Health Service Co-Design


Patient shadowing

During patient shadowing a project member follows a patient through their visit to the health service and documents the experience.

Why use it

Shadowing is used to identify exactly what happens during a patient visit to a service, including:

  • Learning about people's movements through the service
  • Measuring behaviours, e.g. number of visits and waiting times
  • Helping you see things through the eyes of a patient.
When to use it

Use shadowing when you want to identify existing experiences and behaviours. Once you have done this, you can later check the impacts improvements have made using the same method.

What to observe
  • How easy or difficult it is for patients to find their way around the hospital.
  • How long patients have to wait to be seen.
  • How patients are treated by members of staff.
  • What questions patients ask.
  • What forms patients are asked to fill in.
  • How many staff members patients interact with.

1. Decide on your approach to shadowing

What are you aiming to learn?

List your questions.

Who do you need to shadow?

Shadowing is most useful for assessing variability. You can learn a lot by shadowing a small number of people carefully selected to represent the extremes of patients, conditions and/or staff. Identify extreme examples (that challenge the service elements you are exploring) alongside a few ?average? ones. List the types of people you should shadow to answer your questions.

How many people do you need to shadow?

Determine the minimum number of people you need to shadow by assuming you will need 2-3 of each extreme example. Note: it is better to keep numbers small and focus on the quality and depth of shadowing sessions.

How will you make records and document your results?

List the simplest recording and documentation options and develop a recording template.

Now review your outline and streamline your approach as much as possible.

2. Invite patients to participate and obtain their consent

See ethics for further information.

3. Set up, carry out and document the shadowing sessions

If possible, talk to patients about their experiences of the service during or after the shadowing session.

Focus on the meaning of service events and interactions for them, and explore what they meant by their own behaviours. Use non-specific open-ended questions such as "What was going on for you at that moment?" and "What did it mean for you to do that/act that way?".

4. Analyse your results and report on your findings

Suggest service improvements as appropriate.


  • Make sure people are comfortable with being shadowed. If not, you may need to reconsider using shadowing as a method.
  • Do a number of trial shadows with colleagues to ensure it works for you and will give you the information you need to know.
  • You can use the shadowing tool to follow staff as well as patients.