Build Improvements and Empathy with Shadowing
In the Patient Centered Value System (PCVS), we use shadowing to view care as it is experienced by patients, families and frontline employees. With this crucial and simple activity, we accurately capture the powerful voices of our stakeholders, we map the patient’s journey through the complete care experience and we create an opportunity for everyone to share their powerful voice. Shadowing is surprisingly simple, often fun and always valuable. Learn how this simple co-design tool helps you identify improvements, connect with patients, build empathy and create a culture of positive change.
What is Shadowing?
Shadowing is the direct, real-time observation of patients, families and employees as they move through a care experience. It is a foundational tool in PCVS and the key to co-desiging exceptional care experiences. By observing and reporting the authentic perspectives of patients, families and frontline caregivers, you will have the insight and empathy needed to build teams, make changes and improve experiences.
Shadowing identifies opportunities for improvement.
Shadowing gives real-time feedback. Patients, families and employees become partners in co-designing better care when the experience is viewed and documented from their unique perspectives. It is important to gather both objective and subjective information while you shadow:
Where are we now? How long have we been here?
Who does the patient interact with? Why and for how long?
How does this experience look, feel and sound to the patient?
Which processes are smooth? Which ones could be improved?
While times, locations, caregivers and workflows are important elements to document, feelings and reactions are equally as important. Think of shadowing as gathering all of the details of the patient’s unique story. Your observations will be reconstructed to create the picture of a typical patient journey complete with wins, gaps and opportunities to be better.
From your shadowing observations, you construct a Care Experience Flow Map. This can be in the form of a story, a map, a chart or any other visual representation of the patient’s journey. As long as it depicts the places (touchpoints) through which patients and families pass and the people (caregivers) with whom they interact, it will show the current state. Care Experience Flow Mapping is eye-opening and often prompts teams to ask, “How can we work together to improve?” See one team’s care experience mapping process here.
Shadowing leads to empathy.
Shadowing is your pathway to renewed empathy with patients and families. It provides the objective data - where patients and families go, for how long, who and what they see, hear and do. But objective data alone is not enough to motivate change. Shadowing gives a voice to the feelings, impressions and reactions of patients, families and employees as they travel through a care experience. It is this voice that reminds us why we became caregivers, and why we work every day to provide the best care. When we shadow, we connect with our patients. When we connect, we feel increased empathy. This connection and empathy create the urgency to drive and sustain change.
Shadowing creates a culture of continuous improvement.
Shadowing is an ongoing effort and should be done repeatedly over time. The current state of any care experience is dynamic, not static. You will always be evaluating the “new” current state and making changes to get closer to your goals. By shadowing repeatedly over time, you are seeing the ever-changing opportunities to improve as well as the impact of past improvement efforts. Think of shadowing and the improvement projects that result as an ongoing cycle. This cycle of continuous improvement builds energy over time…patients, families and employees feel heard and see their suggestions in action. Teams are more likely to speak up, take ownership and participate in changes as they see the results of co-design in action. The act of shadowing will shift your culture to one that thrives on continuous improvement.
The Ideal Story - A Real-Life Example, Part 1
The Ideal Story is a co-design tool that does more than simply get feedback. The Ideal Story engages your team in the improvement process. Whether it’s a team of frontline caregivers, patients, administrators or any combination, it pulls your group into the story behind the experience.
Let’s face it - every healthcare worker has stories. Some are good. Some are tragic. Many are infused with joy. Others are plagued with thoughts of how it could or should have gone differently. No matter the tone or outcome, each story is an experience, and it is these experiences that we all want to improve.
The first step to improving experiences is often deciding what you’re aiming for, and this is where the ideal story comes in. Read on to discover how one team wrote their Ideal Story, and find an easy-to-use Ideal Story Worksheet here.
Divide and conquer.
The Ideal Story activity can be conducted in many different ways. The team in this example wrote their story by dividing their care experience (an outpatient ophthalmology office visit) into logical “segments.”
Check-in at the desk
Waiting in the waiting room
Being placed in an exam room
Having health history and vitals taken by the nurse
Moving to the imaging area for testing
Back in the exam room to see the doctor
Check-out at the desk
With these segments as a framework, the team got to work imagining the care experience from the point of view of a patient. What should happen? What should not happen? What should be eliminated or added to create an experience that the patient would call ideal?
Break down the silos.
The Ideal Story is meant to be fun and energizing. It is designed to tap into the creative energy of your team and to break everyone out of negative thinking patterns.
