Now Reading: Another way to listen, Video Ethnography

Neuwirth EB, Bellows J, Jackson AH, Price PM. How Kaiser Permanente uses video ethnography of patients for quality improvement, such as in shaping better care transitions. Health affairs (Project Hope). 2012;31(6):1244-50. [Accessed June 6, 2012].

This paper, published by esteemed colleagues at the Kaiser Permanente Care Management Institute, describes results from a program that now includes 37 teams and 130 people, who have engaged in in-depth training to understand the real experience of patients and those who care for them using video:

This method is particularly effective in helping increase understanding of vulnerable people who are not well represented in ap- proaches such as focus groups and patient advi- sory councils—for instance, frail elders, patients nearing the end of life, and those with multiple chronic conditions. Video ethnography also helps in focusing on pivotal points in health care, such as transitions between settings.4

This is a real technique that complements work to involve patients in the design and operation of the health care system. I have previously posted the link to the CMI Video Ethnography Toolkit – you can find out more about this here: Now Reading: Getting Started in Video Ethnography – Tool Kit – Kaiser Permanente Care Management Institute | Ted Eytan, MD.

Showing a video of the patient experience does not replace involving patients in other ways, however it does bring information that doesn’t come from other traditional sources. In the paper, work to uncover why medication reconciliation was not as effective as it could be, even in a system with a comprehensive electronic health record is described. A dose of reality is contained within, which is that an EHR is not enough – the ability to lead, and listen must come along with it.

Medication reconciliation at patients’ homes, in which home health nurses tried to verify pa- tients’ medication lists, was inconsistent and not comprehensive. Discharge instructions often lacked specific details. Home health nurses were unable to access Kaiser Permanente’s electronic health records while in patients’ homes and did not have a definitive list for medication reconciliation.

In a post-EHR health care organization, which hopefully the entire United States health system will be one day, the need to learn faster will never stop.

At Kaiser Permanente, we use video ethnography at various stages of the quality improvement process to identify care gaps, unmet patient and caregiver needs, and effective practices. We also use it to communicate insights to clinical and administrative organizational leaders, identify improvement opportunities, and help build collective will for change.

Here’s a link to the press release with a short video about this work: Kaiser Permanente Finds Videotaping Care can Produce Rapid Quality Improvement | Kaiser Permanente News Center

Take a look. I hope to enroll as a student this summer in a Kaiser Permanente video ethnography course, it’s my last chance in the 2012 training season. Listening can’t be beat.