Go Shadow: Shadowing as a Practical Way to Learn in Health Care

I took part in a recent IHI webinar with Dr. Tony DiGioia, who has been innovating and refining patient and family centered care for more than a decade. In 2006, he started the Patient and Family Centered Care Innovation Center.

Dr. DiGioia and his colleagues have developed a method to help you learn to be more patient centered. A primary tool in their toolkit is shadowing, which means following a patient through a care sequence with your eyes and ears primed to get the patient’s perspective. Practical information in several detailed guides is available on the PFCC website, www.pfcc.org; there’s even an app to help you track details as you shadow.

Shadowing provides a systematic and emotionally powerful way to understand the patient and family perspective across multiple steps of care. Organizations that apply shadowing typically uncover many opportunities to change work practices in ways that will enhance the patient and family perspective. Change ideas generated by shadowing then form the basis for improvement projects.

I’ve come to appreciate two educational advantages to shadowing in addition to generating change ideas for projects.

First, anyone who shadows a patient through a care sequence will get a deeper understanding of how the care system performs and the relationships among parts and people. Staff who work in one care segment get to learn how what they do fits into the larger care sequence. If you have a sense of the larger system, you can better understand why your tasks are important and to keep the aim of care in mind. Knowing why you do something and how it contributes to a larger aim is fundamental.

Of course you can get some sense of the care sequence by flow charting or value-stream mapping, especially when the process diagramming includes patient and family representatives to shape the process descriptions, failures and successes.

Still, the power of shadowing the patient’s experience engages all of our senses and consequently has more impact than most flow charting or mapping sessions. As Dr. DiGioia points out, shadowing can be done by anyone, they need not be advanced specialists in the care being provided at each step. Shadowing by new staff who follow a patient through relevant care experiences can be a central part of orientation and training.

Second, shadowing helps build observational skill so that you are better able to integrate both patient and staff perspectives to improve system performance—to provide great care in a way that is sustainable, without excess levels of stress.

By design, shadowing helps you take the patient’s perspective. However, the skill to see and hear how a system performs is vital to supervisors and managers observing the workplace with the aim to solve problems and make it easier for staff to deliver outstanding care.

So as Dr. DiGioa recommends, Go Shadow!