A transactional approach to patient safety: understanding safe care as a collaborative accomplishment

Abstract

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Video-reflexive ethnography (VRE): a promising methodology for interprofessional collaborative practice research

“…Through the use of video, seemingly mundane and routine activities can reveal habituated practices, reactions and skills taken for granted, and complex interprofessional transactions that make up every day clinical situations. Building on Pedersen and Mesman's (2021) argument, interprofessional practice may be seen as an ongoing, situated, and coconstructed achievement which is not attributable to any individual factor; rather, it is a thoroughly collaborative accomplishment. In this way, the use of video as a method can play an important role in capturing the situated work practices at play in interprofessional collaborative activity.…”

“…This issue of the Journal of Interprofessional Care presents exceptional research undertaken by Carroll et al (2021) in the USA and Pedersen and Mesman (2021) in the Netherlands utilizing Video-Reflexive Ethnography (VRE). Carroll et al present research completed at the Mayo Clinic involving the breast cancer surgery team and the frozen section laboratory team in scrutinizing video footage of their interprofessional collaborative practice: breast tissue is surgically removed and sent to the lab for testing, and biopsy results are made available soon after to the surgeons to enable them to decide whether to finish their operation or continue the surgery.…”

“…The clinical outcomes of this Mayo Clinic practice include the lowest reoperation rates for breast lumpectomy in the USA. Pedersen and Mesman (2021) delve deeper into the underlying methodological assumptions and arugments for VRE, using an example from a video-reflexive meeting at a neonatology ward in a Dutch hospital during which clinicians discussed the use of sterile gloves. Specifically, Pedersen and Mesman draw on John Dewey's writings to position patient safety, and interprofessional collaborative practice, as a transactional accomplishment dependent on situated and shared habits whereby humans and their environments are inseparably linked.…”

Evaluating the safety and quality of portable x-ray imaging in a new infectious disease biocontainment unit: an in situ simulation and video-reflexive study

“…VRE has been used in a variety of settings to explore what creates safe care and to improve healthcare practices. Examples include: infection prevention and control (25)(26)(27)(28)(29)(30)(31); palliative care services (32); interprofessional communication and collaboration (3,33,34); clinical handover and ward rounds (35)(36)(37); polypharmacy management (38); and medical training and education (39)(40)(41). With regard to healthcare facility design, Collier et al (42), used VRE to explore how people, nearing the end-of-life, experience healthcare spaces as safe or unsafe.…”

Ethics in action

“…According to Mesman and Carroll (2021), exnovation amalgamates "excavation" -digging out and exposing what is already there -and "innovation from within" -using what is already there as resources for improvement (p. 157). This understanding of exnovation has guided a variety of practice improvement studies in healthcare settings spanning, among others, interprofessional communication , patient safety (Pedersen and Mesman 2021), infection control (Wyer et al 2015) and palliative care (Collier et al 2018). These studies acknowledge the abilities of healthcare practitioners to order their dayto-day practices and creatively respond to tensions, conflicts as well as unexpected disruptions.…”