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Formative evaluation of the video reflexive ethnography method, as applied to the physician–nurse dyad
  1. Milisa Manojlovich1,
  2. Richard M Frankel2,
  3. Molly Harrod3,
  4. Alaa Heshmati4,
  5. Timothy Hofer3,5,
  6. Elizabeth Umberfield1,
  7. Sarah Krein3,5
  1. 1 School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Department of Medicine, Indiana University, Indianapolis, Indiana, USA
  3. 3 Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  4. 4 Vancouver, British Columbia, Canada
  5. 5 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Milisa Manojlovich, School of Nursing, University of Michigan School of Nursing, Ann Arbor, Michigan 48109, USA; mmanojlo{at}


Background Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests that it is time to consider alternative approaches with greater potential to identify and improve communication than those used to date. We conducted a formative evaluation to assess the feasibility, acceptability and utility of using video reflexive ethnography (VRE) to examine, and potentially improve, communication between nurses and physicians.

Methods We begin with a brief description of the institutional review boardapproval process and recruitment activities, then explain how we conducted the formative evaluation by describing (1) the VRE process itself; (2) our assessment of the exposure to the VRE process; and (3) challenges encountered and lessons learnt as a result of the process, along with suggestions for change.

Results Our formative evaluation demonstrates that it is feasible and acceptable to video-record communication between physicians and nurses during patient care rounds across many units at a large, academic medical centre. The lessons that we learnt helped to identify procedural changes for future projects. We also discuss the broader application of this methodology as a possible strategy for improving other important quality and safety practices in healthcare settings.

Conclusions The VRE process did generate increased reflection in both nurse and physician participants. Moreover, VRE has utility in assessing communication and, based on the comments of our participants, can serve as an intervention to possibly improve communication, with implications for patient safety.

  • communication
  • qualitative research
  • patient safety

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  • Contributors MM conceived the idea, secured funding and led the study. AH, EU, MM and SK collected the data. RMF, MH, TH, SK and EU participated in data analysis and interpretation. All authors provided critical input into the article and have read and approved of the final version.

  • Funding This study was funded by the Agency for Healthcare Research and Quality (R03HS024760). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board of the University of Michigan Medical School.

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

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