Dr Suyin Hor is a transdisciplinary social scientist working with clinicians, patients and managers to make healthcare services safer. With a research background in psychology, education, and sociology, she specialises in visual and learning-based research methods that grapple with the complexity of healthcare at the frontline. She is a specialist in patient safety, across topics including accountability, incident reporting, patient involvement, communication, space, infection prevention and control, and video-reflexive ethnography. In both her teaching and research, Suyin is dedicated to bringing theory and practice together, to equip healthcare practitioners, managers, students and consumers with the skills, knowledge and understanding to successfully navigate, manage and improve the complex and changing contexts of healthcare.
Can supervise: YES
- Health services management;
- patient safety;
- quality/practice improvement;
- qualitative research methods;
- video-reflexive methods;
- participatory research methods
Iedema, R, Carroll, K, Collier, A, Hor, S-Y, Mesman, J & Wyer, M 2019, Video-Reflexive Ethnography in Health Research and Healthcare Improvement Theory and Application, CRC Press.
This innovative, practical guide introduces researchers to the use of the video reflexive ethnography in health and health services research. This methodology has enjoyed increasing popularity among researchers internationally and has been inspired by developments across a range of disciplines: ethnography, visual and applied anthropology, medical sociology, health services research, medical and nursing education, adult education, community development, and qualitative research ethics.
Barratt, R, Gilbert, GL, Shaban, RZ, Wyer, M & Hor, SY 2020, 'Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians', Australasian Emergency Care.View/Download from: Publisher's site
© 2019 College of Emergency Nursing Australasia Background: The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE—specifically gloves and masks—during routine care in the ED. Methods: This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results: Thirty-one behavioural themes were identified that influenced participants' use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion: Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted.
Gilbert, GL, Hor, S, Wyer, M, Sadsad, R, Badcock, CA & Iedema, R 2020, 'Sustained fall in inpatient MRSA prevalence after a video-reflexive ethnography project; an observational study', Infection, Disease and Health.View/Download from: Publisher's site
© 2020 Australasian College for Infection Prevention and Control Background: Maintaining optimal infection prevention and control (IPC) in a busy, clinical environment is challenging. Video-reflexive ethnography (VRE) is a collaborative, interventionist approach to practice improvement. We hypothesised that giving clinicians opportunities to view and reflect on video footage of everyday ward activities would raise awareness of, and suggest strategies to reduce, pathogen transmission risks. We undertook a VRE project, between March and September 2013, in two tertiary hospital surgical wards, with persistently high methicillin resistant Staphylococcus aureus (MRSA) endemicity, despite previous IPC interventions. Methods: This study was a retrospective/prospective observational study, using interrupted time-series analyses, to assess the effects of the VRE project on hand hygiene compliance, inpatient MRSA infections (newly infected patients, per 1000 occupied bed days) and inpatient MRSA colonisation prevalence, measured by serial point prevalence surveys. Follow-up continued until June 2016. Results: The VRE project was associated with changes in IPC behaviour and outcomes. Hand hygiene compliance increased (from 62% to 75%; p < 0.0001) and MRSA colonisation prevalence decreased significantly, in both wards (baseline 42%; average post-VRE 12%; p=<0.0001), MRSA infection rate decreased in one ward. Interpretation of results was complicated by a potential confounding effect of unplanned environmental hydrogen peroxide decontamination (HPD). Improved hand hygiene compliance was a predicted outcome of VRE, but also a potential contributor to reduced MRSA transmission. Conclusion: Separate contributions of VRE (the intervention), HPD and hand hygiene compliance were uncertain, but their combined effect was significantly reduced MRSA endemicity, which previously had been resistant to attempted IPC interventions.
Hooker, C, Hor, S, Wyer, M, Gilbert, GL, Jorm, C & Iedema, R 2020, 'Trajectories of hospital infection control: Using non-representational theory to understand and improve infection prevention and control.', Social science & medicine (1982), vol. 256, p. 113023.View/Download from: Publisher's site
In this paper we undertake an innovative analysis of infection prevention and control (IPC) activities in hospitals, using non-representational theory of space (2005). We deployed video-reflexive ethnography in three wards in two metropolitan teaching hospitals involving 252 healthcare workers as participants. We analysed our data iteratively using non-representational theory, which showed hospital space being constantly produced from varied, intersecting, and sometimes competing trajectories of hospital work, objects and people. The approach enabled multiple material factors impinging on routine IPC (including objects such as rolls of surgical tape), and habitual or prioritised actions (such as safeguarding patient privacy) to be included in analysis. The analysis also included the role of time which has been absent from other discussions of IPC, highlighting the transience of spaces produced through IPC practices and the need to continually re-make them. We found many situations in which the complexity of practice, rather than failures of compliance, contributed to potential microbial transmission. We show how inconsistency and confusion about IPC practice often can only be resolved through action. Our findings suggest that further reduction in preventable hospital infection rates will require better integration of IPC with other work trajectories; a shift in emphasis from compliance monitoring to collaborative practice; and greater use of in situ risk assessment and judgment.
