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A recently published study by Yanes et al1 suggests that observation in clinical environments may have an especially valuable role in capturing the organisational and situational factors that shape clinical processes. In data-dense and high-risk environments, observation sheds light on the specific subprocesses of complex clinical activities (eg, information transfer, communication patterns, distractions) and their effects on patient care. Observation also captures aspects of patients’ and providers' experiences that may be missed by traditional research (eg, interviews or questionnaires) and that people may find difficult to articulate. Yanes et al discuss the different potentialities of in-person and video recorded observations, but the range of observational techniques that can be adopted merit further consideration. In this article, I propose that observational methods in healthcare could, building on recent work,2–4 be extended to include patient shadowing. Such an approach may have particular value as a patient-centred method,3–6 yet it has remained remarkably neglected.
‘Patient-centred care’ has been defined as an approach that seeks to explore patients' desires, preferences, values and concerns with the aim of empowering them to make decisions that best fit their individual needs.7 Identified by the Institute of Medicine as one of the six fundamental elements of high-quality care,8 it is now considered an essential component of care delivery.7 ,8 But despite broad agreement on the principle, precisely what patient-centred should look like in practice has thus far escaped consensus.2 ,9 ,10 It has multiple and sometimes conflicting meanings for different care providers,9 and patients themselves may value aspects of their health experiences that receive little attention in research and practice. Official policies on patient-centredness often coexist with practices that relegate patients to a passive and dependent position.2 Since important questions remain unanswered regarding how to conceptualise …
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