Using Video-Reflexive Ethnography on an Acute Medical Unit:Methodological Challenges, Solutions and Opportunities within a Complex and Busy Healthcare

Video-Reflexive Ethnography (VRE) is an innovative and participatory research and improvement methodology that involves videoing in-situ work practices and collaboratively analysing this footage with participants during reflexive sessions. This involves participants ‘slowing down’, engaging reflexively with their everyday working practices, and taking time out to discuss issues collectively. VRE has increasingly been used across a range of different healthcare settings. However, one setting that has received less attention is the Acute Medical Unit (AMU). AMUs are busy short-stay hospital departments with very high patient throughput and large multidisciplinary teams where patients receive initial assessment, diagnosis and treatment before being moved to other wards or settings. The aim of this study was to examine how VRE as a research and improvement methodology can be applied, in the busy and complex setting of an AMU. In this paper we outline some of the methodological challenges encountered in this setting and discuss how these were transformed into opportunities and solutions. Then, we evaluate our work by using the four guiding principles at the heart of VRE (care, collaboration, reflexivity and exnovation) to test if, and how, the methodology can be used in such a complex and busy setting without losing its methodological rigor and impact. We show how it is possible to initiate and achieve the core principles of VRE in the complex and busy AMU setting through careful planning, constant revision of data collection methods, remaining highly flexible and adaptable to the spatial and temporal rhythms of the ward and being sensitive to hierarchical inter- and intra-professional relationships and vulnerabilities. Finally, we share recommendations for using VRE in other busy and complex settings.Keywords Ethnography, Focus Groups, Observational Research, photovoice, Methods in Qualitative Inquiry<br/

Using Video-Reflexive Ethnography on an Acute Medical Unit:Methodological Challenges, Solutions and Opportunities within a Complex and Busy Healthcare Setting

Video-Reflexive Ethnography (VRE) is an innovative and participatory research and improvement methodology that involves videoing in-situ work practices and collaboratively analysing this footage with participants during reflexive sessions. This involves participants ‘slowing down’, engaging reflexively with their everyday working practices, and taking time out to discuss issues collectively. VRE has increasingly been used across a range of different healthcare settings. However, one setting that has received less attention is the Acute Medical Unit (AMU). AMUs are busy short-stay hospital departments with very high patient throughput and large multidisciplinary teams where patients receive initial assessment, diagnosis and treatment before being moved to other wards or settings. The aim of this study was to examine how VRE as a research and improvement methodology can be applied, in the busy and complex setting of an AMU. In this paper we outline some of the methodological challenges encountered in this setting and discuss how these were transformed into opportunities and solutions. Then, we evaluate our work by using the four guiding principles at the heart of VRE (care, collaboration, reflexivity and exnovation) to test if, and how, the methodology can be used in such a complex and busy setting without losing its methodological rigor and impact. We show how it is possible to initiate and achieve the core principles of VRE in the complex and busy AMU setting through careful planning, constant revision of data collection methods, remaining highly flexible and adaptable to the spatial and temporal rhythms of the ward and being sensitive to hierarchical inter- and intra-professional relationships and vulnerabilities. Finally, we share recommendations for using VRE in other busy and complex settings

Using Video-Reflexive Ethnography on an Acute Medical Unit:Methodological Challenges, Solutions and Opportunities within a Complex and Busy Healthcare Setting

Video-Reflexive Ethnography (VRE) is an innovative and participatory research and improvement methodology that involves videoing in-situ work practices and collaboratively analysing this footage with participants during reflexive sessions. This involves participants ‘slowing down’, engaging reflexively with their everyday working practices, and taking time out to discuss issues collectively. VRE has increasingly been used across a range of different healthcare settings. However, one setting that has received less attention is the Acute Medical Unit (AMU). AMUs are busy short-stay hospital departments with very high patient throughput and large multidisciplinary teams where patients receive initial assessment, diagnosis and treatment before being moved to other wards or settings. The aim of this study was to examine how VRE as a research and improvement methodology can be applied, in the busy and complex setting of an AMU. In this paper we outline some of the methodological challenges encountered in this setting and discuss how these were transformed into opportunities and solutions. Then, we evaluate our work by using the four guiding principles at the heart of VRE (care, collaboration, reflexivity and exnovation) to test if, and how, the methodology can be used in such a complex and busy setting without losing its methodological rigor and impact. We show how it is possible to initiate and achieve the core principles of VRE in the complex and busy AMU setting through careful planning, constant revision of data collection methods, remaining highly flexible and adaptable to the spatial and temporal rhythms of the ward and being sensitive to hierarchical inter- and intra-professional relationships and vulnerabilities. Finally, we share recommendations for using VRE in other busy and complex settings

2017 Making Literature Conference

Keynote Speakers: Tom Noyes, Shari Wagner, Grace Tiffany, Jessica Mesman Griffith, David Griffit

Seeing what works:Identifying and enhancing successful interprofessional collaboration between pathology and surgery.

Utilising frozen section technologies, Mayo Clinic has one of the lowest reoperation rates for breast lumpectomy in the United States. The research reported on sought to understand the successful teamwork between the Breast Surgery Team and the Frozen Section Laboratory at Mayo Clinic. Researchers worked collaboratively with healthcare staff from breast surgery and the frozen section pathology laboratory to identify communication styles and strategies that contribute to the timely and accurate intraoperative evaluation of breast cancer specimens. Using the video-reflexive ethnography (VRE) methodology underpinned by a positive theoretical approach to researching quality and safety in healthcare, the researchers video-recorded the communications associated with specimen resections in surgery and the subsequent pathology diagnoses. Then, 57 staff from the breast surgery and frozen section laboratory teams attended video-reflexivity sessions to collaboratively analyse their communication practices and identify opportunities to optimize interprofessional communication. In this article, we focus on how the flexible, interdisciplinary, and cross-hierarchical communication within the frozen section laboratory supports a rapid and accurate intraoperative evaluation and communication, previously conceptualized by staff as being performed in a linear fashion. Moreover, we detail how the VRE methodology led surgeons and pathologists to implement new strategies and optimize their interprofessional communication

The paradoxes of communication and collaboration in maternity care:A video-reflexivity study with professionals and parents

Background: Research on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”. Methods: We used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units. Findings: We conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”. Discussion: Acknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents. Conclusion: Good communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training