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5. Carrying out observations

Once you receive the go-ahead for the project, your first activity is likely to be observation. This is an extremely important stage that involves spending time within the service, watching how the teams and systems operate on the ground.

This stage involves noting what you see and thinking about how you respond to it, focusing on anything that seems impressive, unusual, surprising, confusing or worrying. Try to imagine you are a patient, or are seeing the service through fresh eyes as a visitor to that area. For example, in one clinic, observers noted that patients who arrived early in the morning had to sit in the dark until the receptionists arrived and turned the lights on. Patients will often not mention this sort of detail, even though it may have a major effect on their experience of care. It is helpful for this stage to be carried out by the project facilitator and other colleagues, if possible. Outside observers can play a crucial role in exploring patients’ experience.

Observation provides valuable insights into how the service works and what patient and staff perspectives might be. These can be especially helpful in suggesting prompts for the later interview stage. It is also a valuable way of building trust with the staff team, as it demonstrates your commitment to and interest in the service. It is an important stage, but very flexible. Depending on resources, you may spend three hours observing one clinic or service, or several days visiting different activities at a range of sites. You will report your findings back to staff at the staff event.

Key points

  • Don’t be tempted to skip this stage of the process – it often highlights issues that will not arise through other activities.
  • Pick particular aspects of the service that are practical to observe. For example, it will be easier to access a clinic waiting area than a one-to-one consultation.
  • When you arrive, introduce yourself to the person in charge – you will hopefully have met them while you were making the case to staff. You should also bring along documentation showing that you have permission to observe, in case staff on the day are unaware of the project. (Example consent form for observation)
  • Do not feel you need to be invisible – explain to people why you are there, and consider bringing along leaflets or business cards to distribute. It is important to reassure staff that you are not there to judge, but to understand the service. Clearly explain the purpose of the observation, and make sure everyone feels comfortable.
  • Be friendly and open, ask questions, look at verbal and non-verbal communication, notice the way people use space, look at the way in which the services change depending on the stage of the patient pathway. Try to notice anything that seems curious or that seems to make people feel uncomfortable, and question it.
  • Plan the timing around what is feasible. Is there anything happening on particular days? Try to cause minimal disruption – for example, do not observe during a ward round.
  • Before you begin your observation, go to the areas you plan to observe and familiarise yourself with the service. Find out where people do which things, where you can sit, and so on. It is helpful if staff can show you round the area so you can understand the patient pathway.
  • Use the opportunity to talk to patients, to approach staff who have been hard to contact, and even to recruit staff or patients into the project. However, approach this sensitively, and run any names past the clinical lead before confirming.
  • If you are observing consultations, seek consent from everyone involved. (Example consent form for observation)
  • If you are working alongside a colleague, do not discuss anything you see in your observations until you are away from the area. Remember to respect staff and patient confidentiality. Ideally, try to report information back anonymously, although this can be challenging with small groups of people.
  • If the interviews raise additional issues that you would like to see working in practice, consider carrying out more observations later in the project.
  • This is a very flexible part of the project. For example, if you have only half a day available, choose busy times when you are most likely to see points of interest relating to patients’ experience. If you have longer, you could spend much more time observing, but do not overstretch yourself, as you will need to write up all your notes so you can refer back to them later in the process.
  • Further tips on how to carry out observations can be found in our guide to observation.