BMJ Qual Saf 20:i83-i86 doi:10.1136/bmjqs.2010.046714
  • Challenges of professional education

Creating safety by strengthening clinicians' capacity for reflexivity

Open Access
  1. Rick Iedema
  1. Correspondence to Professor Rick Iedema, Centre for Health Communication, University of Technology Sydney, PO Box 123, NSW 2007, Sydney, Australia; r.iedema{at}
  • Accepted 6 December 2010


This commentary explores the nature of creating safety in the here-and-now. Creating safety encompasses two dimensions: revisiting specific behaviours by focusing on substandard performance (reflection), and a more broad-ranging attention to everyday behaviours that are taken as given (reflexivity). The piece pays particular attention to this second dimension of creating safety. Two techniques that promote reflexivity are discussed: video-filming real-time, everyday clinical practice and inviting clinicians' feedback about their own footage, and reflecting on the knowledge and questions that patients and families have about their care, and about unexpected outcomes and clinical incidents. The piece concludes that feedback about everyday practice using these methods is critical to enhancing the safety of everyday activity.


  • Funding The research reported on here was made possible thanks to grants awarded by the Australian Research Council and the Australian Commission on Safety and Quality in Health Care.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the University of Technology Sydney, University of NSW, as well as all relevant health service Human Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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