Wellcoming you to Fallon Clinic

1
Patient Shadowing
A Large Scale Organization Change Case Study
Mass Bay OD Learning Group, 10/17/07 Leslie
Zobler L OD Specialist
2
Doctors Interpersonal Skills Are Valued More
Than TrainingPeople place more importance on
doctors interpersonal skills than their medical
judgment or experience, according to the latest
Wall Street Journal Online/Harris Interactive
health-care poll, and doctors failings in these
areas are the overwhelming factor that drives
patients to switch doctors.
THE WALL STREET JOURNAL ONLINE September 28, 2004
3
Patient Shadowing Abstract

• Studies indicate shadowing greatly improves
  physician demeanor and patient satisfaction
• The ability to obtain real-time data
• Fallon Clinics program shadows the entire
  encounter, all patients seen in a day

4
Behavioral Templates

• Fallon Clinic has designed three behavioral
  observation templates
• Physicians (all providers)
• Staff (front-end staff, nurses, medical
  assistants)
• Patient feedback survey

5
Shadowing Coaching Template Support
Staff Physician__________________________________
__________ PSS_______________ Shadow Date
______________________________________ Nurse_____
________ Patient Name _________________________
______________ MA_______________ Shadow Coach
______________________________________ Appointment
Time ____________________________________
Other Relevant Information
6
Shadowing Coaching Template Physician Physician
____________________________________________ Shad
ow Date ______________________________________
Patient Name ________________________________
_______ Shadow Coach ___________________________
___________
7
Key Documents

• Staff Demeanor Observation Template
• Check- in staff
• Medical Assistant
• Nurse
• Check-out staff
• Laboratory staff
• Physician Demeanor Observation Template
• Patient Survey Feedback Template
• Ability to capture all relevant times
• Time of appointment
• Arrival time
• Medical Assistant start and end times
• Time physician begins and ends the exam
• Check-out time

8
Key Elements of Process

• Preparation
• Physician selection notification
• Patient invitation
• Administration documents, templates
• Pre-meeting
• Visit
• Greet patient
• Use templates
• Remain in background

• Post Visit
• Thank You letter
• Complie feedback agreement between co-shadows
• Write reports
• Feedback session
• Follow-up survey (zoomerang)
• Sustainability letter

9
Lessons Learned

• The learning is transferable from site to site
  and from physician to physician
• Outstanding observed behaviors can be easily
  integrated into physician and staff training
  programs
• Opportunity to be used as part of Performance
  Improvement Plans
• Opportunity to be used as part of continuous
  development

10
Feedback
11
Key Points
Large Culture change
Results
System Changes
12
Feedback
Be intentional about feedback, notice
opportunities feedback is a powerful way to
facilitate learning, growth, and productivity

• Speak with honesty, integrity, good intent
  owned by the giver I statements
• Takes into account the needs of both the receiver
  and the feedback giver
• Provide specific descriptive examples
  (observations)
• Show inconsistencies between what people say and
  do explain the effects i.e., help them see
  their blind spot in a respectful way
• Focus on whats missing, not whats wrong
• Directed toward behavior the receiver can do
  something about
• Team Partnering Opportunities

13
What are some challenges?

• What worked? Didnt work?
• Importance of change?