Jessica Mesman (J.)
EXNOVATION: ANOTHER PERSPECTIVE ON PATIENT SAFETY
Safety issues top the agenda in health care. Recent studies show an unacceptably high level of adverse events and near misses. Examples of adverse events are transfusion errors, adverse drug events, wrong-site surgery, restraint-related injuries or deaths, preventable suicides, burns, falls or treatment-related infections. Much of the current patient safety research is on the detection of causes of incidents and near misses. Based on the outcome, protocols and devices are adjusted or developed to eliminate these causes of adverse events. However, considering the high-risk work environment we have reason to wonder why things don't go wrong more often in these complex care settings. Therefore, my research project is not so much interested in the gaps in the safety net, but in the structure of the net itself, notably its informal or unarticulated dimensions. After all, besides the intended formal measures, patient safety is also achieved by an unplanned but effective set of initiatives. In other words, the aim of my project is to explicate the hidden competence and informal built-in structures that are part of systems of safety.
This analytical scope and effort can be understood as an act of ‘exnovation': that which is already present in practice is foregrounded and the implicit is made explicit. Importantly, it offers a new perspective on the staff members' own competence, inventiveness, and the structure that comes with specific styles of ordering day-to-day practices. Explicating and analyzing the role of informal competencies will contribute to our understanding of effective preservation of patient safety. Additionally, it can increase practitioners' awareness of their available resources of resilience. As such this project is aimed to increase the ‘safety sensibility' of staff members and to offer alternative images of patient safety.
To identify the ‘hidden competence' of a practice, participant observation acts as the focal point of my methodology. The participant observation is specifically geared to the location of high-risk situations in the treatment trajectories in order to identify the resources involved in the constitution of a safe practice. The Neonatal Intensive Care Unit (NICU), which specializes in care and treatment of severely ill newborns, is my field of study. My observations on the NICU ward allow me to identify and understand the situational rationalities involved in the preservation and recovery of patient safety in the specific context in which it occurs.
Carroll, K, & Mesman, J. (2018). Multiple Researcher Roles in Video-Reflexive Ethnography. Qualitative Health Research. 28(7), 1145-56.
Hommels A., Mesman, J and Bijker, W.E. (Eds.). (2014) Vulnerability in Technological Cultures. Minneapolis: The MIT Press
Iedema, R., Carroll, K., Collier, A., Hor, S., Mesman, J., &. Wyer, M. (2019). Video-Reflexive Ethnography in Health Research and Healthcare Improvement: Theory and application. Boca Raton, FL: CRC Press
This innovative, practical guide introduces researchers to the use of the video reflexive ethnography in health and health services research. This methodology has enjoyed increasing popularity among researchers internationally and has been inspired by developments across a range of disciplines: ethnography, visual and applied anthropology, medical sociology, health services research, medical and nursing education, adult education, community development, and qualitative research ethics.
Iedema, R., Mesman, J. & Carroll, K. (2013) Visualising Health Care Practice Improvement: Innovation from within. Boca Raton, FL: CRC Press
Why is it that in spite of all the health policy reforms, clinical practice innovations, increasing intersectoral interdependencies and new medical and information technologies, so little has changed in the way we research and evaluate health care? Don't these changes cry out for new ways of being studied and appraised? And don't our approaches to clinical practice innovation cry out for being reinvented too? Surely, we cannot continue to wheel out research and evaluation paradigms, improvement approaches and methods that were designed for 20th century problems and 20th century health care, and assume they will be able to make sense of the problems we experience and the care we provide in the 21st century? These changes necessitate a new paradigm of health service research, evaluation and improvement and this new model adopts approaches and methods that embrace complexity. The approaches and methods can account for the vicissitudes of front-line care, the activities of front-line staff and the experiences of patients and families - where care happens. Visualising Health Care Practice Improvement draws on years of video feedback research shaping an approach that enables not only a retrospective understanding but also a view into the future, of what might be possible. It presents the argument that change is not principally about adopting solutions from elsewhere but that it is conditional on people exploring whether proposed solutions suit existing habituations. It involves a process of exploration, discovery, secession and renewal. Health care managers, policy makers and shapers will find this book enlightening. It will also be empowering to all health care professionals and front-line staff.
