Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique

Abstract

In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.

Healthcare Transformation and Changing Roles for Nursing

“…Use of shadowing as a technique to examine the real-time care experience provides valuable data on process flow, patient experience, and team communication. Seeing care through the eyes of the patient allows for an assessment of the current state and development of improved processes that are grounded in information provided by patients and families ( DiGioia & Greenhouse, 2011 ; Marcus-Aiyeku et al, 2015 ). Combining shadowing data with Lean Six Sigma methodology or with rapid-cycle improvement processes is an approach for ongoing quality improvement that must be integrated into role expectations of the professional care team.…”

Exploring the hospital patient journey: What does the patient experience?

“…Patient shadowing may have an especially valuable role in gaining insights into complex cross-hospital processes, in particular when dealing with vulnerable people who could be excluded from interview studies [26, 27]. Furthermore, some studies have reported how, through shadowing methodology, it is possible to assess the lived experience of patients in a patient-centred perspective [28, 29]. However, methodological and ethical issues of shadowing still need to be explored in greater depth [25, 30].…”

Healthcare Transformation and Changing Roles for Nursing

“…Continued skyrocketing of healthcare costs, less than impressive heath status of the American people, safety and quality issues within the healthcare system, growing concerns that cost and quality issues would intensify with changing demographics, and the reality that there were 50 million Americans uninsured and 40 million underinsured in the United States ushered in the Patient Protection and Affordable Care Act of 2010 ( Salmond, 2015 ). The Affordable Care Act (ACA) is more than insurance reform and greater access for the newly insured but includes programs now led by the CMS aiming to improve quality and control costs-what is being termed value.…”

“…Use of shadowing as a technique to examine the real-time care experience provides valuable data on process fl ow, patient experience, and team communication. Seeing care through the eyes of the patient allows for an assessment of the current state and development of improved processes that are grounded in information provided by patients and families ( DiGioia & Greenhouse, 2011 ;Marcus-Aiyeku et al, 2015 ). Combining shadowing data with Lean Six Sigma methodology or with rapid-cycle improvement processes is an approach for ongoing quality improvement that must be integrated into role expectations of the professional care team.…”

“…Institutions under this model have reengineered patient care processes and standards developing standardized clinical pathways to enhance reliability or consistency in care. Processes identifi ed as important include comprehensive patient teaching spanning from the preadmission phase to the postdischarge recovery phase, standardized order sets, early mobilization, redesign of services for colocation for patient rather than provider ease, use of nurse practitioners to champion the pathway and ensure compliance, and implementing efforts to move patients from the hospital to home with home healthcare as opposed to hospital to inpatient rehabilitation to home with home healthcare ( Enquist et al, 2011 ;Marcus-Aiyeku, DeBari, & Salmond, 2015 ). Practicing in a bundled model requires that organizations examine the distribution of costs across the service or episode, identify, understand, and eliminate variation, map evidence-based pathways of care, coordinate care with providers across the continuum, and use ongoing evaluation and analytics to identify where care can be managed more effi ciently and effectively ( American Hospital Association, n.d. ).…”