Using video to improve safety
Video ethnography helping improve patient care
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.