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'Shadowing' focuses on patients and families to improve health care

Dr. Anthony DiGioia
Published Dec. 11, 2014

A few weeks ago, I received a call from a reader, a retired baker who wanted to tell me about his experience in a well-respected hospital in north Pinellas County. He assured me his health is fine now, but a few things about his hospitalization troubled him.

He told me about a physician ordering the wrong dose of a medication, which made him sicker and kept him in the hospital a few days longer. Then, when he was well enough to leave, he and his wife waited 12 hours for someone to sign off on his discharge.

Finally — and this seemed to bother him the most — his breakfast toast arrived frozen. Ice crystals and all.

After we said goodbye, I marveled that anyone who had survived a significant medication error — something that kills thousands of Americans each year — was so hung up on toast.

I still think the dosage error was the worst thing that happened. But I'm rethinking my position on the toast.

Last weekend, I met an orthopedic surgeon from Pittsburgh at a big conference in Orlando organized by the Institute for Healthcare Improvement. In addition to a busy practice replacing bad knees, Dr. Anthony DiGioia founded the Patient and Family Centered Care Innovation Center at the University of Pittsburgh Medical Center.

DiGioia believes something that may strike you either as radical or a total no-brainer: Focus on patients and their families, and you deliver better care, happier patients and even lower costs.

High-quality medical care matters. But so do helpful parking attendants, technicians who speak to patients respectfully, conscientious housekeepers, and, I might now add, decent toast.

After all, if a hospital can't get the simple stuff right, it's hard to be confident they're doing the complex work well.

Patient-centered care has been a hot topic for years. But the PFCC Innovation Center offers concrete, inexpensive steps to help health care facilities figure out what's most important to their customers, and then put that knowledge to work.

A key step is following people like my friend the retired baker to witness their experiences first-hand. It's called shadowing, the focus of DiGioia's talk on Sunday before an international audience who seemed eager to take his message home.

Anybody — from a nursing student to a housekeeping employee to a CEO — can shadow patients and families who are willing to have somebody tag along. The shadower's expertise isn't so important. The idea is to view what happens through the eyes of patients and families.

It's not a "secret shopper'' program, DiGioia said. The point is to study and improve the system, not ambush individuals who work in it.

Health care workers "know what's wrong,'' said Lisa Schraeder of the PFCC Innovation Center. "Shadowing gives them an opportunity to be heard.''

We got to try some simulated shadowing when DiGioia's team put on a skit about a teenage cheerleader rushed to the hospital with a head injury. We saw her "mother'' dash up to the ER "receptionist,'' only to be told to take a seat and wait, because the receptionist wasn't allowed to leave her desk. "We're short-staffed,'' she said, apologizing.

That rule kept mom and daughter separated for three hours. And that, observed a physician in the audience, is both cruel and slows down the informed parental consent needed for the girl's care.

The skit ended with the girl being sent home with a wad of papers and prescriptions for her mom to decipher. The audience's reaction — uncomfortable laughter and head-shaking — made it clear this scene was all too familiar.

DiGioia described research showing how shadowing is being used to reduce costs by identifying inefficiencies and excesses. He kept the emphasis on the ultimate health care customers, not insurance companies, medical devicemakers and the like.

"The health care industry has so many constituencies,'' DiGioia told me. "But value should be determined by the end user — that's the patient and family. If we have that single focus, hopefully we can modify the whole system.''

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