Us­ing video to im­prove safety

Video ethnog­ra­phy help­ing im­prove pa­tient care

Modern Healthcare - - Front Page -

It’s a whole new kind of re­al­ity pro­gram­ming. About three years ago, Oak­land, Calif.based health­care gi­ant Kaiser Per­ma­nente added a novel tool to its qual­ity-im­prove­ment arse­nal. It’s called video ethnog­ra­phy and ever since its cre­ators de­vel­oped a down­load­able in­struc­tional tool­kit and made it avail­able on the In­sti­tute for Health­care Im­prove­ment’s web­site in De­cem­ber 2010, other or­ga­ni­za­tions have be­gun to take no­tice.

The pro­gram, spear­headed by re­searchers at Kaiser Per­ma­nente’s Care Man­age­ment In­sti­tute, uses short videos to con­vey the pa­tient ex­pe­ri­ence, spark new ideas and pro­pel im­prove­ment ini­tia­tives. Since the pro­gram’s in­cep­tion, the Care Man­age­ment In­sti­tute has com­pleted ap­prox­i­mately 40 projects on such top­ics as med­i­ca­tion man­age­ment, care tran­si­tions, obe­sity and health­care dis­par­i­ties.

Videos are roughly five to 10 min­utes long, al­though they can be shorter, and they show pa­tients and clin­i­cians in the hos­pi­tal, and pa­tients in their homes, says Es­tee Neuwirth, a so­ci­ol­o­gist and the Care Man­age­ment In­sti­tute’s di­rec­tor of field stud­ies. They’re used by qual­ity-im­prove­ment staff to mo­ti­vate lead­ers and clin­i­cians.

“These videos build a will for change,” Neuwirth says. “They al­low peo­ple to see and un­der­stand pa­tients with a new set of eyes. We bring the videos into lead­er­ship meet­ings, we show them to man­agers and team mem­bers, and we use them for train­ing.”

The video projects are care­fully planned and con­ducted by mul­ti­dis­ci­plinary teams of so­cial sci­en­tists, physi­cians, nurses and phar­ma­cists.

“We de­velop the study de­sign col­lab­o­ra­tively, we go out into the field to­gether and we an­a­lyze the data to­gether,” Neuwirth ex­plains. “That makes it much more im­pact­ful.”

The footage is raw, shot by non­ex­perts us­ing small hand-held cam­eras. And that’s no ac­ci­dent, Neuwirth says. Video ethnog­ra­phy for qual­ity im­prove­ment is sup­posed to give view­ers a re­al­is­tic, stripped-down view of a pa­tient’s treat­ment, con­di­tion, habits and life­style. It’s not a tool for mar­ket­ing, she adds.

“There is no script or staged en­vi­ron­ment,” ac­cord­ing to the 56-page tool­kit. “There is no pre­de­ter­mined mes­sage about im­prove­ment op­por­tu­ni­ties. The set­tings are real life, and ethnog­ra­phy teams spend time with pa­tients and staff, see­ing ‘through their eyes’ as fully as pos­si­ble.”

When the pro­ject teams shoot video in pa­tients’ homes, for in­stance, they em­ploy a va­ri­ety of strate­gies to draw peo­ple out and help them to con­vey their story. They of­ten ask peo­ple to give them a tour of their house or show them where their med­i­ca­tions are kept. Some­times they ask peo­ple to sketch out their sup­port net­work or make a time­line show­ing the points of their re­cov­ery.

One of the Care Man­age­ment In­sti­tute’s first video ethnog­ra­phy projects was in Kaiser’s South­ern Cal­i­for­nia re­gion, fo­cus­ing on tran­si­tions of care for heart fail­ure pa­tients. The pro­ject shed light on a num­ber of ways to bet­ter man­age care and im­prove the dis­charge process, and it’s now be­ing used to train all new staff who in­ter­act with heart fail­ure pa­tients, Neuwirth says.

The in­sti­tute’s largest video pro­ject to date tar­geted pre­ventable hos­pi­tal read­mis­sions and in­cluded a sam­ple of more than 40 in­depth in­ter­views with pa­tients and fam­ily mem­bers, as well as 30 clin­i­cians, in sev­eral re­gions of the coun­try.

One such in­ter­view was con­ducted at Kaiser Per­ma­nente Fre­mont (Calif.) Med­i­cal Cen­ter, says Dr. Jy­ot­sna Bomdica, as­sis­tant chief of hos­pi­tal-based spe­cial­ists. Bomdica had seen the power of first-per­son pa­tient ex­pe­ri­ences a few years ear­lier when she in­vited the fam­ily of a pa­tient to come and speak to hos­pi­tal staff. The pa­tient had died dur­ing her stay and her fam­ily was un­happy with the care she had re­ceived. The sub­se­quent in-per­son meet­ing with clin­i­cians and the fam­ily was pow­er­ful, Bomdica says, but set­ting it up was dif­fi­cult and time-con­sum­ing.

Then about a year and a half ago, when the Care Man­age­ment In­sti­tute’s team ar­rived as part of the read­mis­sions pro­ject, Bomdica says she re­al­ized video could have that same res­o­nance, but it could be done much more eas­ily and could also reach a much larger au­di­ence within the or­ga­ni­za­tion.

This time, the pro­ject team in­ter­viewed a pa­tient who had been read­mit­ted to Fre­mont for in­ad­e­quate pain man­age­ment. Shortly af­ter dis­charge, the pa­tient had ex­pe­ri­enced se­vere pain but he and his wife were un­able to reach by phone any of the hos­pi­tal physi­cians who had

“The fun­da­men­tal is­sue in health­care is not the cre­ation of a prod­uct, it’s the so­cial in­ter­ac­tion be­tween one group that is try­ing to help an­other.”

—Dr. Trent Hay­wood

The wife of a pa­tient is in­ter­viewed by a video ethnog­ra­phy team from Kaiser’s Care Man­age­ment In­sti­tute.

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