Empirically Supporting Patient Shadowing and Applications for Co-Design

If you’ve been following us for a longtime, you’ll know that goShadow is a huge advocate for patient shadowing. We know that sustainable and meaningful change does not happen in a vacuum. Only by engaging patients and understanding their experiences through shadowing, meaningful conversations, and asking “What Matters to You?” can you get a full understanding of the care process, to which you can now improve through methods of Co-Design.

Patient shadowing facilitates Evidence-Based Design, because it allows an observer to view the healthcare experience through the patient’s perspective, “What kind of interactions do patients have outside of providers? What are patients and their families thinking and feeling? What unique needs do they have that aren’t being met?” When thinking about process improvement, it is imperative that no group that is impacted by the process is left out of the change-making process, namely, the patients and their families. Both professional and non-professional experiences are valuable and a key requirement for Co-Designing solutions. Though patient shadowing has been championed as a tool for measuring and understanding the critical nuances of the care experience, there is a noticeable lack of empirical studies evaluating its merits and applications, especially within outpatient settings. A paper published in the Patient Experience Journal, The Impact of Patient Shadowing on Service Design: Insights From a Family Medicine Clinic, by Gallan, Perlow, Shah and Gravdal investigates that last point by examining the viability and use-case for shadowing in a primary care environment. Specifically, the stated purposes of the research group were to “utilize patient shadowing to capture the realities of patient experiences in an outpatient family medicine clinic” and to “report opportunities for improvement to clinic leadership.” 

Gallan et al. shadowed 20 patients in an outpatient family medicine clinic over the course of 8 different days across 4 months, from the time patients entered the building to the time they left. This timeframe encompassed check-in, waiting, travelling, exams, discussions, etc. The researchers ensured they observed representative patient groups reflecting the communities this clinic served. Descriptive data, quantitative data (appointment times, waiting times, exam room times, etc) and qualitative data such as detailed patient observations, touchpoints and conversations were recorded in shadowing journals, which were made for public use and download using goShadow’s phone app. Following data collection and analysis, patient shadowing did not only reveal areas that could improve patient and staff experiences but also captures where organizations shine and best practices in action. Researchers shared that the amount of time patients spent in the clinic was reasonable (31 - 66 minutes) with manageable wait times. Best practices of provider’s being friendly, using a comforting voice, and smiling, while seemingly simple, plays a large role in the perceptions of quality of care by patients. Researchers also noted strong conflict resolution skills among physicians, strong efforts to be present when speaking to patients and engaging them with eye contact, as well as excellent teamwork, all of which plays a part in the culture of this organization and its efficiency. 

Although, as noted by Gallan at al. the care delivery was exceptional with healthcare best practices constantly on display, patient shadowing also revealed issues that were noticed in the transitional steps of the overall process. Issues that were only identified because they were following patients and not providers, again, highlighting the importance of being cognizant of different perspectives to understand the full picture to enhance the whole experience. One area for improvement was that nursing assistants should give patients an idea of what to expect during their visit. Even for repeat patients, a quick summary of tests, staff they’ll be interacting with, and where they currently are in that process will go a long way for alleviating anxieties or confusion. Researchers also noted that once a patient was finished in the clinical areas and ready to go home, many of them across all demographics were unsure of how to exit the building or had to ask for directions. Taking a pre-emptive approach and providing directions for patients to reach the front-desk, while small and maybe not even clinically related, will help patients feel comfortable and demonstrates an extra step and willingness by you that patients will remember. Finally, at this specific clinic, it appears that the responsibility of following up with check-out staff was placed on the patient, which opens up possibilities for patients to miss important follow-up items like scheduling another appointment. Providers would verbally provide a laundry list of tasks for patients to do, but oftentimes patients will not be able to completely recall all of it. There is an opportunity here to close the communication gap and help patients retain this information.

The research conducted by Gallan et al. was a successful display of the practical uses of patient shadowing and subsequent recommendations formulated through Co-Design. They fulfilled their stated objectives to observe and document the lived experiences of patients in this outpatient clinic and present their research and recommendations to leadership which can be acted upon to significantly improve patient and staff experiences. To take this a step further and truly encapsulate Co-Design, patients would have a direct voice in the quality improvement process as a supplement to the qualitative data collected through shadowing. According to goShadow data and findings of this paper, issues of communication, gaps in emotional and professional support from leadership, and process inefficiencies are not specific to this clinic, outpatient care or inpatient care. These are solvable industry wide issues that ultimately affect everyone, therefore it makes sense that these issues can only be solved by elevating voices, listening and engaging everyone to Co-Design a new system that works for everyone.   


Source: Gallan, A. S., Perlow, B., Shah, R., & Gravdal, J. (2021). The impact of patient shadowing on service design: Insights from a family medicine clinic. Patient Experience Journal, 8(1), 88–98. https://doi.org/10.35680/2372-0247.1449


Posted on

October 1, 2021

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