Rick Iedema

King's College London | KCL · School of Medicine

Professional identity formation is a relatively new area of interest within health professional education, gaining academic attention after the Carnegie Foundation Report on Medical Education of 2010 called for its introduction into medical curricula in the United States. This chapter presents a critical discussion, introducing various schools of t...

Background The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates lea...

Background Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers inclu...

Background: Health organisations are increasingly implementing ‘embedded researcher’ models to translate research into practice. Against specified aims, this paper examines the impact of an embedded researcher model known as the embedded Economist (eE) Program that was implemented in an Australian Primary Health Network (PHN) located in regional Ne...

Objectives We draw on institutional theory to explore the roles and actions of innovation teams and how this influences their behaviour and capabilities as ‘institutional entrepreneurs (IEs)’, in particular the extent to which they are both ‘willing’ and ‘able’ to facilitate transformational change in healthcare through service redesign. Design A...

Background: The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates le...

Background Variable rate intravenous insulin infusions (VRIIIs) are widely used to treat elevated blood glucose (BG) in adult inpatients who are severely ill and/or will miss more than one meal. VRIIIs can cause serious harm to the patient if used incorrectly. Recent safety initiatives have embraced the Resilient Health Care (RHC) approach to safet...

Purpose: The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of "slow science" as a critical yardstick. Design/methodology/approach: The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It...

The chapter provides an overview of both video-ethnography and video-reflexive ethnography. It relates these two orientations as providing complementary perspectives on socio-organizational complexity, and on enabling learning about that complexity. The first section provides background to the video-ethnographic and video-reflexive endeavours that...

Background Systematic approaches to the inclusion of economic evaluation in national healthcare decision-making are usual. It is less common for economic evaluation to be routinely undertaken at the ‘local-level’ (e.g. in a health service or hospital) despite the largest proportion of health care expenditure being determined at this service level a...

Objective: The aim of the study was to determine from patient-reported data the relationships between patients' experiences of adverse events (AEs), the disclosure of the events, and patients propensity for complaints or legal action. Methods: A cross-sectional survey was administered to 20,000 participants randomly chosen from the 45 and Up Stu...

Background Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers inclu...

This last chapter offers a brief conclusion to the book, emphasising that becoming undone comes about through submitting to that which is bigger than us. COVID-19 and the Australian bush fires are events that are bigger than us, and that will have the effect of engendering a more widespread realisation of becoming undone and a greater sense of life...

This chapter discusses how being moved may engender ecstasis, or ‘standing outside’. It reviews the evolutionary anthropotechnics that made possible such ecstasis. The chapter then asks the question: if becoming is inscribed into life, and if this renders becoming undone likely if not inevitable (before or as death), how are we to understand the co...

This first chapter starts with a description of organisational transgression and dysfunction that affected many people and that became publicised through a number of governmental inquiries, research into organisational ‘incidents’, media reports of scandals, and the like. The chapter then shifts gear to question whether framing these dysfunctions a...

This chapter describes the impact of becoming undone and explores its consequences for the theorisation of meaninglessness. The discussion touches on the effacement of self and moves on from there to address the significance of passivity and of ‘passivity competence’. Bypassing narratives that privilege self-reinvention of self after loss, the chap...

This chapter delves more deeply into affect as descriptor of specific aspects of life. In doing so, I address Wetherell’s concept of ‘affective practice’ and rehearse Martin’s, Leys’ and Mazzarella’s critiques of affect as unqualified, autonomous energy. I next pose, the following question: if some scholars (like Wetherell, Leys, Martin and Mazzare...

This chapter explores the various ways in which being affected may enhance our capacity to act. This involves reviewing claims regarding human’s primordial prosociality, their empathy and sympathy, and the apparent intensification over time in human foresight and affective constraint. Effectively a thesis about human self-domestication, this intens...

“In this book, Rick Iedema shows with profound analytical precision the existential strength of ‘being moved’ and being affected. Departing from a life being shattered, the books exposes with the help of Spinoza, Sloterdijk, and others, the many dimensions of ‘becoming’. Written during the COVID-19 crisis and extreme bushfires a short distance away...

This article has three aims. First, it will set out the ‘potentiating’ premises of video-reflexive ethnography (VRE) and the ways in which VRE potentiates learning through visual feedback as ‘self-irritant’ that invites ‘liminalisation’. Liminalisation invites people to learn by stepping away from their taken-as-given ways of being and saying. Pote...

Given the pace of technological advancement and government mandates for healthcare and system transformation, there is an imperative for change. Health systems are highly complex in their design, networks and interacting components and experience demonstrates that change is very challenging to enact, sustain and scale. Policy makers, academics and...