Iedema, R, Jorm, C, Hooker, C, Hor, S, Wyer, M & Gilbert, GL 2020, 'To follow a rule? On frontline clinicians' understandings and embodiments of hospital-acquired infection prevention and control rules', Health: an interdisciplinary journal for the social study of health, illness and medicine.View/Download from: Publisher's site
This article reports on a study of clinicians' responses to footage of their enactments of infection prevention and control. The study's approach was to elicit clinicians' reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians' learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians' appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians' 'practical wisdom' is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules.
Hor, S-Y, Hooker, C, Iedema, R, Wyer, M, Gilbert, GL, Jorm, C & O'Sullivan, MVN 2017, 'Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards', BMJ QUALITY & SAFETY, vol. 26, no. 7, pp. 552-558.View/Download from: Publisher's site
Wyer, M, Iedema, R, Hor, S-Y, Jorm, C, Hooker, C & Gilbert, GL 2017, 'Patient Involvement Can Affect Clinicians' Perspectives and Practices of Infection Prevention and Control: A "Post-Qualitative" Study Using Video-Reflexive Ethnography', INTERNATIONAL JOURNAL OF QUALITATIVE METHODS, vol. 16, no. 1.View/Download from: Publisher's site
Iedema, R, Hor, SY, Wyer, M, Gilbert, GL, Jorm, C, Hooker, C & O'Sullivan, MVN 2015, 'An innovative approach to strengthening health professionals' infection control and limiting hospital-acquired infection: Video-reflexive ethnography', BMJ Innovations, vol. 1, no. 4, pp. 157-162.View/Download from: Publisher's site
© 2015, BMJ Publishing Group. All rights reserved. Objective To strengthen clinicians' infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their team's practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones.
Wyer, M, Iedema, R, Jorm, C, Armstrong, G, Hor, S-Y, Hooker, C, Jackson, D, Hughes, C, O Sullivan, MVN & Gilbert, GL 2015, 'Should I stay or should I go? Patient understandings of and responses to source-isolation practices', Patient Experience Journal, vol. 2, pp. 60-68.
Wyer, M, Jackson, D, Iedema, R, Hor, S-Y, Gilbert, GL, Jorm, C, Hooker, C, O Sullivan, MVN & Carroll, K 2015, 'Involving patients in understanding hospital infection control using visual methods', Journal of clinical nursing, vol. 24, pp. 1718-1729.
Hor, S-Y, Iedema, R & Manias, E 2014, 'Creating spaces in intensive care for safe communication: a video-reflexive ethnographic study', BMJ Qual Saf, vol. 23, pp. 1007-1013.
Wyer, M, Iedema, R & Hor, S-Y 2014, 'Editorial: Patients: passive subjects or active participants in reducing the spread of infection?', JOURNAL OF CLINICAL NURSING, vol. 23, no. 17-18, pp. 2385-2386.View/Download from: Publisher's site
Hor, S, Godbold, NJ, Collier, A & Iedema, RA 2013, 'Finding the patient in patient safety', Health: an interdisciplinary journal for the social study of health, illness and medicine, vol. 17, no. 6, pp. 567-583.View/Download from: Publisher's site
In the last decade, the field of patient safety has grappled with the complexity of health-care systems by attending to the activity of frontline clinicians. This article extends the field by highlighting the activity of patients and their carers in determining the safety of these systems. We draw on data from three studies exploring patients accounts of their health-care experiences in Australia and internationally, to show how patients and carers are currently contributing to the safety of their own care. Furthermore, we emphasise the importance of patientclinician collaboration in ensuring the success of these activities. We argue that it is no longer sufficient to discuss if patients should be involved with ensuring their own safety. Given that patients are already involved, we propose a new conceptualisation of safety and systems that acknowledges their involvement and supports patientprovider collaboration to achieve safer care.
