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This issue of BMJ Quality & Safety presents a study conducted at the University of Michigan to evaluate ‘video reflexivity’ (VR, also referred to as VRE or ‘video-reflexive ethnography’) as a means for intervening in how physicians and nurses work together.1 The study found ‘increased reflection in both nurse and physician participants’, an outcome also reported (among other things) in related studies from the UK, Australia, New Zealand and the USA.2–6 ‘Increased reflection’ may not set the hearts and minds of quality and safety experts on fire. And yet this finding is significant.
Consider that healthcare improvement initiatives, patient safety research and system-wide implementation programmes have to come to terms with the implications of rising care complexity. This rise in complexity is due to increasing multimorbidity, mobility and migration, ageing, public assertiveness, technological advances, staff turnover, mounting information, scientific uncertainty,7 intensifying bureaucratic regulations and rising financial pressures, among many others. These confounders converge on day-to-day care, and they can tear up its routines and plans in an instant. Reflection on how to proceed amidst the resulting complex circumstances enables clinicians to navigate care more effectively—if by reflection we mean not …
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