1.1 Beyond the procedure

Focusing your video review project

Self-Assessment

Routine can be the enemy of excellence, or at least, if you let it. We all fall into habits, losing the ability to see our own work objectively over time. Video becomes a powerful diagnostic tool on your own practice.

This type of honest self-assessment is a hallmark of continuous improvement. By pinpointing areas for targeted refinement, you unlock your potential and deliver even better care. No matter your specialty, video offers an objective lens, letting you analyze everything from technical skills to the nuances of patient interactions:

• Optimizing Technique: Whether you're suturing, resuscitating, manipulating joints, or administering injections, identify inefficient micro-movements and optimize technique.

• Enhancing Communication: Analyze your nonverbal cues, explanations tailored to individual patients, and how well you address questions or concerns.

• Holistic Assessment: Capture your use of space, your body language, and how these may impact a patient's experience of care.

• Efficiency and Workflow: Analyze routine tasks within your specific role. Are there potential changes in equipment setup, communication with support staff, or documentation that could save you valuable time?

• Research & Training Aid: Even without anonymizing footage, your own recordings can become a valuable tool for developing in-house training materials or refining protocols.

Bridging Gaps

Modern healthcare is a complex ecosystem where specialists, support staff, and researchers work together to deliver the best possible patient outcomes. However, fully understanding the patient experience from every angle can be a challenge. This is where video becomes an invaluable tool:

• Shattering Silos: Video offers a unique window into the work of other teams. See how decisions in one department impact downstream care, fostering empathy and a more holistic view of the patient journey.

• Collaborative Learning: Analyze procedures as a multidisciplinary team, identifying opportunities to optimize workflows, streamline handoffs, and minimize delays.

• Breaking Down Knowledge Barriers: Written reports can only go so far. Video lets less experienced staff "see" how senior colleagues approach complex cases, promoting skill sharing and faster learning curves.

• Fostering a Unified Vision: By revealing how individual actions contribute to the bigger picture, video strengthens the sense of shared purpose and teamwork, crucial for optimal patient care.

Taking a different approach

Studies on video review often focus on quality improvement by measuring a decrease in errors or deviations from guidelines. However, this approach has limitations; it emphasizes safety by minimizing negative outcomes (the Safety-I approach), assuming mistakes stem from individual technical, human, or organizational failures. In the increasingly complex world of healthcare, a newer safety model has emerged: Safety-II. This approach focuses on the ability to succeed under varying conditions, acknowledging that real-world practice often differs from idealized guidelines. Instead of solely analyzing mistakes, Safety-II studies how things usually go right, providing insights into occasional failures. It values learning from variability and performance adjustments as a source of new knowledge.

Safety-II Hollnagel et al. (2013

By visualizing these essential components of care, video review becomes an invaluable quality improvement tool. Reviewing workflow clarifies team member responsibilities and reinforces effective communication. This aligns with the Safety-II approach, which focuses on enhancing a system's ability to succeed under varying conditions and optimizing everyday outcomes. When reviewing videos with all providers involved in hands-on care, opportunities for improvements in daily performance become visible.

By adopting a Safety-II approach, you will learn about your team's resilience and adaptability. However, you also don't ignore failures. Safety-II acknowledges that errors and incidents happen, but it focuses on learning from them without assigning blame.

This may result in a positive environment, coming from a shift in perspective. Instead of constantly looking for what might go wrong (Safety-I approach), Safety-II helps you build on the existing strengths and capabilities within the system.

In contrast, the Safety-I approach often centers around finding causes of failure and preventing them in the future. This can unintentionally put a spotlight on individuals' mistakes. If the organizational culture isn't strong in terms of psychological safety, a Safety-I approach can reinforce a fear of blame. Providers might worry their recorded mistakes will lead to punishment or negative consequences. While mistakes always provide learning opportunities, Safety-I inherently focuses more on what went wrong than what goes right. This can create additional anxiety for providers, knowing that their videos will be analyzed primarily for errors.