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Dr Katherine Carroll

Associate of the Faculty, School of Education
Doctor of Philosophy


Iedema, R.A., Mesman, J. & Carroll, K.E. 2013, Visualising Health Care Improvement, 1, Radcliffe, London.
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Why is it that in spite of all the health policy reforms, clinical practice innovations, increasing inter-sectoral inter-dependencies and new medical and information technologies, so little has changed in the way we research and evaluate healthcare? Dont these changes cry out for new ways of being studied and appraised? And dont our approaches to clinical practice innovation cry out for being reinvented too? Surely, we cannot continue to wheel out research and evaluation paradigms, improvement approaches and methods that were designed for 20th century problems and 20th healthcare, and assume they will be able to make sense of the problems we experience and the care we provide in the 21st century? These changes necessitate a new paradigm of health service research, evaluation and improvement and this new model adopts approaches and methods that embrace complexity. The approaches and methods can account for the vicissitudes of frontline care, the activities of frontline staff, and the experiences of patients and families where care happens. Healthcare managers, policy makers and shapers will find this book enlightening. It will also be empowering to all healthcare professionals and frontline staff. Visualising Health Care Practice Improvement draws on years of video feedback research shaping an approach that enables not only a retrospective understanding but also a view into the future, of what might be possible. It presents the argument that change is not principally about adopting solutions from elsewhere, but that it is conditional on people exploring whether proposed solutions suit existing habituations. It involves a process of exploration, discovery, secession, and renewal.


Iedema, R.A., Long, D. & Carroll, K.E. 2010, 'Corridor communication, spatial design and patient safety: Enacting and managing complexities' in van Marrewijk, A. & Yanow, D. (eds), Organizational Spaces, Edward Elgar, United Kingdom, pp. 41-57.
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This chapter describes how a mUlti-diSciplinary clinical team occupies its clinical space and, in particular, its corridor. When we started to observe the practices of this clinical team in a metropolitan teaching hospital in Sydney in 2004, I the character of the work conversations that clinicians enacted there signalled to us that the corridor performed an important role. These conversations became possible in this corridor space, we suggest, because the team capitalized on what they probably perceived to be a 'liminal' space' that is a space that does not embody strong indications for staff about what' is to take place within it.


Carroll, K.E. 2010, 'Embodied Knowledge: Bringing a new epistemology to the informed consent of oocyte donation', Social Causes, Private Lives, Maquarie Univeristy and The Australian Sociology Association, Macquarie University.
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Carroll, K.E., Bridgeford, S. & Iedema, R.A. 2007, 'Rostered Labour and Intensive Work Places: The Organisational and Industrial Relations Complexities of providing 24 hour care', Our Work...Our Lives: National Conference on Women and Industrial Relations, Our Work...Our Lives Conference, Hawke Research Institute, University of South Australia, Adelaide, Australia, pp. 24-34.
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Iedema, R.A., Long, D., Carroll, K.E., Stenglin, M. & Braithwaite, J. 2005, 'Corridor work: how 'liminal' space can be a focal resource for handling complexities of multi-disciplinary health care', Proceedings of the 11th International Colloquium of the Asia-Pacific Researchers in Organization Studies (APROS), APROS, Melbourne, Australia, pp. 238-247.
This paper presents an analysis of video-ethnographic data of a corridor in an Australian metropolitan teaching hospital. As the video data will illustrate, the corridor connects spaces (wards, consulting rooms) and practices (clinicians consulting each other about shared patients and co-organizing their work). The paper describes how the complexities of multi-disciplinary practice and disease trajectory; the dynamic circulation of bodies and materials, and the material-phenomenological intentionalities embedded in space converge in the corridor, and how this helps transmute 'marginal' space into a site of intense productivity. It is here that the interstices among clinical knowledges, processes, problems and purposes are dynamically negotiated and worked out. The corridor, perceived as liminal space, becomes the place par excellence for the negotiation and resolution of an array of complexities inherent in how multi-disciplinary care intersects with the uncertain trajectories of disease and access to hospital resources. In our conceptualization, the corridor is a space whose perceived liminality becomes a crucial resource: this is a unique site where final decisions can be held in abeyance and where uncertainties and provisional decisions can co-exist; a space where the fixities of hierarchy and specialization can be attenuated if not suspended, and a space where people can agree to work around rules and regulations; in short, a space where tasks and positionings become sufficiently provisional, flexible and negotiable to enable clinicians to weave the complexity of emerging facets of clinical practice into a workable and productive unfolding.
Carroll, K.E. & Iedema, R.A. 2006, 'Incorporating Complexity Theory and Feminism into Video Ethnography', Australian Consortium for Social and Political Research Incoporated - ACSPRI Social Science Methodology Conference Online Proceedings, Australian Consortium for Social and Political Research Incorporated, ACSPRI, Sydney, Australia, pp. 1-13.
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This research uses video firstly as a tool for data collection, and secondly as a method for reflexive sessions that engage both the researcher and clinicians in reflexive viewing of organisational aspects of clinical work. By focusing on empirical data from videoethnographic research in an intensive care unit (ICU) in New South Wales (NSW)1 this paper broadly demonstrates the compatible intertwining of complexity theory, feminist research principles and video-reflexivity.

