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Kaiser Permanente Finds Videotaping Care can Produce Rapid Quality Improvement

Innovative method helped reduce hospital readmission rates by nearly 5 percent

June 4, 2012

Man in hospital bed with someone videoing him for quality improvement

OAKLAND, Calif. — The use of video ethnography was developed as an important part of a comprehensive quality improvement program and contributed to a rapid reduction in hospital readmission rates for elders with heart failure, according to a Kaiser Permanente Care Management Institute paper published in the June issue of Health Affairs.

At the Kaiser Permanente South Bay Medical Center in Southern California, hospital readmission rates dropped from 13.6 percent to 9 percent in six months as a result of a quality-improvement framework that incorporated video ethnography as an effective tool for innovating new solutions in care transitions for elders with heart failure. The initiative also led to improvements in the reliability of the center’s readmissions reduction program.

Care Management Institute

“Video ethnography is a powerful tool for achieving rapid-cycle improvements in quality that keep the needs of patients front and center,” said study lead author Esther Neuwirth, PhD, director of field studies at Kaiser Permanente’s Care Management Institute. “Focusing on the real-time experiences of patients and caregivers allows us to identify care gaps and improvement opportunities and share this knowledge throughout Kaiser Permanente.”

Video ethnography, which involves video-recording interviews and observations of patients and caregivers in real time to identify care gaps, unmet patient and caregiver needs, and effective practices, was found to be particularly helpful with vulnerable populations such as frail elders, patients nearing the end of life, and those with multiple chronic conditions. These groups are typically not well represented in other quality improvement approaches such as focus groups and patient advisory councils.

Typically, the process involves video-recording patients and caregivers as they are being interviewed and observed interacting with each other in a clinic or hospital or at home. The team then reviews the video and identifies recurrent themes, including patient and caregiver needs and choices, care gaps, and effective practices to determine quality improvement priorities. The resulting footage is edited to create a five-to-eight minute video to document quality improvement opportunities in the voices of patients and caregivers. The video is then distributed across the organization as part of a comprehensive quality improvement process.

“Video ethnography allows us to see nuances that otherwise might be missed — discrepancies between what people say, what they do, and what they may think,” said Neuwirth. “It’s also especially effective at motivating and guiding quality improvement efforts because seeing is believing.”

As of June 2012, nearly 40 Kaiser Permanente teams of more than 130 clinical staff, quality-improvement professionals, and clinical and administrative leaders have participated in video ethnography training.

Kaiser Permanente has also conducted video ethnography projects in relation to surgical services, breast cancer care, outpatient medication administration, pediatric weight management, care disparities and other clinical areas.

Additional authors on the paper, all from Kaiser Permanente’s Care Management Institute in Oakland, Calif., include Jim Bellows, senior director of evaluation and analytics; Ana H. Jackson, senior consultant of field studies with the evaluation and analytics team; and Patricia M. Price, a senior consultant of field studies with the evaluation and analytics team.

About Kaiser Permanente

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to:

About Kaiser Permanente’s Care Management Institute

About Kaiser Permanente’s Care Management Institute Since its inception in 1997, the Care Management Institute has provided the tools and techniques that help Kaiser Permanente improve care for its members. We are committed to the Kaiser Permanente promise of providing affordable, high-quality health care with a personal touch. To deliver on that promise, we partner with physicians, clinical experts, leaders, and members to serve as a gathering point for the study of new clinical approaches. For more information, visit