The Art of Staying with Making & Doing: Exnovating video-reflexive ethnography

Jessica Mesman, Katherine Carroll

Research output: Chapter in Book/Report/Conference proceedingChapterAcademic


The breast surgeons knew their surgical practice was highly connected with those practices enacted by the surgical pathologists in the lab in order to provide them with an intraoperative evaluation of the surgical specimen. Yet as the surgeons and pathologists analyzed video clips of the laboratory procedures, they realized that the surgical-pathology team’s effectiveness was not only based on the presence of high-tech diagnostic instruments, but also on their communication and collaboration. Moreover, watching the footage made them aware that their collaboration was not the clearly demarcated structure they assumed it was, but a flexible, interdisciplinary, and cross-hierarchical web. To enhance this communication, the surgeons and pathologists developed a written template to better describe the orientation of the surgical specimen in the patient's breast. They also modified another communication procedure by co-developing a shared script for their use during pathology’s call-backs of pathology reports regarding the surgical specimen into the operating theatre. In so doing, report STS scholars Jessica Mesman and Katherine Carroll, the two groups of surgeons and pathologists expanded their definition of team success by adding interprofessional communication as critical to the outputs obtained from laboratory instruments.
The two professional groups – breast surgeons and pathologists - participated in "video-reflexivity" sessions designed to make visible their strengths and identify pathways for further improvement. Mesman and Carroll describe video-reflexive ethnography as a collaborative visual method to "understand, interpret, and optimize professionals' work practices." The STS scholars gain the permission of hospital practitioners to video them in agreed-upon settings and situations. The scholars produce clips that isolate informal mundane routines and make them literally visible. They then facilitate the discussions that transform the routines into remarkable achievements of everyday work. The video recordings serve as a key for opening up the taken-for-granted daily routines as it provides participants the opportunity to view their work from another angle that offers them a new perspective. As nurses, doctors, and other staff members watch the delivery of complex, dynamic practices, they see "a grand central station," or a "well-orchestrated symphony," or simply "value" in their own work and the work of others around them. Their reflective learning results in a re-awareness, re-appreciation and re-definition of daily practices.
While viewing the video clips with professionals the STS scholars act as "clinalysts" by catalyzing insiders’ knowledge by asking outsider questions. Healthcare practitioners join them in this “constant tension between critique, interpretation, analysis, questioning and concluding" and start to question their dominant ways of understanding binaries and boundaries and articulate and discuss alternative ways of doing on basis of which they can fine-tune and improve their work processes within months. In other words, in the reflexive sessions they found themselves a fast track for improvement and picked up STS sensitivities.
The dominant image of hospital evaluation and improvement emphasizes innovation. External consultants contract with hospital administration to deliver advice and models for change. Mesman and Carroll start off with such an external identity and role. But before the camera ever enters the hospital setting, the STS scholars meet and work with every potentially-affected group to construct a new infrastructure that includes everyone. In this way the method of video-reflexivity provides STS knowledge an infrastructure upon it can travel into practices outside academia. In this new clinalyst infrastructure, the STS scholars neither remain outsiders nor become insiders. They become "alongsiders," a role that confronts challenging issues of methodological accountability and professional vulnerability. Mesman and Carroll describe how their work is not only methodological foundational but also deeply messy. Messiness, as it turns out, is not the only collateral reality of their making and doing. While trying to make a difference all their work --including their initial try-outs- is in real time on location, laid bare in the open. Moreover, their frequent presence "on location" meant that the scholars had made themselves available not only for "praise and advice" from participants but also "direct criticism." What responsibilities do they acquire in the unstable identity of alongsider? In a study of how an emergency department hands off urgent cases to surgery, the STS scholars don blue surgery scrubs, so they do not need to seek permission every time they want to cross the threshold between the two departments. The scrubs made patients "think we belonged to the hospital staff" and sometimes made others in scrubs visibly wonder if the STS scholar was "one of us" or not. And the scholars themselves felt "angst" over the fact that they had seemingly moved from outside to inside but "did not really gain enough time to form genuine relationships with people to be considered as insiders."
The emergent clinalyst infrastructure can persist. It can become robust. During a study of patient safety in neo-natal intensive care, Mesman could not be present for video reflexivity meetings. At first, the meetings were cancelled. Then other members of the video team took it upon themselves to continue. They selected the footage, organized and chaired the meetings, and taped the discussion. The new clinalysts were able to carry on documenting how they go about "doing safety" and identifying what new steps they might take to do safety better. The STS scholars learned that they could design their own exit into the clinalyst infrastructure to the extent that other participants (clinicians) would be willing and able to continue their reflexive learning and practice optimization. In this way, their approach to empiricizing as alongsiders what it meant to improve quality and safety in healthcare also resulted in a situation where clinalyst equally became alongsiders of STS scholarly practices, helping all figure out how STS infrastructures can remain alive at a larger distance from STS scholars.

Original languageEnglish
Title of host publicationMaking & Doing
Subtitle of host publicationActivating STS Through Knowledge Expression and Travel
EditorsGary Lee Downey, Teun Zuiderent
Place of PublicationCambridge, MA.
PublisherThe MIT Press
Number of pages22
Publication statusPublished - 17 Aug 2021


  • making & Doing
  • STS
  • exnovation
  • intervention

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