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Obj ect i ve Tova l i da t et hee f f e c t i ve ne s sofa ni t e r a t i ver e f l e xi veme t hodf ori nvol vi ngf r ont l i nes t a f fi ni mpr ovi ngha ndove ri na r e a sofhi ghc l i ni c a lr i s k. Desi gn Bui l di ngonpr e vi ouss t udi e sus i ngvi de oe t hnogr a phi cme t hodst oi mpr ovec l i ni c a lpr oc e s s e s[ 13] ,t hi ss t udypr ovi de doppor t uni t i e sf orhe a l t hc a r epr a c t i t i one r st ovi e wa ndr e f l e c tonvi de o f oot a geoft he i rha ndove rpr a c t i c e s .Thi se na bl e ds t a f ft oi de nt i f yor ga ni s a t i ona l ,pr of e s s i ona la nde nvi r onme nt a lc ha l l e nge s .Us i ngr e f l e xi vedi s c us s i on,s t a f fde s i gne dha ndove rpr oc e s ss ol ut i onst oa ddr e s spr obl e msi de nt i f i e d.The s es ol ut i onswe r ei mpl e me nt e da nde va l ua t e di nt wopa r t i c i pa t i ngs i t e s . Set t i ng He a l t hc a r epr a c t i t i one r sf r om t woc l i ni c a la r e a swe r ei nvol ve di nt her e s e a r c h,i nc l udi nga nEme r ge nc yDe pa r t me nt ,a nda nI nt e ns i veCa r eUni t .Comi ngf r om ar a ngeofs e ni or i t i e sa ndpr of e s s i ons ,ove r120he a l t hpr a c t i t i one r sc ons e nt e dt oha vi ngt he i rha ndove rpr a c t i c ef i l me d,t obei nvol ve di nt hef a c i l i t a t e dr e f l e xi ves e s s i ons ,a ndt opa r t i c i pa t ei ni mpl e me nt i ngt her e de s i gne dha ndove rpr oc e s s e s . Resul t s He a l t hc a r epr a c t i t i one r swe r ee na bl e dt oi de nt i f yor ga ni s a t i ona l ,e nvi r onme nt a l ,a ndpr of e s s i ona li s s ue st ha ti mpa c t e dont he i rha ndove rpr a c t i c e .Fol l owi ngr e f l e xi vevi e wi ngofor i gi na lha ndove r f oot a ge ,ha ndove rpr oc e s s e swe r er e de s i gne dt o:f a c i l i t a t ee a r l yi ns i ghti nt opr e vi ous l yunr e c ogni s e dc l i ni c a lorope r a t i ona lpr obl e ms ;e nha nc ec oor di na t i ona nde f f i c i e nc yofc a r e ,a nde nha nc e j uni or s e ni orc ommuni c a t i ona ndt e a c hi ng.Me t hodol ogi c a l l y ,t hes t udye vi nc e st ha t‘ bot t omup’ha ndove rr e de s i gnpr oduc e sout c ome st ha tha r bourl oc a lf i t ,pr a c t i t i one rowne r s hi p,a ndge ne r a l pol i c yr e l e va nc ei nt ha tt he ys oughtt or e a l i s ec ont i nui t yofpa t i e ntc a r e ,e f f e c t i ves upe r vi s i on,a ndc r os s di s c i pl i na r yc ommuni c a t i on,a l be i tont hes t r e ngt hofdi f f e r e ntha ndove rde s i gns . Concl usi ons Bywor ki ngwi t hhe a l t hc a r epr a c t i t i one r si nawa yt ha tr e s pe c t st he i ra bi l i t yt one got i a t el oc a lc l i ni c a ls e r vi c ec ompl e xi t ya ndde vi s ef unc t i ona lha ndove rs ol ut i ons ,t hi svi de oba s e ds t udyde mons t r a t e st ha tr e f l e xi veme t hodsa r ea ne f f e c t i vewa yofe nga gi ngf r ont l i nes t a f fi nt her e de s i gnofha ndove rc ommuni c a t i on.He a l t hc a r epr a c t i t i one r ss hows t r ongi nt e r e s ti nt hi sa ppr oa c hbe c a us e t he yknowt hec ompl e xi t yoft he i rl oc a lc l i ni c a ls e t t i ngi nt i ma t e l y ,t he yunde r s t a ndwha ti spos s i bl et oc ha ngea ndhow,a ndt he yga i ndi r e c tc ont r olove rt hewa yt he yr e de s i gnt he i rha ndove rpr a c t i c e s .

Ref er ences [ 1]I e de maR,LongD,For s yt hR,Le eB.Vi s i bi l i z i ngCl i ni c a lWor k:Vi de o Et hnogr a phyi nt heCont e mpor a r yHos pi t a l .He a l t hSoc i ol ogyRe vi e w.2006;15:156 68. [ 2]I e de maR,For s yt hR,Ge or gi ouJ ,Br a i t hwa i t eJ ,We s t br ookJ .Vi de or e s e a r c hi n he a l t h:Vi s i bi l i z i ngt hee f f e c t sofc omput e r i z i ngc l i ni c a lc a r e .Qua l i t a t i veHe a l t h Re s e a r c h.2007;6:1530. [ 3]Ca r r ol lK,I e de maR,Ke r r i dgeR.Re s ha pi ngI CUWa r dRoundPr a c t i c e sUs i ng Vi de oRe f l e xi veEt hnogr a phy .Qua l i t a t i veHe a l t hRe s e a r c h.2008;18:387. *I e de ma ,R.Me r r i c k,E.Ra j bha nda r i ,D.Ga r do, A. ,St i r l i ng, A. ,& He r ke s ,R. ( c ondi t i ona l l ya c c e pt e d) .Vi e wi ngt het a ke nf or gr a nt e df r om unde radi f f e r e nta s pe c t : avi de oba s e dme t hodi npur s ui tofpa t i e nts a f e t y .I nt e r na t i ona lJ our na lf orMul t i pl e Re s e a r c hMe t hods .

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www. communi cat i onsaf et y . or g Thi spr oj e c ti sf unde dbyt heAus t r a l i a nCommi s s i onf orSa f e t ya ndQua l i t yi nHe a l t hCa r e .