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Blending Video-Reflexive Ethnography With Solution-Focused Approach: A Strengths-Based Approach to Practice Improvement in Health Care:

Published on Jan 1, 2019in The International Journal of Qualitative Methods2.257
· DOI :10.1177/1609406919875277
J. Mesman (UM: Maastricht University), Jessica Mesman11
Estimated H-index: 11
(UM: Maastricht University)
+ 2 AuthorsDanielle Bywaters1
Estimated H-index: 1
(UTAS: University of Tasmania)
Abstract
Professionals seldom discuss those things that go well-rather the focus is often on problems, poor outcomes, and what does not go well. Exnovation is about illuminating the invisible or hidden strengths of existing practices in order to improve practice and is central to the contemporary, qualitative elicitation method: video-reflexive ethnography (VRE). VRE is a method to explore and articulate the taken for granted by means of short video clips of one’s own work practice that provides a basis for sharing experiences, assumptions, questions, and concerns about the way things are done in order to effect practice improvement. Reflexivity is key to the method. The creation of a safe space for this shared reflexivity is essential. Improvement activities frequently draw upon problem-focused approaches that imply blame and fault. Such approaches can serve to close down discussion, give rise to anxiety, and inhibit the very improvements sought. In contrast, a strengths-based, solution-focused approach serves to create the safe place where shared practices, rather than individuals, are the center of attention. By focusing on what works well practitioners are encouraged to identify and build on existing strengths. A solution-focused approach used alongside VRE provides a scaffold for building improvement that is relevant to context. In this article, we discuss exnovation, the elicitation method of video-reflexivity, and the incorporation of a strengths-based solution-focused approach with VRE. We highlight the transformative and complementary qualities of these methods and draw upon practical examples from health care to demonstrate how they serve to strengthen and enhance each other.
  • References (23)
  • Citations (8)
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References23
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#1David W. Bates (Brigham and Women's Hospital)H-Index: 138
#2Hardeep Singh (BCM: Baylor College of Medicine)H-Index: 44
The Institute of Medicine’s To Err Is Human, published in 1999, represented a watershed moment for the US health care system. The report dramatically raised the profile of patient safety and stimul...
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#1Katherine Carroll (ANU: Australian National University)H-Index: 15
#2Jessica MesmanH-Index: 11
Hospital-based video-reflexive ethnography (VRE) is a collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals’ work practices and patients’ experiences. For more than a decade, the VRE methodology has spread throughout (research) institutions and hospitals internationally, and VRE has evolved and broadened. Different ways of doing VRE have implications for the role of the researcher. A thorough examination of th...
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Mannion and Braithwaite outline a new paradigm for studying and improving patient safety – Safety II. In this response, I argue that Safety I should not be dismissed simply because the safety management strategies that are developed and enacted in the name of Safety I are not always true to the original philosophy of ‘systems thinking.’
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#1Charles Vincent (University of Oxford)H-Index: 75
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Background Every safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthcare over the last 20 years but are now subject to critique and reassessment. In this paper, we reconsider the purpose and value of incident analysis and methods appropriate to the h...
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Objective To determine physician characteristics associated with exnovation (scaling back on use) and de-adoption (abandoning use) of carotid revascularization. Design Retrospective longitudinal cohort study. Setting Medicare claims linked to the Doximity database provider registry, 2006-13. Participants 9158 physicians who performed carotid revascularization on Medicare patients between 2006 and 2013. Main outcome measures The primary outcomes were the number of carotid revascularization proced...
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The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the ‘innovation’ paradigm, and this paradigm is predominantly ‘gadget thinking’. Others’ solutions are to be adopted here because they produce great outcomes elsewhere. Except now we have to figure out how we can get the gadget to work. Few commentators have been game to shift towards acknowledging that care practices are ...
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