So much for blog entries every month! We have all been affected by the SARS-CoV-2 virus that causes the disease COVID-19 in one way or another. I hope you are all well during these unprecedented times. I’m not sure if monthly blogs will continue. It may be better to blog when some event transpires that would benefit from a patient safety angle that takes a “bottoms up” approach such as video reflexive ethnography (VRE). However, I do want to finish a project I started in the Fall to bring attention to each of the four pillars of VRE. To recap: in December we talked about exnovation, the topic of January’s blog was reflexivity, and in March we discussed care. So collaboration is the subject for this month.
Collaboration in VRE has a specific meaning. When we as researchers approach potential study participants our mindset has to be one of thinking of participants as co-creators of whatever it is we are investigating. We do not call our fellow collaborators “subjects” because to do so would imply that they are passive actors in a world that we want to create, instead of active co-creators of that world with us. We invite participants as collaborators in research with us because VRE is grounded in the here-and-now, so whatever is revealed through the eye of the video camera cannot be known in advance. We as researchers don’t know what we will find because no procedure is ever completed the same twice. It’s a bit like dipping your toe into a river, you never dip your toe into the same river twice because the water is constantly moving.
What I really like about the picture accompanying this blog is that it shows how many people have to come together to put together the various pieces of a puzzle. Each person has access to only one or at most a few of the pieces, and only in collaborating will all pieces fit and the entire meaning of the puzzle be revealed. VRE unfolds in much the same way. Our clinical partners practice in certain ways and because their practice behaviors become habitual over time, the practices lose their salience to the clinicians because they no longer have to think about a specific practice every time it is performed. On the other hand, as researchers we observe what clinicians do and are awe-struck by their ability to perform some activity in what we might perceive to be trying circumstances or under unfavorable conditions. Clinicians may come to us and ask that we review some practice (especially one associated with poor quality care, or one that has flummoxed clinicians’ abilities to find an answer themselves) but we cannot engage with them unless it is through the lens of partnership or collaboration. Clinicians are the experts on what they do, and are the closest to care as it unfolds in real time but we have to be invited to share in their world because it is important to capture the actual practice and not some artificial facsimile of it. Participants should be encouraged to become more active also in directing or filming the footage, because in doing so they may experience a shifting of power relations, which is typical in other participatory methods. Carroll and Mesman point this out in a recent paper, saying that in certain situations researchers may not be needed because the clinicians themselves take full responsibility for practice change.1
To achieve the co-creation of meaning (what might also be called data collection) requires a partnership or collaboration. Collaboration goes beyond data collection though. It also encompasses analysis and re-design of some practice, if necessary. VRE analysis activities include watching video clips with participants soon after they are filmed as a way to member check2 and ask participants, “Did we get it right?” If we didn’t get it right, then more filming is needed and participants can specify exactly what, how, and when to capture the practice in question. Collaboration is necessary in the next phase of analysis too where the task involves choosing from a number of clips to pick out those clips that highlight the practice best. Again, participants should collaborate with researchers to make decisions about which clips offer the best exemplar of some practice, in part because it is the clinicians who will be able to say why one specific clip is better than another. Analysis – and collaboration – then continue during reflexivity sessions where chosen clips are shown and participants comment on what they’ve seen. Finally, any suggestions for change or other actionable steps identified in reflexivity sessions are fed back to participants for them to prioritize and move forward. Without active, thoughtful, and deliberate collaboration, results at the end of analysis may bear little resemblance to the realities of clinical practice that were the genesis of the investigation in the first place. All of this is to say that in the VRE research arena the researcher role is more similar to a facilitator role than what is typically the case. The amount of control given over to participants to fully collaborate can be uncomfortable to researchers, especially for those who take a more quantitative approach to research and are used to controlling and manipulating data. However such control is necessary to produce valid and credible results.
In summary, VRE takes the stance that collaboration with participants extends to all research method phases because it is only through this type of collaboration that a clinical practice can be fully examined both for its strengths as well as any areas that could be improved. “VRE is a method designed to capture the daily, taken for granted, moment by moment interactions and expose these to reflection, subsequent understanding, and modification of practices.”3 A tall order but one made more satisfying and valid by having clinicians as collaborators.
References
- Carroll K, Mesman J. Multiple Researcher Roles in Video-Reflexive Ethnography. Qual Health Res. 2018;28(7):1145-1156. doi:10.1177/1049732318759490
- Morse JM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual Health Res. 2015;25(9):1212-1222. doi:10.1177/1049732315588501
- Mesman J, Walsh K, Kinsman L, Ford K, Bywaters D. Blending video-reflexive ethnography with solution-focused approach: A strengths-based approach to practice improvement in health care. Int J Qual Methods. 2019;18:1-10. doi:10.1177/1609406919875277