insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using IV insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Health Care proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed. Methods and analysis The study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases: Phase I: explore how work is imagined by analysing IV insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients’ electronic records. Qualitative data will include video reflexive ethnography: video-recording healthcare practitioners using IV insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from Phase I and Phase II to develop a model for using IV insulin infusions

Using video reflexive ethnography to explore the use of variable rate intravenous insulin infusions

Background: The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates learning from everyday practices. Video reflexive ethnography (VRE) is an innovative methodology used to capture, reflect on and thereby improve these. This study set out to explore the use of VRIIIs by utilising the VRE methodology. Methods: This study was conducted in a Vascular Surgery Unit. VRE methodology was used to collect qualitative data that involved videoing healthcare practitioners caring for patients treated with VRIII and discussing the resulting clips with participants in reflexive meetings. Transcripts of these were subjected to thematic analysis. Quantitative data (e.g. blood glucose measurements) were collected from electronic patient records in order to contextualise the outcomes of the video-observed tasks. Results: The use of VRE in conjunction with quantitative data revealed that context-dependent adaptations (seeking verbal orders to treat hypoglycaemia) and standardised practices (using VRIII guidelines) were strategies used in everyday work. Reflexive meetings highlighted the challenges faced while using VRIII, which were mainly related to lack of clinical knowledge, e.g. prescribing/continuing long-acting insulin analogues alongside the VRIII, and problems with organisational infrastructure, i.e. the wireless blood glucose meter results sometimes not updating on the electronic system. Reflexive meetings also enabled participants to share the meanings of the reality surrounding them and encouraged them to suggest solutions tailored to their work, for example face-to-face, VRIII-focused training. Conclusions: VRE deepened understanding of VRIII by shedding light on its essential tasks and the challenges and adaptations entailed by its use. Future research might focus on collecting data across various units and hospitals to develop a full picture of the use of VRIIIs

Should I stay or should I go? Patient understandings of and responses to source-isolation practices

Isolation of patients, who are colonised or infected with a multidrug-resistant organism (source-isolation), is a common practice in most acute health-care settings, to prevent transmission to other patients. Efforts to improve the efficacy of source-isolation in hospitals focus on healthcare staff compliance with isolation precautions. In this article we examine patients’ awareness, understandings and observance of source-isolation practices and directives with a view to understanding better the roles patients play or could play in transmitting, or limiting transmission, of multidrug-resistant organisms (MRO). Seventeen source-isolated adult surgical patients and two relatives participated in video-reflexive ethnography and interviews. We learned that, although most of these patients wanted to protect themselves and others from colonisation/infection with a MRO, they had a limited understanding of what precautions they could take while in isolation and found it difficult to obtain ongoing information. Thus, many patients regularly left their source-isolation rooms without taking appropriate precautions and were potentially contributing to environmental contamination and transmission. Some patients also interacted with other patients and their personal belongings in ways that exposed other patients, unnecessarily, to colonisation/infection risk. By not providing patients with adequate information on infection risk or how they could contribute to their own safety or that of others, they are denied the opportunity to fully engage in their healthcare. To improve the efficacy of source-isolation and contact precautions in general, patient care providers should consider colonised or infected patients as active partners in reducing transmission and involve patients and relatives in regular, ongoing conversations about transmission prevention

The 100 patient stories project: Patient and family member views on how clinicians (should) enact Open Disclosure - a qualitative study

Objectives To investigate patients’ and family members’ perceptions and experiences of disclosure of healthcare incidents and to derive principles of effective disclosure. Design Retrospective qualitative study based on 100 semi-structured, in depth interviews with patients and family members. Setting Nationwide multisite survey across Australia. Participants 39 patients and 80 family members who were involved in high severity healthcare incidents (leading to death, permanent disability, or long term harm) and incident disclosure. Recruitment was via national newspapers (43%), health services where the incidents occurred (28%), two internet marketing companies (27%), and consumer organisations (2%). Main outcome measures Participants’ recurrent experiences and concerns expressed in interviews. Results Most patients and family members felt that the health service incident disclosure rarely met their needs and expectations. They expected better preparation for incident disclosure, more shared dialogue about what went wrong, more follow-up support, input into when the time was ripe for closure, and more information about subsequent improvement in process. This analysis provided the basis for the formulation of a set of principles of effective incident disclosure. Conclusions Despite growing prominence of open disclosure, discussion about healthcare incidents still falls short of patient and family member expectations. Healthcare organisations and providers should strengthen their efforts to meet patients’ (and family members’) needs and expectations

Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study

Objectives To investigate patients’ and family members’ perceptions and experiences of disclosure of healthcare incidents and to derive principles of effective disclosure