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Supporting teams to learn and improve together using video-reflexivity

By capturing working practices on film teams are able to discover together areas for learning and improvement. We anticipate that a toolkit will support organisations to adopt this novel approach.

Read comments 18
  • Shortlisted idea
  • 2022

Meet the team


  • Siobhan McHugh
  • Atiyah Ahmed
  • Carol Close
  • Deborah Horner
  • Will Griffiths
  • Lisa Falkingham
  • Will Moule

What is the challenge your project is going to address and how does it connect to the theme?

Improving the quality of healthcare is challenging owing to the complexity of  healthcare delivery: there are many people, processes and systems all working simultaneously.

Using digital technology, VRE enables teams to rapidly capture aspects of care delivery on film to identify areas for improvement.  Teams reflect on ‘work as done’ rather than ‘work as imagined’ in order to discover together things they want to improve.  Originally used as a research method, VRE has been adapted for use in improvement.  Evidence suggests that it can deliver better outcomes for staff, patients and organisations, is low cost and can be applied across multiple settings, contexts and sectors.

At BTHFT, working closely with healthcare research colleagues at the Bradford Institute for Health Research we have used successfully used VRE to improve handovers on Labour ward.  We want to use it with other teams but to date there is no formal resource or toolkit.

What does your project aim to achieve?

The aim of this project is to provide a pragmatic guide, with key tools and tips to support healthcare staff to use VRE as a way to make care better and safer for patients and staff.


1. To co-design a practical video-reflexivity ethnography electronic toolkit with staff and patient representatives at Bradford Teaching Hospitals NHS Foundation Trust.

2. To test the toolkit using a quality improvement approach within a larger Service Improvement Programme for Theatre Services.

3. To evaluate the usability of the toolkit with staff and patient representatives.

We anticipate that VRE will support staff and patients to make meaningful changes to care.  Enabling teams to feel psychologically safe to question the usual ways of working is part of the approach.   Reducing health inequalities is about making sure key voices are heard and empowered to be part of designing solutions for improvement.

How will the project be delivered?

We have drawn upon the expertise and knowledge from healthcare researchers to help apply VRE as a  a quality improvement tool. We have tested VRE in the maternity setting with success.  However, we want to support clinicians to be able to use this low cost approach without expert support.  By designing a VRE electronic toolkit, we will provide a walkthrough guide to support learning and improvement.

Working with researchers, the quality improvement team, the Organisational Development team, clinical staff and patient representatives we will use the principles of co-design to develop the toolkit.

We will test the toolkit using an QI approach (Model for Improvement) and small scale tests of change .  This will allow us to test the idea safely and make adjustments rapidly.  Impact will be measured in terms of outputs from VRE QI projects, staff and patient experience and well being and financial costs.

How is your project going to share learning?

This toolkit could be potentially used by any team, in any healthcare setting to explore the moment-to-moment complexities in clinical care.  The toolkit will be designed to be used electronically with the ability to create paper documents if required.  Q members will have access to the entire toolkit, case studies, the practical tips and costings if an organisation would like to use the approach.  We aim to have videos how to use the toolkit available on line and potential virtual training could be provided.

We believe this is a fantastic way to shake-up the old world of doing, bringing together methods of improvement and digital solutions to enable better outcomes for all and faster, more sustainable change.  VRE helps to support the very ethos of a patient safety culture – where learning and improvement is enabled and owned by organisations, teams, staff and patients.

