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Visualising healthcare practice improvement: innovation from within
  1. Myles Leslie
  1. Faculty Research Associate, Johns Hopkins School of Medicine, Armstrong Institute for Patient Safety and Quality, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202, USA; mleslie2{at}

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Iedema R, Mesman J, Carroll K. Published by Radcliffe Publishing Ltd, London, 2013, pp 232, £35.99 (paperback). ISBN-10: 1846194504; ISBN-13: 978-1846194504

Rick Iedema, Jessica Mesman and Katherine Carroll have written an important book for those interested in solving the challenge of achieving and sustaining local ‘buy in’ for patient safety and quality improvement (QI). Their highly readable text is delivered in two parts, with the first half of the book introducing a strong theoretical foundation for their novel interventional methodology. The second half presents case studies of that method—video reflexive ethnography (VRE)—applied to real-life safety and QI challenges in clinical environments that range from postoperative recovery room handovers, to general medical ward rounds.

VRE deploys video footage to engage clinicians in self-reflection on the complexity of the work they perform. The book's main argument is that drawing clinicians’ conscious attention to areas of practice that have become unconscious and habitual is central to generating locally viable and sustainable QI. The authors develop a practical science to make “moment-to-moment complexity [in care delivery] visible, speakable, and (re)designable” (p. 13).

A robust understanding of how and why an intervention is assumed to work is central to implementation success,1–3 and the authors take this seriously. They ground their introduction of VRE in theories thoughtfully selected from physics, mathematics, neuroscience, education and philosophy. The book's point of departure is that contemporary care delivery is irreducibly complex, and that “clinical staff need to be provided …

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  • Competing interests None.

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