Obtaining the Patient’s Point of View and Its Impact on Simulation Design and Implementation.

Jessica Ray, PhD, Stephanie Sudikoff, MD and other simulation center staff share their use of google glass to enhance simulation for patient and family care.

Wearable technologies such as Google Glass advances simulation training by allowing us to take new perspectives of our health care environment.Image Credit: Jason Fenstermaker

Jessica Ray, PhD, Simulation Learning Consultant, Dr. Stephanie Sudikoff and others from SYN:APSE Center for Learning, Transformation, and Innovation at Yale New Haven Health System discuss the use of Google Glass to enhance Patient safety.

From training in the simulation laboratory to direct patient care, technology is rapidly advancing how we prepare for and deliver services across the health care continuum. With the introduction of wearable technologies such as Google Glass we are now able to capture multiple perspectives of our complex environment from healthcare professionals, patients, and family members, each representing a unique and valuable view. This article is the first in a series that will explore how the emerging technology of Google Glass advances medical simulation and ultimately the delivery of health care. The current article examines how Google Glass enhances simulation design by providing tangible data about the patient’s point of view during medical care and treatment.

Subsequent articles will illustrate the power of this new technology in provider and team training as well as privacy and use considerations when implementing Google Glass in simulation and in clinical settings.

The Patient’s Perspective

As I walked through the doors of our hospital today, I paused to watch some of the people that walk through our halls each day. There was a new father so excited, yet scared, heading home for the first time with a life so small yet so full of promise. A young girl, no more than 10, frail of body yet still with a smile so full of life. A woman in a reversal of roles, guiding her elderly father hand in hand through the entry doors. Each of these people represents the fabric of our hospital. Yet, how seldom we stop to reflect on what our patients, visitors, and volunteers see and feel when they enter our environment. We look to patient satisfaction scores and comments for metrics of success. But are we missing other pieces of the story?

Patient and family centered care and the patient experience are now leading topics across our health care system. As such the demand for training in these domains has increased. Achieving high quality patient and family centered care requires more than technical skill, it requires a deep understanding of what a patient and their family experience traversing the complexities of our health care environment. As simulation educators we are challenged to recreate training experiences that address both clinical skills and the complex interpersonal skills necessary for successful team interactions and patient engagement. Whether interacting with team and family members during a simulated resuscitation or in a simulation focused on teaching interpersonal and communication skills, today our trainings are designed as opportunities to practice and develop the empathy and rapport necessary to deliver high quality patient experiences.

Until recently, capturing the patient or family perspective in simulation relied on feedback provided by confederates playing roles in a scenario. Now we can have these confederates wear Google Glass to collect their perspective during the scenario. These different points of view coupled with instructor observation and static camera feed yield a more robust debriefing.

This article describes a few of the ways we are currently utilizing Google Glass to understand the patient perspective and translate that into practical training for caregivers. As we and our health system partners become more versed in the deployment of Google Glass, the range of possible uses will expand.

Impact on Simulation

As the simulation resource for a large health care system, the past year has brought our center an increasing number of requests for simulation training sessions specifically targeting improvements in interpersonal communication skills and the patient’s experience. As professionals in the healthcare setting it is often easy to think of a patient experience as restricted to the face-to-face patient-provider interaction, yet this is only a brief snapshot of the complex patient.

For the patient or family member their experience with our system begins before they enter the doors of our offices or hospitals. Conversations, paperwork, and directions received prior to a visit set the tone for the remainder of the encounter. Once a patient arrives, tasks such as parking and navigating the entrances of the facility to finding assistance can range from routine to frustrating. Once in the hospital or office, how and when a patient or family member is greeted often makes a lasting impression. Healthcare employees ranging from physicians and nurses to environmental and food service workers each have a key role in the patient experience. Ensuring that a patient’s interaction with our system is a positive one requires a culture dedicated to service excellence and training in interpersonal skills.

To meet the newly identified training needs specific to patient and family centered care we are partnering with individual units as well as staff from patient relations to develop simulations recreating many types of patient and family experience. Scenarios for these simulations range from entering a unit, being introduced to the room and unit, to discharge. In each we strive to create many realistic, interprofessional interactions with the patient and family. Strategically placing Google Glass on high fidelity mannequins, volunteer patients or confederates, playing the role of family members, allows us to capture and debrief important facets of both the patient and family experience. We have also used Google Glass to enhance our ability to follow scenarios that start in one patient unit and require transport to another unit. The perspective from Glass often highlights clinical and environmental changes that may be missed by the participants and the simulation staff.

