# FAQ's

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<summary>General</summary>

**What happens if a mistake is recorded?**

* **Answer:** Mistakes should be reported regardless of video evidence. Clarify your hospital's incident reporting protocols. Regarding legal use of the video, consult legal experts as regulations vary by region. Emphasize that the video's primary purpose is for internal learning and quality improvement and recordings are not used for any other purpose. The [NICU at LUMC](../../../level-1-fundamentals/4.-learning-from-success-stories#nicu-lumc) has made video recordings of resuscitation procedures a standard part of care and also part of the patient file, so these videos are visible to patients.

**How do you make it GDPR compliant?**

* **Considerations:** GDPR is specific to the EU. Adapt answers based on your location's privacy laws.
* **Answer:** Explain the purpose (quality improvement), how the video will be used, data security measures, and their rights (access, deletion). Obtain written consent. Consult your hospital's legal/data protection officer if needed.

**What if there's not enough time to ask patients for consent?**

* **Considerations:** Emergency situations complicate consent. Laws allow for exceptions, but consult legal advisors or an ethics committee on your region's specific rules.

**Can parents see or have the video? How do you ensure they won't post it everywhere?**

* **Considerations:** This may vary based on regulations and consent specifics. For example, in [neonatal care, parents value the review of a recording](https://app.gitbook.com/s/MdMcavmFWyJ3gxr9PXYq/summaries-articles/dive-in-the-history-of-video-review-in-our-nicu).&#x20;
* **Answer:** Discuss parental access with your team. If permitted, have clear usage agreements covering distribution and social media restrictions, while emphasizing the risk of de-identification failure.

**How do you ask healthcare workers for consent?**

* **Answer:** We would recommend [to emphasize voluntary participation](../../level-1-fundamentals/3.-safe-simple-and-small/3.1-safe), explain the benefits, outline video usage (quality improvement, not performance evaluation), and give them control: consent to film, consent to review, consent to use in _Neoflix_.

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<summary>Implementation</summary>

**How do you involve nurses?**

* **Answer:** [Schedule video reflection](../../level-1-fundamentals/2.-planning-your-initiative) around nursing shifts and accommodate their input in the process.

**What kind of equipment do you use? Can you also use additional signals (CTG, respiratory parameters, etc.)?**

* **Answer:** Start [simple](../../level-1-fundamentals/3.-safe-simple-and-small/3.2-simple) (phone for practice), progress to dedicated cameras (GoPro). For syncing other signals, you'd likely need specialized software/hardware – this is an area for technical exploration.

**What can be challenging in rolling out/implementing this project?**

* [**Getting the team to turn on a camera**](../../level-2-in-action/6.-recording-equipment)**:** At some point, this becomes more automatic, but it remains an extra step providers have to take in what is sometimes an "acute" setting,

**How do you store the videos?**

* **Answer:** Secure data storage compliant with healthcare regulations and your hospital's IT policies. Specify encryption and access controls.

**How do you inform a team when setting up Neoflix?**

* **Answer:** Be [transparent about goals, benefits, and the emphasis on non-judgmental learning](../../level-1-fundamentals/2.-planning-your-initiative/2.2-gaining-team-buy-in). Start small, get early wins, and build enthusiasm.

**How much does it cost?**

* **Answer:** Break down costs: equipment (cameras, editing software), personnel time (coordination, reflection sessions), possible IT integration. Seek possible grants or funding sources within your hospital.

**How do you ensure a team films videos? Who picks up the camera? How do you start?**

* **Answer:** [Team leaders model enthusiasm and initiate recordings](../../level-1-fundamentals/2.-planning-your-initiative/2.1-pioneer-team). Make the process easy with clear instructions.

**How can you set up and expand video review? At what pace?**

You can [expand video review](../../level-3-growth/17.-continuous-improvement) at the pace of the healthcare workers. It's important not to make them feel like it's being imposed on them. If they see the value themselves, they will naturally become enthusiastic and come up with their own ideas that can be used to implement video reflection.

