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

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.

Person-centred data collection methods to embed the authentic voice of people who experience health challenges

“…This participatory method is an effective way of achieving partnerships with patients and consumers within health services 28 and provides a way for inclusion of those less visible and lacking representation. This was demonstrated in a study 29 where children took photos to explain things that were important to them, thereby facilitating children's control over the data.…”

“…30 Robust approaches and clear guidance are required about the taking of and use of photographs and specific consent obtained around the use of images in papers, conferences and other forms of dissemination. 29…”

“…VRE is a strength-based method and is about opening up or exnovating healthcare and recognising what works well in practice. 29 Exnovation is more than visualising a clinical episode of care, as its impact is evident in the video-reflexive sessions where clinical care is made explicit. 31 Wyer et al 34 used VRE to explore how patients nursed in isolation identify infection risks.…”

Generative Critique in Interdisciplinary Collaborations: From Critique in and of the Neurosciences to Socio-Technical Integration Research as a Practice of Critique in R(R)I

“…VRE researchers have rather been casted as mediators between different interests and facilitators of 'reflective spaces' ( [150], p. 203; [151], p. 33). Their task is to set reflective impulses and ensure the functioning of collective deliberation [152]. Similarly, embedded scholars could work with the STIR decision protocol to facilitate collective deliberation and unfold group decision-making in research teams.…”

Navigating and understanding organisational complexity in health services: The value of POSH-VRE

“…There is growing international interest in, and scholarship about VRE (Collier et al, 2019; Dadich, Collier, Hodgins, & Crawford, 2018; Mesman, Walsh, Kinsman, Ford, & Bywaters, 2019). Consider, for instance, the VRE International Association – ‘an international collective of like-spirited scholars and practitioners with an interest in… VRE as a transformative methodology’ (n.d., para.…”