Background Efforts to address the complex global problem of antimicrobial resistance (AMR) highlight the need for imagination and innovation. However, nursing has not yet leveraged its potential to innovate to prevent AMR advancing. Aims This paper focuses on the initial phase of an ongoing research and development study that seeks to foster nursi...

In this paper we undertake an innovative analysis of infection prevention and control (IPC) activities in hospitals, using non-representational theory of space (2005). We deployed video-reflexive ethnography in three wards in two metropolitan teaching hospitals involving 252 healthcare workers as participants. We analysed our data iteratively using...

Background: Maintaining optimal infection prevention and control (IPC) in a busy, clinical environment is challenging. Video-reflexive ethnography (VRE) is a collaborative, interventionist approach to practice improvement. We hypothesised that giving clinicians opportunities to view and reflect on video footage of everyday ward activities would ra...

Patient involvement offers many opportunities for surgical education. This chapter presents ideas and examples to stimulate new ways of designing educational experiences. Patient involvement in medical education is presented as more than storytelling; it is how patients can be active teachers, curriculum developers and assessors. Involving patients...

Background Professional identities are influenced by experiences in the clinical workplace including socialisation processes that may be hidden from academic faculty and potentially divergent from formal curricula. With the current educational emphasis on complexity, preparedness for practice, patient safety and team-working it is necessary to eval...

Background: Professional identities are influenced by experiences in the clinical workplace including socialisation processes that may be hidden from academic faculty and potentially divergent from formal curricula. With the current educational emphasis on complexity, preparedness for practice, patient safety and team-working it is necessary to ev...

Background Intravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in...

Background: Professional identities are influenced by experiences in the clinical workplace including socialisation processes that may be hidden from academic faculty and potentially divergent from formal curricula. With the current educational emphasis on complexity, preparedness for practice, patient safety and team-working it is necessary to eva...

Purpose The aim of this study was to explore the service and policy structures that impact open disclosure (OD) practices in New South Wales (NSW), Australia. Participants and methods An explorative study using semi-structured interviews was undertaken with 12 individuals closely involved in the implementation of OD in hospitals at policy or pract...

This innovative, practical guide introduces researchers to the use of the video reflexive ethnography in health and health services research. This methodology has enjoyed increasing popularity among researchers internationally and has been inspired by developments across a range of disciplines: ethnography, visual and applied anthropology, medical...

This article seeks to establish the educational and social significance of narrative and affect in anaesthetic training. Data were obtained from focus group discussions involving three groups of eight (total 24) young anaesthetists from around Australia held at an Australian and New Zealand College of Anaesthetists (ANZCA) residential conference. A...

This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in...

Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitg...

Objective Since Australia initiated national open disclosure standards in 2002, open disclosure policies have been adopted in all Australian states and territories. Yet, research evidence regarding their adoption is limited. The aim of the present study was to determine the frequency with which patients who report an adverse event had information d...

Objective: Evidence of the patient experience of hospitalization is an essential component of health policy and service improvement but studies often lack a representative population sample or do not examine the influence of patient and hospital characteristics on experiences. We address these gaps by investigating the experiences of a large cohor...

Purpose To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement. De...

Background Engagement is essential in trials research but is rarely embedded across all stages of the research continuum. The development, use, effectiveness and value of engagement in trials research is poorly researched and understood, and models of engagement are rarely informed by theory. This article describes an innovative methodological appr...

Background: Understanding a patient's hospital experience is fundamental to improving health services and policy, yet, little is known about their experiences of adverse events (AEs). This study redresses this deficit by investigating the experiences of patients in New South Wales hospitals who suffered an AE. Methods: Data linkage was used to i...

Aims: To examine user compliance and completeness of documentation with a newly designed Observation and Response Chart and whether a rapid response system call was triggered when clinically indicated. Background: Timely recognition and responses to patient deterioration in hospital general wards remains a challenge for health care systems globa...

Background: Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurse...

This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE) to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC). This study included...

Background Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical pract...

Background Process evaluations are essential to understand the contextual, relational, and organizational and system factors of complex interventions. The guidance for developing process evaluations for randomized controlled trials (RCTs) has until recently however, been fairly limited. Method/Design A nested process evaluation (NPE) was designed...

This paper considers the ways in which clinicians enact 'being a team', by analysing how they inform one another about critical patient information. The process where this information exchange happens is known as 'clinical handover'. The study that informs this paper spanned ten months of data collection in four hospitals, involving 150 clinicians...

