Back to Basics: Shadow to See with New Eyes and Understand the Current State

Getting started with an improvement project can be daunting - it can be hard to determine what tools to use to understand the current state, what data to collect, and where to start. There are many process-level tools that can be used to collect baseline data. It can be challenging to collect quantitative and qualitative data that reflects the very personal experiences within healthcare. Using goShadow’s suite of tools allows for hard data to be collected while building empathy for those living the processes day in and day out. 

Shadowing and asking “What Matters to You?” (WMTY) are two simple co-design tools that become powerful when used together. Shadowing is a simple observation tool used to understand experiences and processes objectively. It allows for the collection of real-time qualitative and quantitative data at a grassroots level, which can be coupled to drive change. Shadowing is a quick and easy way to gain an understanding of the current state and identify a variety of improvements ranging from low-hanging fruit to complex multi-team initiatives. 

Shadowing becomes even more meaningful when patients, families, and employees are asked WMTY as pre-work. WMTY is a shared decision-making framework used to flip the script from asking “What’s the matter with you?” and enables care teams and leaders to understand what is most important to their patients and employees. By asking WMTY you can understand the patient and employee experiences as shared, and that many opportunities for improvement identified will positively impact both stakeholders. Examples include increased care team communication and more time interfacing with the patient which aligns well with what patients want: to be included, heard, clearly communicated with, given a plan, and in control. Based on employee and patient feedback the improvement team can pinpoint specific opportunities to improve within its team and pay special attention to while shadowing. 

Getting started with shadowing is accessible and easy to do. There is no right or wrong time to start and anyone can do it - just jump in! The Art and Science of Shadowing breaks shadowing down into four easy steps. Shadowing can be done on pen and paper or the goShadow app depending on comfort and ease of use. The steps are as follows below:

1) Get Ready and Determine your Scope 

- Identify what experience you want to shadow, and where that experience begins and ends.

- Example: an outpatient office visits that begins at check-in and ends at checkout.

2) Use the App to Observe and Record 

- Introduce yourself to the patient and family. Assure them no patient information is collected, and at any point in the process they may ask you to step out if preferred.

- Use the App (or pen and paper!) to document the experience. 

- Collect timestamps of specific data like care team members, locations (where patients and families go, for how long, and with whom), and consumables. 

- Be sure to collect qualitative data while shadowing and don't be afraid to ask questions. 

- Example: While shadowing an outpatient office visit you may record that when the patient is in the exam room - the medical assistant, advanced practice provider, and physician are with the patient for different periods of time asking the patients different questions. 

3) Report your findings 

- If using the goShadow App, simply sync the application to load the data into goShadow’s web platform. Otherwise, collate your handwritten shadowing notes into an Excel spreadsheet. 

- The goShadow platform will auto-generate reports of your choosing.  

4) Re-shadow the experience

- All experiences should be re-shadowed following implementation of improvements to measure change. 

- Example: Shadowing revealed duplicate work when collecting patient history. Care team roles were streamlined, and re-shadowing demonstrated a quicker room turnover and decrease in patient wait times.

goShadow offers many tools to support you and your team in your shadowing initiatives. Access resources on our website or email us to learn more.

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Posted on

January 21, 2022