Transforming the Joint Replacement Experience

How Patient Shadowing Improved Performance, Value, Staff and Patient Experience in Pittsburgh area Total Joint Replacement Centers

Advances in technology haven’t just transformed clinical procedures-- they have transformed patient experiences as well. UPMC Magee Women’s Hospital, an orthopaedic Center of Excellence, is at the forefront of these advances. In a recent effort to improve patient experience and reduce surgical delays at the hospital’s Bone and Joint Center, hospital administration and staff, ranging from clinicians to operations, began to observe, or shadow, patient and staff processes to truly understand the joint replacement experience from the perspective of the patient and family.

What is patient shadowing and how did UPMC Magee Women’s Hospital utilize it so effectively? We’ll taking a deep dive into patient shadowing. Here’s what is on the agenda:

  • Essential background information on patient shadowing as a strategy for the improvement of patient care pathways, experiences and outcomes
  • A look at how UPMC Magee Women’s Hospital used patient shadowing tools to transform the joint replacement experience
  • Tools for a successful patient shadowing experience


What is patient shadowing?

Patient shadowing is a strategy for understanding the patient experience that helps medical professionals understand the true current state of the patient care experience; one that includes both qualitative and quantitative data from any stakeholder’s perspective.

Why is this important? Often, due to silos inherent in healthcare, caregivers don’t have a clear understanding of the full cycle of care, which means they may not fully comprehend the challenges a patient faces before or after meeting with them.

Patient shadowing is a quick, easy and thorough way to assess how the patient and their family experiences the entire cycle of care.  After shadowing, any team has a comprehensive view of the care delivery pathway and a blueprint for how to improve that delivery to make it more efficient, cost-effective, reliable and easy for the stakeholders involved.

How does patient shadowing work?

For such an effective strategy, patient shadowing is a relatively simple process.

  • Define the experience. Select a care experience to shadow (for example: pre-op appointments, day of surgery, maternity etc.).
  • Choose a shadower. This person will follow patients and their families throughout the experience, recording details, observations and information about the experience in real time. A good shadower is a good listener, a keen observer, and can objectively view the process being shadowed.
  • Prepare for shadowing. Understand hat types of patients are cared for in this procedure? What are the perceived steps in the care pathway? Who are the key players involved in the pathway? What are the current roadblocks to good care?
  • Schedule the experience. Get the permission of the patient and/or family prior to shadowing. Meet with key staff and walk the patient pathway to better understand flow, layout and  introduce the shadower/shadowing team to the key clinical and operations staff with whom you will be interacting.
  • Shadow the experience. The shadower follows the patient and their family throughout the selected care experience, observing and recording the experience from the patient's perspective. Information typically recorded includes which caregivers are involved in the process, the duration of each step in the process, associated tasks and comments or questions raised by the patient and their family or staff.
  • Report findings. Use the information gathered from patient shadowing experiences to draw conclusions about the patient care experience and pathway. Use these finding to identify small changes that can quickly improve experience, efficiency or outcomes of the selected pathway.

Patient Shadowing at UPMC Magee Women’s Hospital Bone and Joint Center

Patient shadowing sounds like a great way to gain a deeper understanding of the patient experience, but what does it look like in practice? According to Anthony M. DiGioia III, MD, Medical Director of the UPMC Magee Women’s Hospital Bone and Joint Center (BJC), patient shadowing is uniquely effective and has helped his team uncover key insights to make significant improvements in the joint replacement surgery care pathway.

For example, according to DiGioia, patients scheduled for the first and second surgeries of the day at the Bone and Joint Center used to be told to arrive at the hospital by 5:OO AM on the day of their surgery, but unknown circumstances often led to frequent surgical delays. To investigate, shadowers -- in this case, caregivers, student interns and volunteers -- followed patients throughout their day of surgery, from their arrival to discharge, to gather information.

So what was going on?

Findings indicated that the simple directive to arrive by 5:15 AM actually caused a lot of trouble. Shadowers discovered that, though patients were directed to enter by the main lobby at 5:15, the main lobby doors were not unlocked at that hour of the morning.

For patients, that meant navigating the outside of the hospital, in the dark, until they could reach the emergency entrance. Considering that these patients were being treated for joint problems, this process was often time-consuming and painful, and led to lower overall satisfaction scores for their joint replacement experience.

Shadowers also discovered that patients often had trouble getting from the parking lot to the building, and navigating within the large hospital due to their mobility issues.

As a result of these findings, the Bone and Joint Center took immediate action to correct these problems. The solutions were simple, the main lobby doors are opened earlier to accommodate patients with early surgery times, and the hospital provided wheelchairs in the main lobby to assist patients who had issues to walking to the pre-surgical waiting room.

These changes have not ony improved the joint replacement experience for patients and their families, they have cut down on delays in first and second surgery start times, improving overall operating room efficiency and staff satisfaction.

The success of patient shadowing as a process improvement tool has made the UPMC Magee Bone and Joint Center a national leader in clinical outcomes and patient satisfaction. It has also inspired further process improvement efforts in other total joint Centers of Excellence in the United States and abroad.

“The weakest link in delivering value is knowing the true costs for the whole care experience,” said DiGioia. That’s why the Bone and Joint Center is currently exploring value-based contracting options to continue shadowing patient experiences. By taking advantage of options such as bundled payments and reference-based pricing, and by combining an activity-based costing method with patient shadowing, DiGioia is confident that his team will continue to improve patient experiences while reducing  the cost of care.

Strategies for Effective Patient Shadowing

What can you do to ensure that your patient shadowing experience is effective? The keys to a successful patient shadowing experience are simple:

  • Organization. In order to record a shadowing experience in detail, shadowers must have a way to quickly and accurately record information and time multiple, concurrently occurring events.
  • Collaboration. Turning a shadowing experience into real improvements involves a great deal of analysis and requires the help of many people within a team or an organization. Having an effective way to share and report on data is essential.

Luckily, shadowers now have an effective patient shadowing tool, goShadow, to help run shadowing and improvement projects smoothly and more effectively..

Patient shadowing is an effective strategy for understanding and improving any processes. If the success of the UPMC Magee Women’s Hospital Bone and Joint Center shadowing initiative is any indication, shadowing is an exciting option for any hospital or private practice to explore in order to quickly take action that can impact clinical outcomes, operations, engagement and satisfaction of patients and staff.

Posted on

February 1, 2019