The "clinalyst": Institutionalizing reflexive space to realize safety and flexible systematization in health care

Rick Iedema*, Katherine Carroll

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Purpose: This paper aims to present evidence for regarding reflexive practice as the crux of patient safety in tertiary hospitals. Reflexive practice buttresses safety because it is the precondition for flexible systematization - that is, the process that involves frontline clinicians in designing, redesigning and flexibly enacting care processes. Design/methodology/approach: The paper presents an account of a collaborative video-ethnographic project with a multi-disciplinary team in an acute spinal unit. Video-ethnography was combined with video-reflexivity to provide practitioners with the opportunity to become involved in data interpretation and solution generation. Findings: The study reveals that an outsider analysts/catalyst (or clinalyst) is critical to engaging frontline practitioners in reflexivity. The clinalyst is able to elicit insights and perspectives that assist practitioners in revisiting and revising their processes and practices, principally because video-based reflexivity connects "what we do" directly to "who we are". Practical implications: Because complexity will be an indelible part of health care work, health care organizations should invest in developing "reflexive space" where learning about complexity becomes possible. Instead of continuing to invest in research efforts seeking to derive and test staff compliance with guidelines and protocols, and training centred on simulation, these organization must begin to engage with the lived complexity of clinical work in order to skill up incoming clinicians. Originality/value: Enhancing clinical practitioners' capability to confront complexity in their practices is currently not a standard component of clinical training or work-based learning. Video-reflexive ethnography in tertiary health care is unique in involving clinicians in "making sense" of and deriving solutions from lived complexity.

Original languageEnglish
Pages (from-to)175-190
Number of pages16
JournalJournal of Organizational Change Management
Issue number2
Publication statusPublished - Apr 2011
Externally publishedYes


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