Getting the Facts about patient and family experience: Shadowing (presentation)

This post is the follow-up to a tour of the Center for Total Health that I gave Howard Chiou (@medxanthro) who’s a MD-PhD student in medical anthropology at Emory University.

Since Howard’s an anthropologist, he’s interested in the culture of health care systems and how we learn about them and make them better.

One thing I do wherever I go is shadow, to see the experience of the patient and family receiving care, in a medical office.

Why? It doesn’t matter what spreadsheets and data “say,” a system works or it doesn’t when the customer is receiving the service the way the want, in the shortest amount of time. The only way to know this is to see it first hand. After all, it’s what our patients do – they are not consoled by spreadsheets showing good aggregate data when they feel they were just not listened to. See a very sad example of this happening in the slides below.

This is a presentation that I gave to a team I work closely with, the “Digital Workforce Capabilities” team of Kaiser Permanente. Yes, we have a team like that, and yes they are as interested in the patient experience as I.

Howard says I think like an anthropologist. I say I think like a family medicine specialist. I guess all doctors should think like both :). Going to where the patient and family receive care (or produce health) for that matter is the difference between looking at data and understanding facts.

There’s a sad story in the slides below of what happened in one health system when people focused on data instead of facts. It’s so sad, in fact, that I usually have to pause for a moment when I try and explain to people what happened.

This could happen anywhere, especially if you don’t know the facts of what’s happening where you are. That’s what these slides are teaching.

With credit to friend and fellow LEAN enthusiast Mark Graban (@MarkGraban), who’s the person/place I go to when I want the best examples of “gemba”.

Comments/questions welcome. Click to enlarge any of the slides.

Oh, and would you like to shadow where you work and don’t know where to start? Be sure to look into attending the Patient and Family Centered Care VisionQuest event at the Kaiser Permanente Center for Total Health on May 10, 2013. Information and registration here ->


This is an excellent presentation and I love the guidelines. Thanks for sharing, Ted.

Ted Eytan, MD