Person centeredness is a simple concept that ensures a patient, client, and or consumer is at the center of all care delivery. This definition helps stakeholders understand the concept of person centered care; however, the uniform execution remains flawed in the healthcare experience. The Institute of Medicine identifies patient centered care as one of the six essential pillars to delivering high-quality care. Despite this, the healthcare industry continues to struggle with how to interpret feedback and implement change. To achieve a shared goal all stakeholders must be willing to understand the holistic experience of a patient and employee. Shadowing is the process of following an individual or individuals through their daily experience with the goal of collecting observations and qualitative and quantitative data to improve care experiences and workflows. Shadowing, often referred to as patient journey mapping or process mapping, is used to map the current state of a flow from the perspective of the shadowee. Shadowing is a framework that can be applied to any industry and any organization. Improving barriers to communication and teamwork, as well as process inefficiencies, will only be successful if we understand the day to day of the employee. 

goShadow’s app and training programs provide users with the ability to collect real time data, observations, and time a process from start to finish. After a day of shadowing, the data is uploaded and utilized to create customizable comprehensive reports which assists the goShadow team in making data-driven recommendations. Achieving a shared goal requires a shared understanding. goShadow empowers all stakeholders to feel like their voice, opinions and concerns are being heard and acted upon. The following example shows the malleability of goShadow’s shadowing framework and how goShadow bridges gaps with patients and employees to improve outcomes and increase satisfaction. 

goShadow’s team shadowed employees at a hospital's sterile processing unit to get to the root cause of inefficiencies and never event occurrences. The Sterile Processing Unit is organized into two sections, the decontamination side and the clean side. Unclean surgical equipment used during a procedure is sent down on an elevator for the decontamination side to scrub, rinse, and soak before sending to the clean side where employees assemble and wrap trays, sterilize equipment, and sort. Prior to shadowing, the departmental goal was to decrease inefficiencies on the decontamination side. The goShadow team was able to identify several aspects of the processes that contribute to inefficiencies.  

Observations of the decontamination side revealed the presence of a significant learning curve, low morale, frustration with the loaner system for visiting surgeons, technical difficulties with scanners, an inefficient elevator system, and decontamination discrepancies leading to increased workload. Observations on the clean side revealed employees spend the majority of their time searching for equipment that is often not housed in the facility, workflow is frequently interrupted, and most trays have required tools which saves employees time. The lack of physical space, and budget constraints explained why there were 9 to 10 employees on the clean side at any given time and only 2 to 3 on the decontamination side leading to increased stress. The goShadow team utilized the feedback, concerns, and observations of the department to produce actionable recommendations.

goShadow Recommendation:

1. Use the Buddy System: Consider years of experience when assigning employees to specific shifts so that  seasoned employees can support new hires. 
2. Communicate expectations and the “why”: Establish strict  guidelines to time and condition of implant trays with representatives. Communicate and implement consequences of not adhering to the time standards (delayed case starts, employee dissatisfaction, overtime, etc).
3. Modernize and train: Work with IT to: train employees how to troubleshoot scanner issues, increase number of scanners, and request another COW closer to wall washers. 
4. Partner with OR teams: Give opportunities to shadow the process in central sterile or OR teams.  Set expectations on the condition of which and when to return case carts so that processing can be completed efficiently without loss of equipment. 
5. Work towards high reliability: Re-educate and emphasize the importance of following decontamination standards even when an item is returned. Don’t view this as a mistake but a good catch. It is an opportunity to investigate the system so that patient safety standards can be hardwired through reporting, non-punitive investigation, and creation of stop gaps. 
6. Reduce distractions: Improve systems for searching for items and assembling/pulling add-on trays to decrease workflow interruption. Consider the use of a “float” tech as well as restructuring how supplies are stored.
7. Use visual cues to remind individuals of standard work: Display decontamination time standards and photos of the process above work areas to improve the differentiation in the decontamination process and time for similar items. 
8. Enhance teamwork: Work within the department to identify and understand any ideas they have for how morale could be improved. Create a system for supporting and backing up one another at bottlenecks during peak times. Start with identifying low hanging fruit and collaboration with other departments. 
   

Shadowing using goShadow is a framework that puts people first and transcends industry lines. The ability to bridge gaps with patients, providers, executives, and families is essential to achieving holistic value to achieve a larger goal. goShadow provides meaningful and actionable recommendations and implementation plans to healthcare organizations worldwide through shadowing. This method is proven to increase patient and employee satisfaction, productivity and increase the quality of organizational longevity.