In the last decade, the field of patient safety has grappled with the complexity of health-care systems by attending to the activity of frontline clinicians. This article extends the field by highlighting the activity of patients and their carers in determining the safety of these systems. We draw on data from three studies exploring patients' accounts of their health-care experiences in Australia and internationally, to show how patients and carers are currently contributing to the safety of their own care. Furthermore, we emphasise the importance of patient-clinician collaboration in ensuring the success of these activities. We argue that it is no longer sufficient to discuss if patients should be involved with ensuring their own safety. Given that patients are already involved, we propose a new conceptualisation of safety and systems that acknowledges their involvement and supports patient-provider collaboration to achieve safer care. © The Author(s) 2013.
Iedema, RA, Allen, SL, Britton, KL & Hor, S 2013, 'Out Of The Frying Pan? Streamlining The Ethics Review Process Of Multisite Qualitative Research Projects', Australian Health Review, vol. 37, no. 2, pp. 137-139.View/Download from: Publisher's site
This paper describes the ethics approval processes for two multicentre, nationwide, qualitative health service research projects. The paper explains that the advent of the National Ethics Application Form has brought many improvements, but that attendant processes put in place at local health network and Human Research Ethics Committee levels may have become significantly more complicated, particularly for innovative qualitative research projects. The paper raises several questions based on its analysis of ethics application processes currently in place.
Hor, S, Iedema, RA, Williams, K, White, L, Kennedy, P & Day, A 2010, 'Multiple Accountabilities in Incident Reporting and Management', Qualitative Health Research, vol. 20, no. 8, pp. 1091-1100.View/Download from: Publisher's site
In this article, we examine the current and increasing emphasis on accountability and patient safety in health care, focusing on practices of incident reporting and management in New South Wales, Australia. We describe the frames of accountability associated with an incident reporting system, and explore how this system manifests in practice. In contrast to literature that situates incident reporting and local practices as oppositional, we used ethnographic methods to observe the incident management practices of clinical staff in a hospital, and found evidence to characterize this relationship differently. We found that accountability has multiple conceptualizations, and we present three findings that demonstrate how the reporting system and incident management policy are interwoven with local enactments of accountability. We suggest that systematic efforts toward improvement cannot be divorced from the local context, and emphasize the importance of local ecologies of practice in facilitating the meaningful utilization of such incident reporting systems.
Iedema, RA, Mallock, NA, Sorensen, R, Manias, E, Tuckett, A, Perrott, B, Brownhill, S, Piper, DA, Hor, S, Hegney, D, Scheeres, HB & Jorm, CM 2008, 'The National Open Disclosure Pilot: Evaluation of a policy implementation initiative', The Medical Journal of Australia, vol. 188, no. 7, pp. 397-400.
Objective: To determine which aspects of open disclosure work for patients and health care staff, based on an evaluation of the National Open Disclosure Pilot. Design, setting and participants: Qualitative analysis of semi-structured and open-ended interviews conducted between March and October 2007 with 131 clinical staff and 23 patients and family members who had participated in one or more open disclosure meetings. 21 of 40 pilot hospital sites, in New South Wales, South Australia, Victoria and Queensland, were included in the evaluation. Participating health care staff comprised 49 doctors, 20 nurses, and 62 managerial and support staff. In-depth qualitative data analysis involved mapping of discursive themes and subthemes across the interview transcripts. Results: Interviewees broadly supported open disclosure; they expressed uncertainty about its deployment and consequences, and made detailed suggestions of ways to optimise the experience, including careful pre-planning, participation by senior medical staff, and attentiveness to consumers experience of the adverse event. Conclusion: Despite some uncertainties, the national evaluation indicates strong support for open disclosure from both health care staff and consumers, as well as a need to resource this new practice.
Iedema, R, Piper, D, Beitat, K, Allen, S, Bower, K & Hor, S-Y 2016, 'Risk and Clinical Incident Disclosure: Navigating between Morality and Liability' in Communicating Risk, Palgrave Macmillan UK, pp. 17-35.
Hor, SY & Iedema, R 2015, 'Bruno Latour: From Acting at a Distance Towards Matters of Concern in Patient Safety' in The Palgrave Handbook of Social Theory in Health, Illness and Medicine, pp. 660-674.View/Download from: Publisher's site
Hor, S-Y 2011, 'Accountability and patient safety: A study of mess and multiplicities'.
Hor, S-Y 2006, 'Exploring Gifted Primary Students' Perceptions of the Characteristics of Their Effective Teachers'.