'As soon as you've been there, it makes it personal': The experience of health-care staff shadowing patients at the end of life

A Qualitative Study Exploring Patient Shadowing as a Method to Improve Patient-Centred Care: Ten Principles for a New Gold Standard

BACKGROUND

In recent years there has been an increased emphasis on patient experience as a dimension of quality in healthcare, and subsequently a drive to understand care from the patient's perspective. Patient shadowing is an approach which has been used in service improvement projects, but its potential as a Quality Improvement (QI) method has not been studied in practical and replicable detail. This research aimed to do this, and to produce clear guidance for future teams.

METHODS

Qualitative interviews were conducted with 20 clinical and non-clinical participants of a national quality improvement programme in England, which focused on improving the experience of patients at the end of life. All participants had shadowed patients. Data were analysed using thematic analysis.

RESULTS

There were two broad themes: 1) The process of shadowing: how participants went about shadowing, adopting different approaches and making judgements about the care they observed, and any challenges they had encountered. 2) The impact of shadowing: on the engagement and motivation of those who shadowed, and in terms of service changes to benefit patients and their families.

CONCLUSION

The findings led to a new set of 'gold standard' principles to benefit both staff and patients where shadowing is used as QI method. These, together with new guidance, will ensure that shadowing is conducted as a team exercise, and that all those involved are more robustly prepared and supported, and that its purpose as a method to improve patient experience will be better understood.

'As soon as you've been there, it makes it personal': The experience of health-care staff shadowing patients at the end of life

BACKGROUND

Patient shadowing is an experiential technique intended to enable those who shadow to understand care experience from the patient's point of view. It is used in quality improvement to bring about change that focuses on what is important for patients.

AIM

To explore the acceptability of patient shadowing for health-care staff, the impact of the experience and subsequent motivations to make improvements.

METHOD

A qualitative study with a diverse sample of 20 clinical and non-clinical health-care staff in different end-of-life settings. Data were analysed thematically.

RESULTS

Anticipated anxieties about shadowing did not materialize in participant accounts, although for some it was a deeply emotional experience, intensified by being with patients who were at the end of life. Shadowing not only impacted on participants personally, but also promoted better insights into the experience of patients, thus focusing their improvement efforts. Participants reported that patients and families who were shadowed welcomed additional caring attention.

CONCLUSION

With the right preparation and support, patient shadowing is a technique that engages and motivates health-care staff to improve patient-centred care.