Journal articles

Wyer, M., Jackson, D., Iedema, R., Hor, S.Y., Gilbert, G.L., Jorm, C., Hooker, C., O'Sullivan, M.V. & Carroll, K. 2015, 'Involving patients in understanding hospital infection control using visual methods.', Journal of clinical nursing, vol. 24, no. 11-12, pp. 1718-1729.
This paper explores patients' perspectives on infection prevention and control.Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored.Video-reflexive ethnography.Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions.Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency.This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care.This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback abou...
Carroll, K.E., Lenne, B.S., McEgan, K., Opie, G., Amir, L.H., Bredemeyer, S., Hartmann, B., Jones, R., Koorts, P., McConachy, H., Mumford, P. & Polverino, J. 2014, 'Breast milk donation after neonatal death in Australia: a report.', International breastfeeding journal, vol. 9, no. 1, p. 23.
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Lactation and breast milk can hold great value and meaning for grieving mothers who have experienced a recent death of an infant. Donation to a human milk bank (HMB) as an alternative to discarding breast milk is one means of respecting the value of breast milk. There is little research, national policy discussion, or organizational representation in Australia on the subject of breast milk donation after infant death. On 29 November 2013 the Mercy Hospital for Women in Melbourne, Australia hosted Australia's first National Stakeholder Meeting (NSM) on the topic of milk donation after neonatal death. The NSM drew together representatives from Australian HMBs, neonatal intensive care units (NICUs) currently using donor human milk, and Australia's chief NICU parent support organization. The NSM was video-recorded and transcribed, and analyzed thematically by researchers. This article reports the seven dominant themes discussed by stakeholders during the NSM: the spectrum of women's lactation and donation experiences after infant death; the roles of the HMB and NICU in meeting the needs of the bereaved donor; how bereaved mothers' lactation autonomy may interface with a HMB's donation guidelines; how milk donation may be discussed with bereaved mothers; the variation between four categories of milk donation after neonatal death; the impact of limited resources and few HMBs on providing donation programs for bereaved mothers in Australia. This article provides evidence from researchers and practitioners that can assist HMB staff in refining their bank's policy on milk donation after infant death, and provides national policy makers with key considerations to support lactation, human milk banking, and bereavement services nation-wide.
Herrmann, K. & Carroll, K. 2014, 'An Exclusively Human Milk Diet Reduces Necrotizing Enterocolitis', Breastfeeding Medicine, vol. 9, no. 4, pp. 184-190.
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Carroll, K. 2014, 'Body dirt or liquid gold? How the 'safety' of donated breastmilk is constructed for use in neonatal intensive care', Social Studies of Science, vol. 44, no. 3, pp. 466-485.
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When mothers of preterm infants are unable to produce sufficient volumes of breastmilk, neonatologists in many Western countries prescribe pasteurized donor breastmilk. Breastmilk has a paradoxical presence in the neonatal intensive care unit: while it has therapeutic properties, it also has the potential to transmit disease. National health authorities and local neonatal intensive care unit policies each delimit the safety of donor milk by focusing on the presence or absence of pathogens. It is in this light that breastmilk from the human milk bank is both sought and legitimated to minimize safety concerns. This research uses data arising from an ethnographic study of two human milk banks and two neonatal intensive care units in the United States, and 73 interviews with milk donors, neonatal intensive care unit parents and clinicians. The primary research question framing the study was What are the underlying processes and practices that have enabled donor milk to be endorsed as a safe and legitimate feeding option in neonatal intensive care units?' This study is framed using three key principles of Latour's new critique', namely, adding to reality rather than debunking it, getting closer to data rather than turning away from fact and creating arenas in which to assemble. As a result, conceptions of donor milk's safety are expanded. This case study of donor milk demonstrates how Latour's new critique can inform science and technology studies approaches to the study of safety in health care.
Carroll, K.E. & Herrmann, K. 2013, 'The Cost Of Using Donor Human Milk In The NICU To Achieve Exclusively Human Milk Feeding Through 32 Weeks Postmenstrual Age', Breastfeeding Medicine, vol. 8, no. 3, pp. 286-290.
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Objectives: Donor human milk (DHM) is increasingly being used in neonatal intensive care units (NICUs) to achieve exclusive human milk (EHM) feedings in preterm infants. The aim of the study was to determine the cost of DHM to achieve EHM feeding for ver
Carroll, K.E. 2013, 'Infertile? The emotional labour of sensitive and feminist research methodologies', Qualitative Research, vol. 13, no. 5, pp. 546-561.
