Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, UK.
School of Social Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, UK.
Int J Qual Health Care. 2022 Apr 16;34(2). doi: 10.1093/intqhc/mzac018.
In recent years, there has been an increased emphasis on patient experience as a dimension of quality in healthcare and subsequently a drive to understand care from the patient's perspective. Patient shadowing is an approach that has been used in service improvement projects, but its potential as a quality improvement (QI) method has not been studied in practical and replicable detail.
This new research aimed to produce clear guidance on patient shadowing for future Quality Improvement projects.
Qualitative interviews were conducted with 20 clinical and non-clinical participants of a national QI programme in UK, which focused on improving the experience of patients at the end of life. All participants had shadowed patients. Data were analysed using a thematic analysis.
There were two broad themes: (i) The process of shadowing: how participants went about shadowing, adopting different approaches and making judgements about the care they observed and any challenges they had encountered. (ii) The impact of shadowing: on the engagement and motivation of those who shadowed and in terms of service changes to benefit patients and their families.
The findings led to a new set of 'gold standard' principles to benefit both staff and patients where shadowing is used as a QI method. These, together with new guidance, will ensure that shadowing is conducted as a team exercise, that all those involved are more robustly prepared and supported and that its purpose as a method to improve patient experience will be better understood.
近年来，人们越来越重视患者体验作为医疗保健质量的一个维度，因此也越来越关注从患者的角度了解护理。患者跟随是一种在服务改进项目中使用的方法，但它作为一种质量改进 (QI) 方法的潜力尚未在实际和可复制的细节中进行研究。
这项新研究旨在为未来的质量改进项目提供关于患者跟随的明确指导。
对英国全国 QI 计划中 20 名临床和非临床参与者进行了定性访谈，该计划重点是改善患者临终时的体验。所有参与者都曾跟随过患者。使用主题分析对数据进行分析。
有两个广泛的主题：（i）跟随的过程：参与者如何进行跟随，采用不同的方法，对他们观察到的护理和遇到的任何挑战做出判断。（ii）跟随的影响：对跟随者的参与和积极性以及对患者及其家属有益的服务变化的影响。
调查结果导致了一套新的“黄金标准”原则，使患者和员工都受益，在使用患者跟随作为 QI 方法的情况下。这些原则，以及新的指导，将确保跟随作为团队活动进行，所有参与者都得到更充分的准备和支持，并且将更好地理解其作为改善患者体验的方法的目的。
