Video ethnography and reflexivity for the multidisciplinary team in cardiac theatres

Abstract

Communication is a complex social skill that is constantly being refined and developed through our experiences. Development of communication skills is an iterative process and reflecting on past experiences enables one to critically analyse the effectiveness of their interactions with others. The concept of reflexivity provides a platform for self-analysis and self-evaluation; it is a highly personal and sometimes challenging technique that provides real time feedback. The aim is to elucidate the understanding between the healthcare professions and encourage development of team practice. In this study we have decided to use the combined approach of video ethnography and team reflexivity as described before by Carroll and colleagues.1 Data collection took place in cardiothoracic theatres of a tertiary referral hospital in South East London. Footage was captured during periods of inter-disciplinary communication such as: WHO checklist, going on cardiopulmonary by-pass (CPB), coming off CPB, and the sign-out phase. Selected clips were presented to the team in a debrief session where the facilitator guided discussions by encouraging individuals to critically analyse their performance and verbalise emotions and thoughts behind actions. Reflexive discussions revolved around power struggles displayed by the nurse trying to gain the team's attention, which lead to the surgeon taking lead of the situation. Flattening of the hierarchy is important hence members identified innovative techniques to enhance communication, including the use of a microphone during the sign in and out period. Most notably, the team suggested the development of a monitor for the perfusionist showing the surgical field, as miscommunication during CPB off phase could have severe consequences for the patient. Additional ideas included the use of a coding system during sign-out at the end of the case. All of these techniques draw attention to the dynamic nature of social interactions and increasing awareness of this has allowed individuals to guide their own practice within a complex unit. Effective use of videoethnography and reflexivity (VRE) has shown to improve teamwork, dissolve power relations, and equip participants with personalised constructive feedback. Healthcare is a dynamic environment, and we need to build our work force to face the challenging tasks in a clinical setting. The use of reflexivity lends itself to ideas of improvements by change, hence allowing personal and professional development. Reference1.Carroll K, Iedema R, Kerridge R. Qual Health Res 2008; 18: 380–90