Shadowing to improve patient care

Ongoing improvement to the care and experience of both patients and their families is of utmost importance to everyone involved in healthcare – but how?  Anything which helps us to answer that question must be applauded and an excellent example has arrived this week in the shape of the Patient and Family Centred Care Toolkit, courtesy of The King’s Fund.  One of the tools advocated is the practice of “shadowing”: basically the observation and recording of each step of a patient or families experience, then using this as a catalyst for change.

Having had first-hand experience of this practice – both in the role of observer and the observed – I would strongly advocate its benefit to anyone involved in an NHS leadership role.  You undoubtedly learn from the opportunity to observe colleagues in action with patients.  The detached position enables the stimulation and crystallisation of ideas regarding what needs to change.  There is also much to be gained by the colleague being observed.  Firstly, a heightened self-awareness is inevitable when you are in the spotlight, with conscious recognition of what often happens automatically.  Secondly, it provides an excellent opening for learning through feedback.

All sounds good?  Yet there is an unmentioned, essential requirement that must be considered to ensure any such exercise is a success: the need for excellent communication skills for those involved.  To begin with, any doctor who wants to initiate a shadowing exercise should expect to face a degree of resistance and is likely to need to influence others to overcome this.  Just like influencing, the ability to give genuinely useful feedback to colleagues, while avoiding or addressing any resulting conflict is another skill which must be developed and practiced.

When combined with constructive feedback and supportive challenge, the practise of shadowing is a very powerful tool to improving patient and family centred care.  To enable this, the continued advancement of communication skills for doctors with their teams has to be a priority.