Shadowing helps clinicians achieve ideal patient care experiences

National Association for Healthcare Quality (NAHQ)Apr 27 2015

Patient-centered care is best achieved when the care team understands every moment of the patient and family experience in their journeys through a health care system - from parking in the hospital garage to being treated in the intensive care unit. This is the core value of a novel quality improvement program implemented at a leading U.S. medical center and presented today at the National Quality Summit, sponsored by the National Association for Healthcare Quality (NAHQ, www.nahq.org.)

For its first-ever National Quality Summit, NAHQ assembled a roster of leading experts in healthcare quality management to discuss an increasingly significant concern - how to assure favorable outcomes when transitioning patients from one clinical environment to another or to the home. Speakers at the Summit will cover clinical, social, economic and public policy influences on healthcare transition quality.

"Health care providers should view all care as an experience through the eyes of patients and families," said Pamela Greenhouse, MBA, executive director, Patient and Family Centered Care Innovation Center (PFCC), University of Pittsburgh Medical Center (UPMC). "Our goal is to help patients, families and health care providers learn from each other and partner to co-design ideal care delivery."

Greenhouse explained that the UMPC Patient and Family Care Center developed a six-step program designed to break down organizational silos and barriers to achieve ideal patient care experiences.

The program identifies care experiences and processes that need to be improved and forms cross-functional project teams of personnel involved in targeted patient and family experiences. They include clinicians and non-medical staff, such as administrators and even parking staff, billers and schedulers. "The ultimate goal is to close the gap between the current state and the ideal," said Greenhouse.

Shadowing Provides First-hand, Real-time Feedback
A critical step in the PFCC methodology is shadowing, which is real-time observation of patients and families as they move through each step of their health care journey. Greenhouse explained that shadowing not only provides objective information, such as where patients and families go and who they come in contact with, but also subjective feedback - impressions, concerns and ideas.

"We partner with patients, family and staff in gathering this information. The goal is to capture the current state of the care experience you are tying to improve," Greenhouse said. "We often meet families in the parking garage because for us the experience begins when we first connect with them, but for families and patients, it begins earlier and transcends walls and departments."

Greenhouse added that shadowing makes patient engagement much more than a marketing buzzword. "Through shadowing, we gain an enlightened perspective that reveals the entire health care experience rather than just the process. Shadowing leads to empathy, which leads to insight, and provides an emotional connection not possible by analyzing data."

UMPC has achieved successful outcomes within dozens of clinical specialties thanks to shadowing and the overall PFCC program. One example of the benefits of shadowing, reported by Greenhouse, is the way it has been used to improve experiences and clinical outcomes among bariatric surgery patients. "Shadowing showed that patients and families were receiving insufficient education about common complications of the procedure - poor hydration, abdominal pain and nausea," said Greenhouse. "This prevented many patients from managing these symptoms post-discharge and often resulted in return visits to the hospital."

As a result of the observations and seeking patient and family input for redesign, hydration information is now included in pre-op/discharge education packages, and patients are quizzed before discharge to help clinicians gauge their understanding of hydration. Also, bariatric surgery patients leave the hospital with a pre-measured water bottle and a discharge journal for recording information about fluid intake, wound assessment, pain and nausea frequency and severity.

Another success cited by Greenhouse is improvement in medication compliance among cardiothoracic surgery patients. In many cases, patients discharged with prescriptions did not get them filled or were confused about how and when to take their medications. A shadowing collaboration of nurses, pharmacists, social workers and patients determined that providing the medications and focused medication education to patients before discharge would improve their ability to take medications correctly. "A project such as this is aimed at eliminating post-discharge medication errors, reducing hospital readmissions related to medication, and improving the patient experience," said Greenhouse.

The UMPC Patient and Family Care Center methodology has been adopted by more than 35 healthcare provider organizations worldwide.