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A researcher's emotional labour is inextricably linked to the methodological and ethical underpinnings of doing' sensitive and some feminist research. However, a key component of the emotional labour theory does not fit with the emotional labour enacted
Waldby, C., Kerridge, I., Boulos, M. & Carroll, K.E. 2013, 'From altruism to monetisation: Australian women's ideas about money, ethics and research eggs', Social Science & Medicine, vol. 94, no. 1, pp. 34-42.
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We report the results of a qualitative study carried out in metropolitan Australia between 2009 and 2011 that canvassed the issue of payment for research oocyte donation with participants drawn from three potential donor groups; fertility patients, repro
Naylor, J., Mittal, R., Carroll, K.E. & Harris, I. 2012, 'Introductory insights into patient preferences for outpatient rehabilitation after knee replacement: implications for practice and future research', Journal Of Evaluation In Clinical Practice, vol. 18, no. 3, pp. 586-592.
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Objectives Current perspectives concerning clinical decision making favour inclusion of patient preference for therapy. This exploratory study aimed to forge introductory insights into patient preference for outpatient-based rehabilitation after total knee replacement (TKR). Methods TKR recipients from six public hospitals participating in a prospective, longitudinal study assessing outcomes after surgery were surveyed 1 year after surgery about preferences for rehabilitation. Surveys were conducted face-to-face or via postal questionnaire. Questions included global satisfaction (percentage scale) with therapy received, future preference for therapy and the reasons underpinning preference. Results Ninety-three (93/115) TKR recipients participated [mean age 68 (SD 8) years; 66% female; 75% face-to-face interview]. Group-based (39/93) and one-to-one therapies (38/93) were the most common modes experienced. Most participants (81/93) were highly satis?ed (satisfaction 75%). Future preference was associated with satisfaction with past exposure regardless of mode (P = 0.02), hence no overall preference for one mode emerged. Commonality existed in the reasons why patients preferred speci?c modes. The most common reason for preferring group-based therapy was psychosocial bene?t whilst the more personalized approach was the most common reason for preferring one-to-one therapy.
Carroll, K.E. & Waldby, C. 2012, 'Informed Consent And Fresh Egg Donation For Stem Cell Research Incorporating Embodied Knowledge Into Ethical Decision-Making', Journal Of Bioethical Inquiry, vol. 9, no. 1, pp. 29-39.
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This article develops a model of informed consent for fresh oocyte donation for stem cell research, during in vitro fertilisation (IVF), by building on the importance of patients' embodied experience. Informed consent typically focuses on the disclosure
Carroll, K.E. & Mesman, J. 2011, 'Ethnographic context meets ethnographic biography: a challenge for the mores of doing fieldwork', International Journal of Multiple Research Approaches, vol. 5, no. 5, pp. 155-168.
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Research involves a complex network of universities, external funding bodies and industry, and researchers are increasingly faced with pressure to produce outcomes within tight temporal deadlines. This offers fresh challenges to research practice, including ethnographic research, which is traditionally based on long-term engagement in the field. This article details challenges to our ethnographic assumptions as a result of working on a highly time-bound video project in an Australian hospital. We frame the unexpected challenge to our latent ethnographic mores by forming a framework of two approaches to research: the descriptive-analytic approach and productive-reflexive approach. The article reveals how the unexpected foregrounding of our ethnographic mores played a critical role in questioning research practice. This article highlights the importance of researcher biography and the plurality and flexibility required of researchers in contemporary collaborative networks.
Iedema, R.A. & Carroll, K.E. 2011, 'The 'clinalyst': Institutionalizing Reflexive Space To Realize Safety And Flexible Systematization In Health Care', Journal of Organizational Change Management, vol. 24, no. 2, pp. 175-190.
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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 tha
Iedema, R.A. & Carroll, K.E. 2010, 'Discourse Research That Intervenes In The Quality And Safety Of Care Practices', Discourse and Communication, vol. 4, no. 1, pp. 68-86.
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Drawing on work done in the area of health services research, this article outlines a view of discourse analysis (DA) that approaches discourse as a co-accomplished process involving researcher and research-participant. Without losing sight of the analyt
Nugus, P., Carroll, K.E., Hewett, D.G., Short, A.E., Forero, R. & Braithwaite, J. 2010, 'Integrated Care in the Emergency Department: A complex adaptive systems perspective', Social Science & Medicine, vol. 71, no. 11, pp. 1997-2004.
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Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients needs across this journey is challenging. The journey is usually accounted for in a linear way e as a continuity of care problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.