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<summary>Video review</summary>

**Who guides video review?**

* **Answer:** The[ chair](../../level-2-in-action/11.-lets-neoflix/11.3-tasks-of-the-chair) of the video review session. Representatives from all disciplines lead to more comprehensive discussions. Train them in facilitation and constructive feedback.

**How do you edit videos to make them usable for video reflection? How do you ensure integration with software?**

* **Answer:** Basic [editing](../../level-2-in-action/9.-after-the-intervention/9.2-simple-video-editing) is possible with many software options. For advanced features, a dedicated video editing suite might be needed. Integration with patient monitoring systems would need custom programming.

**How do you organize video reflection in a way that is safe and effective?**

* **Answer:** Organizing video review with regards to the [safe learning environment](../../level-2-in-action/11.-lets-neoflix/11.2-a-safe-learning-environment) included clear feedback rules (specific, non-judgmental), skilled chairperson to guide discussions, time management, and focused preparation for each video segment.

**How do you use video reflection to improve quality (effectiveness)?**

* **Answer:** [Identify actionable insights from discussions, develop and implement improvement plans, track changes or outcomes to evaluate success.](../../level-2-in-action/12.-improving-care-through-the-neoflix-approach)

**Can you perform multi-center video reflection without feeling judged?**

* **Answer:** Yes, with thorough preparation, ground rules, and a facilitator focused on collaborative learning, not criticism. Consider that a mistake as something that doesn't work and has reasons that can potentially be addressed. Or better yet, why does it usually go well? And [from that perspective, look at why something goes wrong.](../../../level-1-fundamentals/1.-preproduction/1.1-beyond-the-procedure#taking-a-different-approach)

**How do you keep video reflection running?**

* **Answer:** Shared ownership (multiple team leaders), streamlined processes, celebrating successes.

**What are the dangers of video reflection?**

* Blame culture. Focusing too much on perfect execution. Micromanaging. Emphasize that it's about learning how this team, in this context and in this situation, acts and makes choices. Consider: is there variation in how something could have been done, what factors influence the course of the situation, etc.?

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<summary>NICU LUMC specific</summary>

[Click here](../neoflix/streamlining-neonatal-care-a-success-story) for more information.

**How many videos have you recorded in total?**

* We expanded the Neoflix project in August 2021 with identifiable images.
* Since then, we have had 58 Neoflix episodes in about 2 years.
* In total, we have recorded 113 videos of 9 different procedures, and we are still counting.

**How do you analyze the data?**

* The videos are pre-discussed with those involved and then shown in a _Neoflix_ session. There, we evaluate the procedure in the video with the healthcare providers. Our project focuses on the Neoflix discussions. So we note what is said there, what points are raised, and how we can use that to make quality improvements. We then carry out action research (Plan-do-check-act) to improve quality and to see if it has had an effect. My research also focuses on action research and qualitative interview research.

**Is there currently a form of privacy/protection for the filmed employees?**

* The choice to be filmed is voluntary. Providers can also decide individually whether a video will be used in Neoflix.

**Could there be any rights attached to these videos?**

* We will delete the videos after the project. Before that, anyone can refuse to have a video used in Neoflix. We do not know whether they can be used in legal cases. This has also never happened since video reflection started in 2014.

**Where/in what situations do you see or expect the most added value of Neoflix?**&#x20;

* In acute or (neonatal) intensive care, it is difficult to reflect on complex/acute procedures, although they have a lot of influence on the patient or patient outcomes. Debriefing or evaluation of these moments is often limited by incomplete documentation or by recall bias (not being able to remember an event from the past well).
* Recording care and discussing videos with healthcare professionals among themselves allows them to reflect on care exactly as it is, in complete transparency. In addition, healthcare professionals also have the opportunity to learn from each other, something that is becoming less and less possible as healthcare professionals become more experienced. Video reflection gives healthcare professionals the opportunity to gain new insights to improve quality of care.

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