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“A return to basics is needed to re-humanize health care delivery and health care work environments.”
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Co-Designing an Environment Where Patients and Staff Thrive

By IHI Multimedia Team | Thursday, November 14, 2019
To both patients and care providers, health care systems often are a labyrinth of siloed pathways and processes. Basic communication between patients and providers is often lost. A return to basics is needed to re-humanize health care delivery and health care work environments. We need to peel our eyes away from the computer screens and mobile devices that often separate patients from providers or providers from one another. We must co-create environments that foster joy and hardwire experience improvement.

Humanizing Data

The era of big data has created standards and comparative metrics for just about everything, ranging from patient experience to operating room start times. Despite the volumes of data being collected, most of it does not scratch the surface of telling the patient story or capturing the experience of the teams that are at the front lines of patient care. Additionally, systems designed to create higher connectedness and access for patients and care teams have instead formed physical barriers to basic human interactions. Looking someone in the eyes when you speak to them is becoming as antiquated as physician home visits. Data is power, but the human aspect behind that data is often missing where it matters most. Data collected through patient shadowing can be the notable exception.

Patient shadowing, or doing direct observations, customer discovery, and asking key stakeholders “What Matters to You?” are not new concepts. They have been embedded into clinical shared-decision making and process improvement methodologies, ranging from the Institute for Healthcare Improvement’s (IHI) Model for Improvement to Lean and Six Sigma, that have been adopted by health care organizations worldwide. 

While creating a tool for care teams and providers to automate and aggregate the collection of this data might seem unnecessary, the value that qualitative and quantitative shadowing data provides to patients and front-line teams can be invaluable. Moreover, it has been shown that this data, when fed back to those at the frontlines, facilitates the co-design of better care delivery and patient experiences that improve efficiency, engagement, and satisfaction at all levels of an organization.

While there is a science to process improvement and building reliable care systems in health care, there has yet to be a universal “how to” for experience improvement. And there is no silver bullet. Change is hard, especially when it’s not exactly clear what truly matters to key stakeholders. Since data has power to drive change, many organizations, patients, and front-line teams ask, “Where do I start?” Here are a few suggestions:

  • Give stakeholders a voice. Use shadowing and real-time feedback to discover the true current state and what matters.
  • Create a road map. Use perception mapping to reach the ideal state.
  • Co-design experiences. Use interdisciplinary teams to create a strategy to close the gap between current and ideal states. Identify low hanging fruit with an eye toward long-terms projects and results. Communicate the strategy and a time-bound plan with all stakeholders.
  • Utilize “what matters” data and shadowing to focus improvement efforts. Measure and anticipate patient and staff experience scores as well as process improvement

A Case Study

Intensive care units are some of the busiest in any health care environment. As a result, patient satisfaction and communication between care teams and patients becomes secondary to delivering care. In a recent project, our team tested the framework above. Starting with process discovery, experience mapping, and asking simple questions aimed at generating actionable feedback while identifying pain points and areas of opportunity. Very quickly, it became apparent that the care team, patients, and family shared similar values and reported similar struggles. Most notable were gaps in communication starting with admission and a lack of resources needed to prepare for discharge.

The interdisciplinary care team, patients, and families were each asked five to seven questions. Provider questions included: 

  • What makes you most proud in your role? 
  • Are there any process(s) that you would improve? How would you improve them? What resources would be needed?” 

Patient and family questions included: 

  • What has gone well in your experience?  
  • What resources would you and your support team like to have in order to prepare for discharge from the hospital?

The responses were aggregated and reported weekly to the working group, as well as medical and nursing leadership. In conjunction with the qualitative feedback, time-stamped shadowing data revealed the same gaps in communication from patients’ and providers’ viewpoints. Research into the unit’s HCAHPS feedback also aligned with what we discovered.

The interdisciplinary team utilized data representing patient experience, care team workflows, and pain points to assemble a strategy and identify easy wins that could be tested immediately and measured by engaged frontline staff. A specific area of opportunity was the transition from ICU admittance until a formal plan of care was established.


LEARN MORE: IHI National Forum


The shadowing team did a deep dive into the patient pathway and processes. A family communication protocol and checklist were created that encompassed this initial time frame ranging from less than sixty minutes through twelve hours. Patient and family touchpoints, care team talking points, when they occur, and who completes them were formatted on a single-sided piece of paper to be tested over eight weeks. All stakeholders were queried using a similar open-ended format to measure success. Number of family calls onto the unit requesting information during this initial segment were measured and compared.

While the pilot is ongoing, the initial impact on patient experience, staff engagement and provider time spent answering phone calls from family members all reflect a marked improvement. The team is now engaging other colleagues to follow the same process to develop a communication protocol and related patient education materials that will be incorporated into daily rounds starting at the time of admission.

Angela DeVanney is co-founder of goShadow. Her team will describe their work at the IHI National Forum during session A09/B09: Co-Design an Environment Where Staff Thrive on Tuesday, December 10, 2019 from 9:30 AM to 10:45 AM and again at 11:15 AM to 12:30 PM.

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