My team is regularly engaged to conduct ethnography studies of the patient experience. Ethnography is a form of qualitative research that allows a trained observer to observe and document the experience. In healthcare, ethnography is becoming more commonplace as a means to study the patient experience.
The Baird Group methodology has given hospital leaders an inside look at the inpatient experience. The documentation, paired with in-depth interviews between the ethnographer and the patient sheds light into the patient experience on a deep and meaningful level. Patients openly talk to the researcher about their feelings and reactions to staff and physician interactions with them throughout their stay. This is particularly important because it’s the patient perceptions and emotional response to the encounters that will drive the patient’s experience and ultimately the scores.
But ethnography isn’t for everyone. It’s best applied in organizations that really want to improve and are ready for the truth.
We were recently conducting a series of ethnography visits for a hospital that clearly showed a disconnect between what leaders THOUGHT was happening and what was actually occurring on the units. One leader was highly confident that staff was making hourly rounds and were scripting key messages. When he learned that some staff were merely entering the room hourly and scanning the patients wrist band then leaving without interaction he was shocked. In fact he openly said, “I can’t believe that!” But it was the patient’s reaction to the drive-by scans that got his attention. The patient stated, “I feel like a loaf of bread or pack of gum being scanned at the market. I’m a ‘thing’ and not a human.” That story and the connection to the patient emotion spoke volumes.
On the same unit, another care partner documented introductions and hand-off during bedside report followed by punctual yet efficient hourly rounding. In that situation, the patient stated, “They keep me in the loop and I feel like they are really attentive. And I know who to call because they put their direct numbers on the board.” The contrast in the two patient experiences on the unit helped the manager to link the expected tactics to the patient’s feelings.
On another unit, the patients reported having the call light answered over the intercom with a promise to send someone who never came. That same organization boasts of their “no pass zone” where everyone is expected to respond to call lights regardless of title or position. But in reality, the light remained on for 20 minutes with 6 different staff members passing by without acknowledging the light or the patient. When the patient described her feelings they ranged from frustration about the wait time to fear about what it implied. “What if I had a real emergency? Would no one take me seriously?”
When engaging ethnography as a measure of the patient experience, be ready to hold up a mirror. What you think is happening, may not be nearly as consistent or glowing as you’d like. And at the same time, you’ll unveil some wonderful internal best practices ripe for duplication. You just need to find and share the stories that will engage the heart.