The team in our example kept it light and fun by dividing into small groups and assigning a segment to each group. Groups weren’t necessarily made up of people who worked in that segment and that was fine - because the story is written from the perspective of the patient. Every person working on the story had interacted with patients and families and had ideas of what worked and what didn’t. More importantly, every person had been a patient or the family member of a patient and could identify the good and the not-so-good.
Think “blue sky.”
The small groups had 20 minutes and 3 ground rules:
Imagine care that is free from barriers, restrictions or limitations.
Tell us what you’d do if you had all the staff, all the space and all the resources you needed to deliver a great experience.
Write from the patient’s perspective.
Piece it all together.
At the end of 20 minutes, the small groups came back together to share their stories. The group with the first segments (check-in and waiting) read their story while a facilitator recorded key words and phrases on a dry-erase board. When the first group finished, the next group shared their story, the facilitator recorded, and so on until all groups had gone. What resulted was not only a complete experience in story form, but a team that was energized by the challenge of thinking outside the box. Because they weren’t asked to solve problems or fill gaps, they got carried away with the task of generating ideas. They took full advantage of the opportunity to imagine care that represented their personal and professional values, and they wrote an Ideal Story that reflected those values.
Identify your projects.
Using the keywords and themes pulled from the Ideal Story, the team created a project list that included:
Paperless Check-in,
Service-based Care Pods,
Coat Hooks for Exam Room Doors,
and more!
They prioritized the projects - starting with a focus on “low-hanging” fruit, then moving to heavier lifts. To show the value of each proposed project, the team used the PCVS Project Plan to connect their ideas to larger organizational initiatives. With that template, each project had a visible tie to at least one of their four goals impacting quality, service, people or finance.
Change with time.
As the team began the work of implementing person-centered improvements, they recognized that no care experience is (or should be) static. They set a date to re-visit their Ideal Story in six months. During the re-visit, the team would read their Ideal Story and decide:
Are we heading in the right direction?
Are we creating an experience that is ideal for patients and families?
Are we supporting employees in delivering ideal care?
Has anything in our environment changed that is now creating a barrier?
How are we evaluating experiences in real time?
Reconnect with the Ideal Story.
The Ideal Story is a co-design activity that taps into the heart of caregiving. It connects us to the stories of patients, families and frontline employees. It connects us to the joy and the humor and the empathy that fuel our professional lives. It reignites the passion for caregiving and reminds us that we have the knowledge, the ideas and the power to create experiences that change lives.
Use this simple co-design tool to engage your team and discover the powerful connections between people and their stories.
The Ideal Story: Tips, Tricks and “How-to”
All improvements begin with a story. Each patient, family and employee that comes through your organization has a story to tell…and the stories of these individuals add up to your organization’s culture. If you want to improve the culture, and the experiences that occur within it, the Ideal Story activity is one co-design tool you should use.
Writing a story can feel overwhelming, especially when it’s tasked to a team. This article will give you one step-by-step approach along with helpful tips and tricks. But just as stories and experiences differ, so do approaches to the Ideal Story activity. Feel free to use what fits for your team or change the approach as necessary. Just keep your mission and ground rules in mind, then tap into your team’s creativity and let the inspiration come!
Your mission:
Write the story of the ideal care experience.
Don’t work in a direct care setting? The Ideal Story activity will still work for your team. Write about an education experience, an employment experience or a volunteer experience. The key is to write the story of what is ideal.
The ground rules:
Write from the point of view of the patient, client or customer.
Imagine an experience free from barriers, restrictions and limitations. Truly “blue sky thinking.”
Don’t worry about sounding professional or technical. Write a story. Create a narrative that shows what it’s like to truly walk through an experience.
How to get started writing:
As a team, divide your experience into logical “segments.”
Think like a patient…segments are often things like check-in, waiting, meeting with the doctor, etc.
Divide your team into pairs or small groups. Assign one or two segments to each group.
Tell your groups the ground rules above and let them get started.
Give a time limit - 20 minutes usually works well.
If the creative energy is strong and groups need more time, extend it by 5 or 10 minutes.
When the time is up, groups should stop writing and come back together to start constructing the complete Ideal Story.
Download the Ideal Story Worksheet to use with your team.
How to build the complete Ideal Story:
When all groups are finished writing their ideal segments, bring the groups back together. Groups will share their stories “in order.” While each group reads their narrative, a facilitator will be responsible for writing down key words, themes and ideas in a spot that can be seen by the entire team (dry-erase board, shared screen, poster board, etc.). Encourage participation and feedback. When the small groups have finished reading their segments, have someone collect all of the stories so they can be typed and saved.
