Evaluation of video reflexive ethnography as a tool for improvement of teamwork and communication at the multi-disciplinary maternity unit handover

The implementation of video reflexive ethnography (VRE) is suggested to be a successful tool through which to prompt change and improvement at the inter-professional handover in acute healthcare. This thesis was designed to evaluate VRE as an improvement approach, focused on prompting improvement at the inter-professional clinical handover in an acute maternity team. The main aims of the work were to: 1) understand how team reflexivity has been implemented as a tool for improvement in inter-professional hospital-based healthcare teams, 2) to understand whether VRE is feasible and acceptable as a tool for improvement in an acute maternity unit, 3) the role of the facilitator in the successful delivery of VRE and 4) whether and how VRE was successful in prompting change and improvement. A mixed-methods approach was taken to address these main objectives, and a systematic review of the literature was conducted. Semi-structured interviews and ethnographic field notes were employed to gather data on the feasibility and acceptability of VRE, staff perceptions of the VRE process, and the contextual factors important in the successful delivery of VRE. Qualitative data from the reflexive feedback sessions was explored to understand how staff discovered potential issues from the video footage and collectively developed potential solutions. A short before and after survey was employed to gather the perceptions of the wider staff group on the changes to the handover process. The quantitative data generated was assessed using independent samples t-tests, and suggested significant perceived improvement in communication at the inter-professional handover. Qualitative data was assessed using a combination of inductive and deductive thematic analysis and adapted framework analysis, and illustrated the specific discoveries and solutions identified in the reflexive feedback sessions, as well as information about feasibility, acceptability and salient contextual factors in the delivery of VRE. The qualitative data was used to develop an initial logic model to map the process of VRE. The thesis also considers the implications of the research and potential for future work, as well as limitations and the challenges of undertaking applied research in an acute healthcare environment.