Over half of patients at a rehabilitation hospital reported wanting greater involvement in their care decisions. To address this, the hospital conducted patient and family shadowing where observers followed patients to experience care from their perspective. This identified themes like explanations during rounds and involvement in discharge plans. A post-intervention survey found a statistically significant improvement in patients feeling involved in care decisions and clinically relevant improvements in understanding doctor explanations and recommending the hospital. Engaging medical leaders and balancing data with reflection time led doctors to change practices without formal rules.

1. Over one half of all patients admitted to the Rehabilitation service at
the Royal Melbourne Hospital reported that they would like greater
involvement in the decision-making process regarding their care
(The Royal Melbourne Hospital Post Discharge Patient Experience
Survey, n=32, July 2013 – June 2014).
This was surprising given the treating medical and allied health teams
within the Rehabilitation Unit conducted biweekly ward rounds, case
conferences, communication chart rounds and family meetings (where
required) for all patients admitted to the service.
Evidence suggests that greater patient (and family) engagement and
involvement in discharge planning and care, improves the overall
hospital experience and related outcomes.
.
Strategy for change
Patient and Family Shadowing is an effective way of allowing staff
to view the process through the patient’s eyes. It “…involves having
a committed and empathic observer follow a patient and family
throughout a selected ‘care experience’ to view and capture details
of the entire care experience from the point of view of the patient
and family” (DiGioa, 2011).
The Patient Experience Team and the treating medical team in the
Rehabilitation Unit developed the following:
• The Patient and Family Shadowing proposal
• A summary of existing literature
• A step-by-step action plan and person allocated for actions
• Tools including:
• A tip sheet for new ‘shadower’
• Patient shadowing protocol and template for data collection
• Patient information sheet and consent form
• Quality Assurance checklist
Fifteen patient and family shadowing ‘care experiences’ were
observed in August / September 2014. A number of shadowers
completed more than one.
By using grounded theory, the qualitative data was independently
analysed by two separate analysts and data validated with the wider
medical group.
To undertake Patient and Family Shadowing in order to improve the
Post Discharge Patient Survey score on question 11 “Did you feel as
involved as you wanted to be about decisions about your care?”.
The ‘medical ward rounds’ were selected given the ability of the
medical team to influence patient involvement in the relevant ‘care
experience’.
Introduction
Aim
Methods
Results (continued)
Acknowledgements
Hanna, Georgina¹; Doan, Katie¹; Ng, Louisa²; Khan, Fary²
¹ The Royal Melbourne Hospital (RMH), Transformation and Quality Unit – Patient Experience Team, Melbourne, Victoria, AUSTRALIA
² The Royal Melbourne Hospital (RMH), Royal Park Campus – Rehabilitation Unit, Melbourne, Victoria, AUSTRALIA
The power of empathy: Greater
involvement of patients in decisions
in their care through Patient and
Family Shadowing
Results
Measurement of improvement
Emerging themes:
•Arrival of ward rounds, introductions and overall impressions
•Provision of explanations and addressing concerns
•Ward round members being present and the patient/family members
•“The (Discharge) Plan” for the patient / family
•Comfort and privacy
This data was discussed amongst Senior medical staff at their monthly
meetings, each discussion occurring a month or two apart, with input
from the Patient Experience Team.
The survey data post-intervention (Oct-Dec 2014) showed a
statistically significant improvement in Question 11, “Did you feel as
involved as you wanted to be in decisions about your care?”.
Q 6. When you had
important questions to ask
a doctor, did you get
answers that you could
understand? This data
relates to responses of
“yes always” July 2013-
June 2014 = 50% (n=32)
and Oct-Dec 2014 = 75%
(n=18), was not
statistically significant
result but certainly
clinically relevant.
50%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
More patients got answersthey could
understand,when they had important
questionsto ask a doctor
Pre-intervention (July 2013-June2014) n=32 Post-intervention (Oct-Dec 2014) n=18
84%
94%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
More Rehabilitationpatients would
recommendRMH to a relative or friend
Pre-intervention (July 2013-June2014) n=32 Post-intervention (Oct-Dec 2014) n=18
Q 21. Would you
recommend the Royal
Melbourne Hospital to a
relative or friend? This
data relates to responses
“yes”, rating it either “8, 9
or 10” out of a possible 10.
July 2013-June 2014 =
84% (n=32) and Oct-Dec
2014 =94% (n=18), was
not statistically significant
result but certainly
clinically relevant.
Discussion
Effects of changes
“Doctors are all engaged, this is an issue that’s important to them”
-Medical Head of Rehabilitation Unit
“Themes from the shadowing highlighted areas we were aware of but
didn’t realise their impact (on patients) and (discovered) new ways to
do things better”
-Medical Head of Rehabilitation Unit
“I can see that doctors are paying more attention to the data and
changing practice “
-Nurse Unit Manager
The Medical Head of the Rehabilitation Unit subtly changed her
language to encourage more patient ownership of their own journey
“How long do you think you’ll need to be in Rehab for?”
Lessons learnt
Careful consideration was given to how best engage the doctors.
Striking a balance between formal presentation of data versus giving
‘time and space’ to reflect, was key for success.
Strong medical leadership and commitment with a clear directive
from the hospital Executive to improve kick started the process, and
kept the momentum going.
Based on their shadowing experiences, the doctors reflected on and
changed their practice without need for formal rules or prescribed
and/or audited processes.
It is possible that the improved results may be attributable to an
increase in the response rates to the survey, potentially providing
more representative results.
Conclusion
Message for others
Engage the interest and vision of the medical leaders in the area and
align their vision and priorities with those of the organisation.
Find the correct balance between use of data to stimulate and inspire
versus allowing space and time for the doctors to reflect and generate
their own solutions.
Invite doctors to collect the data themselves, rather than management
“forcing” data upon them. This strategy ensured that treating medical
clinicians were fully engaged and facilitated a rich empathic experience
that resulted in a positive change in practice.
It is not about ‘adding more time’ - but doing things ‘differently’ for
improved person-centred outcomes.
Amy Levinson, Dr Aladdin Elmalik, Dr Lucy Selleck, Julie Louie, Dr
Brent Doolan, Dr Bronwyn O’Gorman, Dr Astrid Richards and Dr Krystal
Song.
The survey data post-intervention (Oct-Dec 2014) showed a clinically
relevant improvement in Question 6 “When you had an important
question to ask a doctor, did you get answers that you could
understand?” and in Question 21 “Would you recommend The Royal
Melbourne Hospital to a relative or friend?”