Get ready for the lightbulb moments.
Get ready to hear groups calling out, “We had that, too!” What your team will quickly find is that many of them share ideals. The energy will build as they discover consistent themes and ideas that develop organically throughout the story. These commonalities will turn into improvement projects that are prioritized by order of urgency or importance.
How to use your story to create and prioritize projects.
As the facilitator is writing down key words and ideas, the larger team will begin to see themes emerge clearly. Safety. Communication. Quality. Workflow. As themes emerge, your team can further group the ideas into categories and begin to prioritize. Some projects will be quick wins, “low-hanging fruit” that can be accomplished easily and quickly.
Pro tip:
Tackle a few quick wins first. These projects will generate momentum and positive energy to keep your team engaged (and possibly engage others, as well).
Some projects will be heavier lifts that will require your team to gather baseline data, evaluate the current state and build multi-disciplinary teams. Don’t shy away from these projects. Use shadowing, “What Matters to You?” and Team Building to work toward your team’s vision of ideal care. The improvement process may not always be quick and easy, but there are PCVS tools to help you succeed.
Pro tip:
Use the PCVS Project Plan to keep current, future and completed projects organized. The PCVS Project Plan helps you align your projects with unit, facility and system-level goals. It also serves as a living record of everything your team has accomplished.
Go from current to ideal together.
Now that your Ideal Story is written, and you have a list of short and long-term projects prepared, use the co-design tools and approaches of PCVS to move your team through the improvement process.
Remember, your team’s story can (and should) change over time. Use it as your roadmap when creating ideal patient, family and employee journeys. Revisit it from time to time to be sure you’re heading in the right direction or to reflect on how far you’ve come. Your team will benefit from the opportunity to co-design better experiences. Better experiences will result in better outcomes and engagement. The power of storytelling will bring everyone into this journey of improvement.
Change isn’t easy. PCVS can help.
No question about it, change can feel threatening. Many teams, when confronted with the seemingly monumental thought of switching to a patient-centered practice, will react with hesitance at best…or resistance at worst. “After all,” they may say, “we already do that. Don’t we?”
The Patient Centered Value System (PCVS) is your tool for creating change that is built from the perspective of patients, families and frontline caregivers. By engaging everyone in the process of designing and delivering excellent care, PCVS leads to better outcomes, better experiences and more joy. How can it do this without being overwhelming? Read on to find out.
Ask the right questions.
Successful and sustainable change depends on the input and participation of all stakeholders - from the patient, to the operator that schedules the appointment, to the valet at the hospital, to the doctors, nurses, therapists and everyone in between. The PCVS methodology starts by asking each person, “What matters to you?” then builds new care, processes and solutions to match their responses. Without asking what matters most, we risk creating a subpar experience that is built on assumptions instead of reality.
PCVS starts by asking what matters, and continues by asking for real-time perspective and insight. PCVS Shadowers spend time observing and recording the lived experience in real time. While they observe and record, they ask patients the questions that get to the heart of care:
Why did you come in today?
What are you hoping happens today?
How long have you been here?
How many doctors and nurses have you seen, and how for how long were they with you?
It is these questions that help us understand what works well and what could be better in the patient’s eyes. Instead of assuming our patient wants or needs certain care and services, we take the time to ask. We take their input back to our teams and get to work creating changes that align with their vision.
Be transparent.
Tell your employees and patients that you are focused on creating patient and family centered care. Make it the framework for every huddle and staff meeting. Start every patient encounter with “what matters.”
But what will patients and families think when we tell them we’re going to start now? Our fear of change prompts us to ask many negative questions that only serve as roadblocks. In healthcare, it is this traditional thinking that keeps us stuck and prevents us from making improvements. Our long-established conventions and traditions have led us to an age where person-centered care is talked about as a priority, but is not practiced in real time.
Find answers with PCVS.
The Patient Centered Value System has tools and approaches that will lead your team through a journey of change.
Break complex change into manageable parts with PCVS.
Changing your organization’s culture to one of participatory and continuous change can feel overwhelming. The solution is to use the PCVS methodology to energize and engage the people who are most affected by change - the patients, families and frontline employees. PCVS breaks complex challenges into manageable parts so that organizations listen, employees and patients feel heard, teams are energized and experiences improve.
Jessica Carlson