From little things big things grow: the power of shadowing patients
26 September 2014
Hesham Abdalla, Paediatric Consultant and Clinical Service Lead at George Eliot Hospital in Nuneaton, writes about shadowing a mother and her seriously ill baby, and the insights this offered about the organisation from a patient’s perspective
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A couple of months ago I shadowed a mother and her three day old baby through my department. My colleagues looking after the baby suspected she had contracted sepsis, a potentially life-threatening infection that can be transmitted to babies during labour.
I have shadowed patients many times over recent years to understand and improve the service I provide. However, shadowing someone so young and so ill, and taking the time to really talk to her mother, was a difficult but powerful learning experience. Shadowing involves spending a couple of hours with a patient, just listening and being with them- observing their journey without problem solving.
Prior to my joining the George Eliot Hospital eight months ago as a consultant paediatrician and now clinical service lead, and following a public consultation, the trust had closed its paediatric inpatient ward. Although this was a difficult decision for the local population, it meant the trust could continue to offer higher a local high quality service to those children not needing inpatient care. This has been born out in a recent peer review that rated as one of the best trusts in the region at this. Part of my job at the trust is to making sure those few children who do need inpatient care have a safe and efficient transfer to our partner hospital.
A chance to stand back
With any service redesign, there is much to do to make sure the new processes work well. Shadowing patients gives me and other members of the paediatric team a chance to stand back from the day job to see these processes from another perspective, with the aim of identifying and prioritising what needs to improve both for patients and for staff.
When the opportunity arose to shadow a patient being transferred from George Eliot to Walsall, I knew it would give me insight into how this part of the patient pathway was being implemented. As is so often the case with shadowing, I learnt so much more than about just the transfer process.
On the journey in the ambulance, the mother expressed anger, saying she had known from almost the moment her baby was born that something was not right. She told me she had raised concerns with the midwives but felt they had ignored the voice of a fourth-time mum.
As this mother pointed out, had her concerns been listened to, her baby may have been transferred to the local special care baby unit (SCBU), and not have to be put through a transfer to another hospital and the inconvenience this would cause to her and her young family.
Learning points
There were a number of learning points I took away from this experience. Although the mum was very complimentary of the care she had received when being readmitted through the children’s needs assessment unit, there were many things we could do better.
The staff needed to be show more sensitivity to mothers’ concerns and communicate this effectively. We also needed to explore whether recently discharged newborns, who develop complications, could be readmitted to the SCBU in order to avoid unnecessary journeys.
There were issues with hospitality. The mum had been offered a sandwich while she waited in the children’s needs assessment unit, but the sandwich never came.
There were issues with pain relief. The mum had had a caesarean section only a few days previous, but staff were not able to give her any analgesic for her pain until she registered with A&E, something she was reluctant to do as it meant leaving her baby.
As part of our service improvement programme in paediatrics, I encourage all staff to shadow a patient once or twice a year. Their experiences are fed back to the rest of the team to deepen their learning and spread it to others. Those gaps in the service that are exposed are addressed. In this case we have changed the process so that selected infants can be readmitted to the SCBU, avoiding the journey that this mother and baby had to go through.
An inexpensive opportunity
Shadowing is an inexpensive way to help staff see things from the patient’s perspective. The power lies in staff dismantling their current view of the service they are delivering, and then seeing the cracks, the things that need to be fixed. They are then invigorated to do something about it themselves. Allowing ourselves to see our service from another perspective can be difficult; not everyone wants their misconceptions shattered, but seeing it from the patients’ perspective is absolutely necessary if we are going to transform care to meet their needs.
Have you experienced patient shadowing? If so, what insights did the process offer you? Has there been a lasting impact?