Patient Walkthrough: How To Do It

During a walkthrough, a clinician or staff member plays the role of the patient, and another accompanies him or her as the family member. They go through a clinic, service, or procedure exactly as a patient and family do. They do everything patients and families are asked to do, and they abide by the same rules. They do this openly, not as a mystery patient, and throughout the process ask staff members a series of questions to encourage reflection on the processes or systems of care and to identify improvement opportunities.

The staff conducting the walkthrough take notes to document what they see and how they feel during the process. They then share these notes with the leadership of the organization and quality improvement teams to help develop improvement plans. For many who do this, it is the first time they have ever entered their clinics, procedure rooms, or labs as the patient and family do. Clinicians are routinely surprised about how easy it is to hear staff comments about patients from public areas and waiting rooms. Walkthroughs usually turn up many problems with flow, signage, and wasteful procedures and policies that can be fixed almost immediately.

• Let the staff know in advance that you will be doing a walkthrough. As a result of this warning, they will probably be on their best behavior. However, experience suggests that it is far better to have them part of the process than to go behind their backs. Ask them not to give you special treatment.
• Go through the experience just as the patient and family member would.
  • Call in advance if the patient would have to.
  • Get dropped off or find a place to park. Try to act as if you have never been there before.
  • Follow the signs.
  • Tell the clerk that you are simulating a patient’s experience and that you want to go through whatever a normal patient would have to do (e.g., the check-in process).
  • Fill out the forms if there are ones to fill out.
  • Find out how long a patient would typically wait and sit in the waiting room for that amount of time.
  • Wait your turn.
  • Do the same in the examining room.
  • If a patient would undress, you should undress.
  • If a patient does a peak flow meter, you should too.
  • Ask each healthcare provider to treat you as if you were a real patient. If you are doing a walkthrough of the cardiac catheterization service, hold the sandbags on your leg for the required amount of time.
• As you go through the process, try to put yourself in the patient’s (or family member’s) position. Look around as they might. What are they thinking? How do they feel at this moment?
• At each step, ask the staff to tell you what changes (other than hiring new staff) would make the experience better for the patient and what would make it better for the staff. Write down their ideas as well as your own, and also write down your feelings. As you do the walkthrough, think about how you would answer the following questions and ask the staff you interact with to answer them when you can:
  • What made you mad today?
  • What took too long?
  • What caused complaints today?
  • What cost too much?
  • What was wasted?
  • What was too complicated?
  • What involved too many people or too many steps?
  • What did you have to do that was just plain silly?
• Finally, between the two of you (patient and family member), make a list of any issues you identified and any improvements that could be made. Keep track of the things that can be fixed the next day versus problems that will take longer to remedy.