Background Current guidelines for incident management and open disclosure emphasize team collaboration and openness yet little is known about how and to what extent junior doctors and nurses view and integrate these principles into their learning and practices. Purpose This research aimed to compare and contrast junior doctors and nurses' attitud...

Aims and objectives: To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients. Background: Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Fi...

In recent years, healthcare incident disclosure has gained increased attention from policy makers, academics, insurers, clinical professionals, patients and consumer groups and lawyers (Australian Commission on Safety & Quality in Health Care, 2013; Clinton & Obama, 2006; Lamo, 2011; Levinson & Pizzo, 2011; Sage et al., 2014; Studdert & Richardson,...

Objective The aim of this study was to investigate patients' and families' perspectives of safety and quality in the setting of a life-limiting illness. Design Data reported here were generated from a qualitative study using video-reflexive ethnographic methodology. Data were collected over 18 months and generated through participant observation,...

Objective: This study aims to determine the likelihood that rural nurses perceive a hypothetical medication error would be reported in their workplace. Design: This employs cross-sectional survey using hypothetical error scenario with varying levels of harm. Setting: Clinical settings in rural Tasmania. Participants: Participants were 116 el...

Abstract Isolation of patients, who are colonised or infected with a multidrug-resistant organism (source-isolation), is a common practice in most acute health-care settings, to prevent transmission to other patients. Efforts to improve the efficacy of source-isolation in hospitals focus on healthcare staff compliance with isolation precautions. In...

Purpose: Preventable patient harm due to adverse events (AEs) is a significant health problem today facing contemporary health care. Knowledge of patients' experiences of AEs is critical to improving health care safety and quality. A systematic review of studies of patients' experiences of AEs was conducted to report their experiences, knowledge g...

Objective: To strengthen clinicians’ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants: Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outc...

This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the "ICTs for healthcare development" model to ascertain be...

We are investing considerable resources in defining and measuring patients’ care expectations. Such measurement will yield insight into whether and how services are meeting patients’ experience expectations. But because measurement is inherently distanced in time and space, it does not resolve patients’ experience of feeling ‘reluctant to directly...

While 'home' is cited most frequently as being the preferred place of death, most people will die in institutions. Yet, the meaning and significance of home for people nearing the end of life has not been fully explored. The aim of this article is to critically examine the meaning of home for dying patients and their families. The qualitative study...

Introduction: User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with se...

Aims and Objectives. This paper explores patients’ perspectives on infection prevention and control. Background. Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front- line clinicians’ practices; patients’ roles have been less explored. Design. Video-ref...

The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the ‘innovation’ paradigm, and this paradigm is predominantly ‘gadget thinking’. Others’ solutions are to be adopted here because they produce great outcomes elsewhere. Excep...

This article outlines the main tenets of affect theory and links these to Sloterdijk’s spherology. Where affect foregrounds prepersonal energies and posthuman impulses, spherology provides a lens for considering how humans congregate in constantly reconfiguring socialities in their pursuit of legitimacy and immunity. The article then explores the r...

Discussion of unanticipated problems in care with patients and their families ('open disclosure') is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice. We consider some reasons for...

If there is anything that is unique about Bruno Latour’s body of work, it is his inclination to question not just others’ practices and assumptions (notably that of scientists), but also his own. In that regard, Latour’s philosophy differs markedly from that of The Pink Panther’s Inspecteur Clouseau: Housekeeper: You’ve ruined that piano! Inspecteu...

This paper discusses the role of video-based research methods in social research. The paper situates these methods in the context of rising levels of visibility of professionals in government-funded organisations. The paper argues that while visual research may appear to play an ambiguous role in these organisations, it can also enable practitioner...

Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Austra...

Introduction Evidence of patients’ experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit; investigating the experiences of a large cohort of recently hospitalised patients aged 45 year...

Background The built environment in acute care settings is a new focus in patient safety research, with few studies focusing primarily on the design of ward environments and the location and choice of material objects such as light fittings and hand-washing basins. Methods We report on an interventionist video-reflexive ethnographic (VRE) study tha...

Background Clinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the de...

Objective To analyse rural patients' and their families' experiences of open disclosure and offer recommendations to improve disclosure in rural areas.DesignRetrospective qualitative study based on a subset of 13 semistructured, in-depth interviews with rural patients from a larger dataset. The larger data set form a nationwide, multisite, retrospe...

In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice. Aim The aim of this work was to both critically evaluate and extend the current evidence base relating to o...

This presentation reports on a three-year Australian National Health and Medical Research Council funded project which focuses on strengthening clinicians’ infection control across a number of clinical specialties. The project is unique as it involves videoing in situ infection control practices, showing the resulting footage back to the clinicians...