How you can contribute

  • Promotion - We need champions to help get our idea notice and generate excitement about the possibilities
  • Networking - This tool could have wide application and we are looking for similar ideas
  • Critical friends - Gathering feedback or testing out the tool in different settings are very welcome!
  • Strategy - This approach helps to support the NHS Patient Safety Strategy and could a useful low cost tool

Plan timeline

21 Mar 2022 1. Start Out: Setting up (months 1 to 2)
21 Mar 2022 2. Design and Plan: Co-design work shops (months 3 to 6)
21 Mar 2022 3. Test and refine the toolkit: PDSA cycles (months 7 to 12)
21 Mar 2022 4. End stage: Final product, evaluation and dissemination (months 13 to 15)


  1. Really like this proposal! Casted my vote :)


  2. Guest

    Alison Powell 1 month, 1 week ago

    Used VRE in our improvement journey, was a great opportunity to test new tools and see how they can support improvement journeys and learning as an MDT.

  3. A fantastic and much needed project idea which will help make this powerful method more accessible! Im sue you are doing this, but I think it will be important to capture and emphasise factors that underpin successful use of the toolkit. Really excited to see how this project progresses - good luck!

    1. Guest

      Siobhan McHugh 1 month, 1 week ago

      Thanks Ruth - that's a really good point. It will be really important for us to understand the feasibility of use of the toolkit, but like you say how it is being used successfully so that this learning itself can be shared and replicated in different contexts.

  4. Great idea and really powerful approach to understand and improve

    1. Guest

      Siobhan McHugh 1 month, 1 week ago

      Thanks Robin. It is a really powerful tool which is why we want to make this accessible to all NHS organisations rather than it being purely used in health services research. In fact, it would be much more useful as a continuous learning and improvement tool at an organisational level!

  5. Guest

    Great idea. Such a powerful way of learning together (healthcare staff and patients) to identify areas for improvement. This tool would be effective for healthcare teams to reflect on uncivil interactions and behaviours from multiple sources (e.g. peers, managers, patients, relatives) without researcher/observer interference. Could VRE be used to address incivility within teams? 🤔

    1. Guest

      Siobhan McHugh 1 month, 1 week ago

      This is a really interesting question! I wonder if the process of learning collaboratively might go some small way to reducing levels of incivility too. It may be that focusing specifically on incivility in video footage might create problems if the collective reflexive sessions aren't well facilitated, but from experience there was an element of individual learning for all staff from the footage in addition to collective improvement ideas, so I wonder again if that individual learning might help individuals to reflect on behaviours at all levels?

  6. Guest

    Beth Fylan 1 month, 1 week ago

    This sounds like and exciting, innovative project and one which can support team improvement as well as strengthen working relationships.

    1. Guest

      Siobhan McHugh 1 month, 1 week ago

      Thanks Beth. Absolutely - the work underpinning this idea found that, in addition to prompting staff-led improvement, benefits extended to improvements in team morale, team working and staff well-being.

  7. Guest

    Sallly Moore 1 month, 2 weeks ago

    Sounds like a brilliant way to integrate your research into practice

    1. Guest

      Siobhan McHugh 1 month, 1 week ago

      Thanks Sally. I certainly hope so. It feels more important than ever that we can develop a tool to support staff-led ideas for change and improvement.

  8. Guest

    This sounds like a fantastic idea. Often how we talk about what we do/did differs from what actually happens. This method will help us all learn together. Love it!

    1. Guest

      Siobhan McHugh 1 month, 1 week ago

      Thanks so much Erin. Absolutely - capturing in situ video footage is a perfect way to make visible all of the invisible work that is done by healthcare staff on a daily basis. This tool means that staff can discover positive aspects of their work, whilst also making sure ideas for improvement are led by those people who are doing the work.

  9. Guest

    LeeAnne Elliott 3 months ago

    Great idea to support all staff in a team and patients in identifying areas for improvement while reviewing work as done with opportunity to continue to review as changes tested.

    1. Guest

      Liz Tomlin 3 months ago

      Thank you LeeAnne - it could be a great way to understand lots of different kinds of issues. - theatre stores want to use it to work out the best way to organise equipment to save time and reduce costs and increase efficiency!

  10. Great idea! Hope it goes well.

    1. Thanks Anna!  I think it could be a really powerful tool to support staff to understand what really happens during care delivery and identifying things that matter.

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