Shadowing the Patient for a Better Care Experience

How Patient Shadowing Identified Areas of Improvement for One Facility

Have you or a loved one ever gone into the hospital for surgery? Nearly everyone has been in this scenario, whether it was first hand or for a friend or family member. Now, think back to that day at the hospital – do you recall the process being time-consuming and anxiety-driven?

If you said yes, you’re not the only one. Truth is, no one enjoys visiting hospitals. But the long, drawn-out process for the day of surgery is not only inefficient but also causes added stress on top of an already tense day for patients and family members alike.

Hospital visits are taxing for everyone involved, but through patient shadowing, the Bone and Joint Center at Magee-Womens Hospital of UPMC is making strides to improve the patient experience. Read more to learn:

  • How the Bone and Joint Center used patient shadowing to identify and address delays in their surgery start times
  • What patient shadowing is, the six steps in the shadowing process, and how it helped to improve patient satisfaction in the program
  • How patient shadowing can work with other process improvement tools to further improve patient experience and decrease costs associated with the care cycle
  • How the Bone and Joint center worked to lower care cycle costs by identifying high cost steps in the process

But -- some hospitals are working towards identifying ways to reduce this stress and make the patient care process easier. So, let’s take a look at one of these situations.

Step One: Identify the Problem

This story starts off when the Bone and Joint Center at Magee-Womens Hospital of UPMC identified that late start of surgery times had a direct, negative, impact on patient satisfaction.  

Once surgery delays were known to be a root problem, they decided to dig deeper into their current state to identify what gaps in care are building up to late start times. . To get an unbiased opinion on the process, the Bone and Joint Center chose to use patient and family shadowing to help identify opportunities for improvement t in their current surgery system.

Before jumping right into the case study and its results, you may be wondering what exactly patient and family shadowing is. It is the idea of following (aka, shadowing) patients and their families through each step in their healthcare process. The hope is to identify areas of improvement through co-design that will engage with patients, families, staff, and physicians to improve experience, efficiency, and staff satisfaction.

The person who is participating in the program as a shadower should be someone who is not heavily involved in the process, such as a student or volunteer. This shadower should be someone who pays close attention to detail and approaches the experience with an open mind.

Patient shadowers gathered in a hospital hallway
Shadowers following the patients and families through their entire care cycle, from admissions to discharge .

Starting at the Beginning

Alright, now that we are all caught up, let’s get back to identifying the problem. The Bone and Joint Center knew that if they were to have a clear understanding of exactly where the problem began in their process, they’d have to start at 5:30 a.m. when the first two patients arrive for surgery.

It was quickly identified that the process had flaws from the start – patients were told to arrive at the main lobby of the hospital, but the main doors were locked at these early hours. Not only did this frustrate and confuse patients, but it also forced them to walk from the main lobby to the emergency room entrance.

Now, that may not sound like a big deal, but keep in mind that the people arriving at the facility that morning were receiving  a knee or hip replacement surgery. So even walking  a short distance could be a major task for the patients.

By shadowing, it was easy to see the delayed surgery schedules started from the moment the day began. This allowed the facility to make a few simple, yet effective, adjustments that made a big impact.

Implementing What They Learned

From this specific shadowing experience, the program  was able to identify that changing the hours of their main lobby could make a huge difference in patient satisfaction. So, they quickly communicated with the hospital to  open the main lobby doors earlier so that to make sure they were open for the first two appointments of the day.

a knee replacement patient stands with the assistant of a walker beside their hospital bed
Understanding the specific need for patients before and after a total knee and hip replacement is important in the  patients ultimate satisfaction. Understanding how they move around and navigate the hospital is vital.

Now that these doors were unlocked and ready for patients to arrive at 5:30 a.m., the program  was already making small changes to improve surgery start times.. This also eliminated the need for surgery patients to have to walk any extra steps than needed -- making for a much happier patient.  

To take it even a step further, scooters became available to assist patients once they were in the building. They could use these scooters to move around the hospital and get them to the third-floor surgery unit.

These minor adjustments allowed for more on-time surgeries throughout the day, and overall better patient satisfaction. Getting the day started off in the right direction made for an improved process and overall better patient experience.

With one successful shadowing project in the books, the Bone and Joint Center set their sights even higher.

The Six Steps To Patient Shadowing

The patient shadowing process can be broken down into six steps:

  1. Identify the care experience to be shadowed (such as the day of surgery or pre-operation steps)
  2. Select a shadower
  3. Gather information about the care experience with the goal of creating a flow map that details the current state.
  4. Connect and coordinate with the patient and family, which includes asking permission to shadow
  5. Observe and record the experience through the eyes of the patient and family noting each step in the care pathway, the caregivers with whom the patient/family comes in contact, the duration of each step in the care pathway, and first-hand comments and questions raised by caregivers and the patient/family
  6. Report findings to the working group and project teams with the goal of improving the patient experience, staff satisfaction, and efficiency.

Once each step of the process has been completed, it’s important to present the collected information to the teams. In the case of the Bone and Joint Center, the teams were willing to take the information made available through shadowing and improve their current processes. Shadowing  provided them with a chance to catalog what the patient experiences.

The facility was able to take patient shadowing to the next level by grouping the shadowing process with an activity-based costing method. This method helped to determine the true costs associated with  total hip and knee replacements.

To determine the true cost, healthcare providers had to:

  • Follow the path of a patient through the care experience
  • Identify the actual cost of each resource, such as personnel, equipment, and consumables
  • Document the time the patient spent with each resource

Luckily, to make this process a little easier, the Bone and Joint Center already had a lot of these steps in place -- so all they had to do was factor in the associated costs. To do this, they assumed the joint replacement care cycle began 30 days prior to surgery and ended 90 days post-surgery. Now it was time to re-shadow the care process with this in mind.

a technician smiles as she takes a patient's blood pressure
Each step in the care process must be documented to understand the total cost associated. From nurses taking blood pressure to the implant replacement itself.

To make sure they had the full scope of the cycle, they decided to shadowed three patients who were undergoing total hip and knee replacements with these costs in mind. By following them from the beginning of the cycle until the end , they were able to get a full picture of where the highest costs were incurred.

Unsurprisingly, they found that the operating room was the most expensive part of the process. From there, they were able to identify that the first and second inpatient post-op days were also high on their cost list. The other item that was identified as a high cost was consumables, which accounted for around 50 percent of the total cost. Important to note is that the most expensive consumable was the implant itself.

One of the biggest improvements that were implemented from this process was a one-stop pre-operative visit for joint replacement patients. During this visit, patients have the opportunity to meet the center staff, tour the hospital, complete screening and testing, and more. By combining all the pre-operative requirements into one visit allowed for fewer appointments and conservation of staff time..

This improved clinical outcomes, readmission rates, and provided the center with patient satisfaction rates well over the national average.

Improving Future Patient Experiences

All in all, the Bone and Joint Center has had an extremely positive experience with patient shadowing methods. From identifying issues in their own patient care processes to identifying areas of improvement and cost-efficiencies -- it is a success story for both the facility and the patients.  

Is your healthcare facility doing everything they can to provide the best patient experience? Healthcare facilities that are taking advantage of patient shadowing are outperforming the rest and providing the highest patient satisfaction, make sure your facility doesn’t fall behind.  

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Posted on

May 24, 2019