Paper short abstract:

In this paper we discuss the sticky middle ground between fluid and fixed characteristics of healthcare practices. We argue that this sticky business is productive and has potential for practice optimization. We will show how the method of video-reflexivity contributes to this role in several ways.

Paper long abstract:

The zone of healthcare delivery can be characterized both as highly fluid (huge turn-over of patients and high-density zone of uncertainty) and highly fixed (proliferation of protocols, guidelines, rules). We argue that this fixedness and fluidity meet in tandem, and in tension, to produce practices that demonstrate a kind of viscosity in their pliability. Moreover, practices are also sticky because they are resistant to change. Notwithstanding this resistance, practices are always changing, i.e. there is no such thing as 'frictionless practice'. Sometimes though there is only very little friction - so very little effect (e.g. a new guideline with no perceived relevance); sometimes too much friction - and practice stops or is forced to 'flow around' the object of too much friction (e.g. an unreasonable rule that results in workarounds). The space in between, where two 'surfaces' meet and have some transformative impact on one another's trajectory and/or character, is where friction can be productive (either positively or negatively) and thus has potential for practice improvement.

To gain insight in the productivity of frictions requires scrutinizing the viscosity of practices. As we will demonstrate, the method of video-reflexive ethnography is an apt technique to make sticky practices visible as it uses video to create sticky representations of everyday practices that are then used by participants to engage in reflexivity and redesign of those practices. However, by doing so this method creates stickiness as it is immersing in practice and building up relations.