In the past two weeks, we have held two sessions of LEDS focused on video reflexive ethnography (VRE). VRE is an approach to research in healthcare improvement pioneered by Professor Rick Iedema, and developed by Rick and his colleagues over the last 15 years. On 20th March, we discussed Chapter One of Iedema’s recent co-authored publication Video reflexive ethnography in health research and healthcare improvement: theory and application (2019, CRC Press). Then, on 27th March, we were very pleased to welcome Rick to an informal Q&A session following his seminar to the Centre for Language and Communication Research here at Cardiff University.
VRE uses the tool of video recording of healthcare processes and practices, combined with engagement of healthcare practitioners and patients in reflexive feedback sessions structured around viewing and discussion of video extracts, to encourage a focus on how individuals can improve care in complex situations by attending to and changing their everyday practices. VRE research adopts a post-qualitative and participatory stance, within which practitioners and patients are co-collaborators in the process of recording and reflecting upon everyday working practices in order to improve them.
In the discussion on 20th March, we considered some of the similarities and differences between VRE and linguistic ethnography (LE). Both approaches aim to make the familiar strange, or to bring a new perspective to bear on a social situation. However, they emphasise the use of different tools and methods to achieve this: participant reflection on video footage as central to analysis in the case of VRE; and close linguistic or semiotic analysis by the researcher of social interaction in the case of LE. Some of the aims and goals of VRE and LE are clearly aligned – both, for example, seek to engage critically with social interaction – and there is potential for them to be used very fruitfully together.
An interesting exchange took place on the topic of whether or not VRE would be considered a form of LE, with individuals’ perspectives on how “language” is defined emerging as pivotal to their views. One aspect of VRE that the group noted as exciting, and novel, is the characterisation of complexity as something to embrace and engage with rather than try to make fit within a model. This has relevance for today’s increasingly complex social world, and for contemporary approaches to theorising it. VRE’s focus on care within complexity is well suited to modern healthcare contexts, but we pondered whether VRE could also be used in other sites of social interaction which (on the face of things) exhibit different levels of complexity.
In the Q&A on 27th March we had the opportunity to ask Rick some of these questions, and others, for ourselves. Themes covered in the Q&A included the elements of risk and face threat involved in doing VRE (for researcher and participants alike) and management of this; methodological issues such as how video is recorded and then selected for reflexive feedback sessions; and whether the increased familiarity that we all have with real-life video material in the age of social media and reality TV impacts on the use of video in research and professional practice.
Rick highlighted that, as with any linguistic ethnographic project, the relationships that are established between researchers and research participants are foundational and are central to the success of a VRE project. Putting care for participants and researchers at the forefront of VRE practice is therefore extremely important, since inevitably a relationship of trust is needed and must be fostered over time. There is risk inherent in individuals being invited to review their own working practices and each other’s, and this risk needs to be carefully and sensitively managed to promote a focus on the desired outcome of improvements in care.
We at LEDS would like to extend our sincere thanks to Professor Iedema for sharing his time, experience and expertise with us. Those present really enjoyed the thought-provoking session, and the topics raised are of relevance to several ongoing research projects.
If you would like to know more about VRE, take a look at the website of VREIA, the International Association of Video Reflexive Ethnographers. Also, the recent publication Iedema et al (2019) Video reflexive ethnography in health research and healthcare improvement: theory and application (CRC Press) covers both the theoretical grounding and practical dimensions of VRE research, and is highly informative. Happy reading!