Walking the Walk

Hi! My name is Hannah Hamlin and I work as a project manager at goShadow in Pittsburgh, PA. I handle all of our on-the-ground projects at home; I work with our teams to organize shadowing efforts, analyze data, formulate reports, and keep tests of change and improvement efforts moving forward. I recently traveled with the Operation Walk Pittsburgh team to Antigua, Guatemala to essentially do the exact same job, but in a developing country. This project had unique challenges, particularly that I was bringing our patient experience and process mapping tools to a new environment and in a different language. This challenge was quickly overcome when looking at the impact of “What Matters to You” (WMTY) and discovering what patients, families, and care teams value in their care.

This piece is the first in a series detailing goShadow’s work while on Operation Walk Pittsburgh’s 2019 medical mission trip to Antigua, Guatemala. Over the next few weeks, I will demonstrate how our tools, perception mapping, shadowing, and “What Matters to You” (WMTY), can be used anywhere, at anytime, to improve and recognize ideal processes and experiences. Final results were used to create analysis and reports to foster collaboration between the Operation Walk and Las Obras care teams. 

Obras Sociales del Santo Hermano Pedro is a space that most of us from the U.S. would look at and think, “Are you sure this is a hospital?” From the outside, Obras appears to be a small church.

Once you enter the main door, a labyrinth of smaller clinics, a modern operating room, outdoor wards, and offices reveal themselves. Up until two years ago, the hospital, which hosts 44 medical mission teams throughout the year, doubled as a group home for nearly 150 patients who suffered from debilitating developmental or genetic disorders. While Obras has all of the necessities to provide comprehensive care, with fewer than 50 inpatient beds in three to four wards, the hospital is small and many areas, both indoors and outside are multipurpose. 

Similar to the United States, traditional silos in outpatient and inpatient care delivery systems exist. While these silos appear to be universal, in a facility such as Las Obras, where the care providers and physical spaces that separate these silos are mere steps away from one another, many of the inherent coordination and communication barriers that exist in the U.S. were not observed in Guatemala. 

A patient’s journey begins when they’re evaluated in an outpatient clinic months prior to their day of surgery. If they meet the medical and surgical criteria and are deemed candidates, they are counseled on weight loss, smoking cessation, and other reversible co-morbidities, and return within 30 days of surgery to be cleared by the medical and anesthesia teams. The patient arrives on the morning of surgery and post surgery spends one to two days on the inpatient ward doing twice daily physical therapy, preparing to go home. 

I used this universal pathway as a baseline to create my own perception map to use as a comparison for my final, real time shadowing observations of the Guatemalan patient experience. 

Perception mapping is a technique used to engage, understand, and identify the components of a patient’s experience. This tool can generate new ideas, discover pain points, or target areas for improvement when compared to the true process map revealed through shadowing.

In the next newsletter, learn how I was able to employ perception mapping to compare and contrast process at Obras to what I have experienced with similar pathways in Pittsburgh and how I plan to hardwire Operation Walk’s experience and quality improvement efforts through staff and patient engagement.

Las Obras Hospital
Hospital Courtyard

The first steps after surgery!
Physical Therapy
Surgeon meets with family
Checking X-rays
Patient with their family after surgery.
Ready to go home!