Carroll, K.E. 2009, 'Outsider, Insider, Alongsider: Examining reflexivity in hospital-based video research', International Journal of Multiple Research Approaches, vol. 3, no. 3, pp. 246-263.
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This research examines the power relations between the researcher, clinicians, the video camera and its footage in two innovative methodologies called 'video ethnography' and 'video-reflexivity'. These methodologies have successfully facilitated clinician-learning and clinician-led practice redesign in Australian hospitals. Yet, to date, the literature has not acknowledged the power relationships that exist within these methodologies' creative potential. This article uses a feminist framework to further theorise these methodologies as feminist video researchers have already problematised issues of power, researcher reflexivity and the collaborative use of video. Using an Australian intensive care unit (ICU) as a case study, this article unpacks the power relations involved in the use of video ethnography and video-reflexivity. It argues that researcher reflexivity and attention to power relations needs to be at the forefront of researchers' practice to ensure that video ethnography and video-reflexivity's careful use remains foundational to the methodology, rather than being reliant upon happenstance or individual researchers' ethical care.
Carroll, K.E., Iedema, R.A. & Kerridge, R.K. 2008, 'Reshaping ICU Ward Round Practices Using Video-Reflexive Ethnography', Qualitative Health Research, vol. 18, no. 3, pp. 380-390.
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In this article, we outline a study method with which structural changes to clinical communication were achieved within a local intensive care unit (ICU). The study method involved in-depth, round-the-clock observation, interviewing, and video filming of how intensivists conducted their practices, as well as showing selected footage to the clinicians for feedback. This feedback component iteratively engaged clinicians in problem-solving their own communication difficulties. The article focuses on one such feedback meeting and describes changes to the morning ward round and planning meeting that this feedback process catalyzed: greater time efficiency, a greater presence of intensivists in the ICU, more satisfied nursing staff, and a handover sheet to improve the structure of clinical information exchanges. We argue that in embodying not a descriptive but an interventionist approach to health service provision, this video-ethnographic method has great significance for enhancing clinicians' and researchers' understanding of the rising complexity of in-hospital practices, and for enabling them to intervene in these practices.
Long, D., Forsyth, R., Iedema, R.A. & Carroll, K.E. 2006, 'The (Im)possibilities of clinical democracy', Health Sociology Review, vol. 15, no. 5, pp. 506-519.
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In this article, we argue that homogenising discussions of medical dominance on the meta-level of professions do not fully capture the complexity that characterises current clinical care in multidisciplinary health care teams. We illustrate this through an empirical study of a multidisciplinary team attempting to enact their work in a clinically democratic way. The challenges that arose in putting this into practice highlight the depth and complexity of enculturated medical dominance in Australian hospital practice. Our study shows that effective facilitation of clinician reflexivity has the potential to challenge and change deeply embedded structures and behaviours.
Carroll, K.E. & Reiger, K. 2005, 'Fluid Experts: Lactation consultants as postmodern professional specialists', Health Sociology Review, vol. 14, no. 2, pp. 101-110.
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Since their accreditation as a professional specialty in 1985, lactation consultants have grown in number and prominence in maternity care. In North America and Australia, breastfeeding management is now a domain increasingly presided over by certified experts. This article explores the way in which this speciality has established a distinctive identity that straddles seemingly contradictory maternalist and medicalised discourses. Drawing on professional sources and on a small study of Victorian lactation consultants, it explores the shift from the maternalist imagery characteristic of voluntary breastfeeding support groups, to a more complex message about breastfeeding as a contemporary social practice. We argue that the way in which lactation consultants negotiate complex relationships with peers and clients gives rise to a fluid professional identity. This reflects not only their historical legacy and recent changes in health systems and professional roles, but also a postmodern cultural context, in which women negotiate their embodied identities as mothers, lovers and workers.


Braithwaite, J., Travaglia, J., Westbrook, M., Jorm, C., Hunter, C., Carroll, K.E., Iedema, R.A. & Ekambareshwar, M. UNSW 2006, Overview Report On The Evaluation Of The Incident Information Management System, pp. 1-33, Sydney, Australia.
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This report presents the findings of multiple studies conducted to evaluate the Incident Information Management System (IIMS) for NSW Health. IIMS was introduced by NSW Health to act as a core mechanism for safety and quality improvement in Area Health Services (AHSs).