Provider and coach perspectives on implementing shadow coaching to improve provider–patient interactions

Abstract

Background Healthcare organizations want to improve patient care experiences. Some use ‘shadow coaching’ to improve interactions between providers and patients. A Federally Qualified Health Center (FQHC) implemented a half‐day observation of individual primary‐care providers by a ‘shadow coach’ during real‐time patient visits, including an in‐person verbal debrief afterwards and a written report with specific recommendations. Shadow coaching identified areas for improvement. We aimed to characterize lessons and barriers to implementing shadow coaching as a mechanism to improve interactions with patients and change organizational culture. Methods We examined provider and coach perceptions of shadow coaching through interviewing coached providers, stratified by provider type and Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance, and the coaches who coached the most providers. We interviewed 19 coached providers and 2 coaches in a large, urban FQHC. Content analysis identified implementation barriers, facilitators and themes. Results Coaches reported needing ‘buy‐in’ throughout the organization and the need to be credible and empathize with the providers being coached. Most providers reported behaviour changes based on recommendations. Almost all providers recalled at least one coaching recommendation that was actionable. Providers and coaches highlighted patient‐level and practise‐level barriers that impeded their ability to implement recommended improvements. CAHPS data was reported as an effective performance management metric for measuring change, counselling providers, and evaluating provider‐level efforts but was not always specific enough to yield tangible recommendations. Conclusions Regular messaging by leadership about the priority and purpose of shadow coaching was essential for both physician engagement and its mature implementation across the organization. Coaching could be embedded into a long‐term strategy of professional development with periodic re‐coaching. Re‐coaching sessions could target issues raised by providers, such as dealing with difficult patients or specific populations. Research on the timing and content of re‐coaching is needed.

Prioritizing ethical patient care responsibilities: A call to restructure student training practices in federally qualified health centers

“…Cultural humility training should be required by FQHC training sites for all trainees and employees prior to them engaging in direct patient care. 36 Instances of using concerning or racist language towards patients, inappropriate displays of empathy, misgendering trans patients, and approaching patients as “interesting cases” or curiosities rather than living humans are just some of the issues the authors have experienced with trainees in FQHC spaces.…”

Shadow Coaching Improves Patient Experience for English-Preferring Patients but not for Spanish-Preferring Patients

“…Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient experience measures, the national standard for collecting, tracking, and benchmarking patient care experiences across settings including ambulatory care, 8 – 11 are typically used to monitor and target modifiable provider behaviors to improve patient experience. 12 , 13 CAHPS data can also be used to analyze the experiences of different patient subgroups. 14 – 16 …”