The Google Glass wearer captures seemingly small yet important behaviors, such as, how family members are greeted upon entering a unit, if direct eye contact is made when greeting a family member, if assistance is offered for navigating the unit; each set the tone for a visit. As a patient and family member enter the room, Google Glass allows us to see their first impression of the room’s appearance and how both the patient and family member are oriented to their new space and the processes of the unit, for example, ordering food and schedules. As nurses begin their routine accompanied by an electronic charting workstation on wheels (WOW), Glass can capture how providers and staff position themselves and their equipment during patient and family interactions. This view also helps us develop a better understanding of how and when patients are included in care planning, bedside reporting, and bedside charting. As providers visit the patient, the perspective from Glass demonstrates the importance of nonverbal communication including eye contact and physical positioning (i.e. sitting, standing, hand and arm placement, etc.) during important conversations.

When viewing the video stream, we are able to illustrate how overheard conversations in the hallway, personal conversations between staff, and environmental factors such as noise level impact the patient’s care, comfort, and satisfaction. For staff accustomed to the unit, their sensitivity to these background factors can lower across time. Utilizing Glass during simulations to show the patient’s view of the environment can help improve staff mindfulness.

Google Glass allows us to capture and embed the perspectives of patients and family and the impact of teamwork and communication in both emergent and routine clinical simulations. In real world environments successful communication skills are necessary both across the team of providers and with family members. Simulations often include a role player as a family member, who can capture a recording of the scene as a family member. Video from this vantage point brings a new and powerful perspective not readily available from the traditional stationary birds-eye view camera. In these situations, we have found Google Glass to be a powerful feedback tool for training staff and practitioners in ways to speak with family. While a birds-eye capture of a scene can provide powerful images of an individual’s actions, Google Glass captures a perspective that provides detailed feedback on eye contact, voice tone, intonation, and the use of confusing terminology.

Utilizing recordings from Glass during debriefings allows us to address how family members viewed an unfolding emergency. In these simulations we are now able to train for family centered care by examining how team members are designated to stand with the family member and how the actions of the team are explained to the family member as an emergency response progresses. Similar to the larger patient-family centered care simulations, Glass allows us to explore the nuances of communication in the emergency settings.

In the high energy emergency setting viewing the family perspective highlights for care givers the importance of avoiding clinical jargon as well as the need for attending to the speed and tone of their explanations. Capturing a view broad enough to include the commotion and energy of the emergency situation, Glass illustrates the importance of providing time and space for crucial conversations.

During debriefings, Google Glass allows participants to see and hear these interactions through the eyes of the patients and family members adding a new perspective and dynamic. This new view provides instructors greater granularity in the debriefing videos and allows for deeper reflection on specific behaviors demonstrated during the scenario that directly impact patient and family experiences. Much like traditional video debriefing, we are finding that video from the eyes of patients and family members provides participants a powerful, objective prompt for reflecting upon their actions.

Strategically placing Google Glass on patients and family members during simulation captures key interactions for teaching patient and family centered care.Image Credit: Jason Fenstermaker & David Dias

Looking Forward

Moving forward we see expanding opportunities for Glass as part of our simulation program. As requests for our services continue to diversify and expand we envision utilizing Glass to understand the patient experience across the health system continuum.

A growing segment of our simulations now focus on system workflow and process improvement. While workflow is most often considered from the worker’s perspective, a systems approach recognizes that the patient and family perspectives should be included. As captured in both of the examples above, communication is a key feature of success in all facets of health care whether examining patient satisfaction or clinical care. Closely coupled with successful communication is the coordination of care across the interprofessional health care team. From a patient perspective we find the health care experience often seems disconnected.

Examining the flow of information from the eyes of the patient we are now able to identify areas for improved coordination and communication of care planning between providers and their patients. While solutions are often unit and team specific, simulations demonstrating how and when patients and family are included in the care conversation allow care teams to discuss how their workflows can improve from a patient and family perspective. Utilizing Glass to follow processes such as admission and discharge through the eyes of the patient and family would allow us to capture communication and the perspective of time.

Building an appreciation of the patient experience and training for improved patient-family centered care is but one of the many ways we see wearable technologies advancing health care. In the next article in this series we will explore ways in which capturing the provider experience with Google Glass advances training and patient care.

Thus far our simulations have captured and modeled patient experiences based on comments from patient satisfaction reports along with guidance from patient and family advisors. We are exploring other ways in which Glass can allow us to capture and embed actual patient experiences into simulation. As we continue to insert Google Glass into our simulation work, there are challenges that need to be addressed including careful consideration for patient privacy, employee privacy and lack of interference with clinical care. In the final article of the series we will discuss security and privacy issues and other technical considerations for utilizing new media technologies such as Glass.

About the Authors

Waiting for information about authors from JR

Jessica M. Ray, PhD, Cheryl Mayeran, MPH, EMT, Jason Fenstermaker, David Dias, Stephanie Sudikoff, MD

SYN:APSE Center for Learning, Transformation and Innovation, Yale New Haven Health