From ‘best practice’ to ‘best Fit’. Evaluating the implementation of Video Reflexive Ethnography as an improvement tool in a NICU setting

Healthcare operates in a hyper-complex environment that necessitates continuous quality improvement. Video-Reflexive Ethnography (VRE) is a collaborative, practice-based methodology supporting team learning by using video footage of everyday clinical practice to stimulate shared reflection. This study explores the implementation of VRE in a Level 3 Neonatal Intensive Care Unit (NICU), focusing on facilitators, barriers, and the intervention’s impact on teamwork, communication, and sustainable implementation. In doing so, it contributes to the growing body of literature that examines VRE as an object of quality improvement research.<br/><br/>Between September 2020 to August 2022, ethnographic observations, reflexive session recordings, focus groups, and semi-structured interviews were conducted to assess how VRE was integrated within an interprofessional NICU team. Beyond identifying practical enablers and challenges, the study examines bottom-up engagement, the value of a best fit approach to practice change, and the emergence of collateral realities—unintended and performative consequences of reflective interventions.<br/> <br/>Key facilitators included voluntary participation, shared ownership, and a focus on exnovation: identifying and building on existing strengths. Challenges included time constraints, initial scepticism, and sustainability concerns. VRE was experienced as a method that improved technical and non-technical skills, enhanced interprofessional collaboration, and supported relational and procedural learning. Unanticipated effects, such as changes professional behaviour and team dynamics, further embedded reflexive learning into daily routines. <br/><br/>VRE can complement existing quality improvement strategies, like Crew Resource Management (CRM), by adding a reflective, adaptive layer. Sustaining its use requires institutional support, structured facilitation, and integration into daily workflow, without compromising its participatory and flexible character.<br/>