Shadowing is a research method that combines observing events and short on-the-go interviews to investigate people\'s roles and behaviours in various settings. Even though it is not a widely used method in architectural research, it can be adapted to focus on the interaction of individuals with the built environment. This is especially important in healthcare environments, where people are vulnerable and more dependent on their surroundings. In this article, I reflect on the experience of adapting and using the shadowing method to explore stroke inpatients\' interactions with the built environment during their recovery in rehabilitation centres. This research study was the first to employ shadowing in the stroke patient population on such a large scale. One day (12 consecutive hours) was spent with each of the 70 participating stroke inpatients, recording their interactions with the built environment in different forms - on the floor plans, as narrative descriptions, creating sketches of situations and noting down patients\' remarks. This method was useful in capturing the built environment\'s role in patients\' daily experiences in rehabilitation centres. Research in healthcare facilities includes various challenges, and close contact with the patient population of older adults with stroke introduces numerous unexpected events and ethical dilemmas in the field. At the same time, this method provides research insights that would otherwise be unobtainable. Researchers are given practical information and recommendations on how to prepare for using shadowing for architectural research and what to expect in the field.

BACKGROUND: In recent years, there has been an increased emphasis on patient experience as a dimension of quality in healthcare and subsequently a drive to understand care from the patient\'s perspective. Patient shadowing is an approach that has been used in service improvement projects, but its potential as a quality improvement (QI) method has not been studied in practical and replicable detail.
OBJECTIVE: This new research aimed to produce clear guidance on patient shadowing for future Quality Improvement projects.
METHODS: Qualitative interviews were conducted with 20 clinical and non-clinical participants of a national QI programme in UK, which focused on improving the experience of patients at the end of life. All participants had shadowed patients. Data were analysed using a thematic analysis.
RESULTS: There were two broad themes: (i) The process of shadowing: how participants went about shadowing, adopting different approaches and making judgements about the care they observed and any challenges they had encountered. (ii) The impact of shadowing: on the engagement and motivation of those who shadowed and in terms of service changes to benefit patients and their families.
CONCLUSIONS: The findings led to a new set of \'gold standard\' principles to benefit both staff and patients where shadowing is used as a QI method. These, together with new guidance, will ensure that shadowing is conducted as a team exercise, that all those involved are more robustly prepared and supported and that its purpose as a method to improve patient experience will be better understood.

Patient shadowing is an experiential technique intended to enable those who shadow to understand care experience from the patient\'s point of view. It is used in quality improvement to bring about change that focuses on what is important for patients.
To explore the acceptability of patient shadowing for health-care staff, the impact of the experience and subsequent motivations to make improvements.
A qualitative study with a diverse sample of 20 clinical and non-clinical health-care staff in different end-of-life settings. Data were analysed thematically.
Anticipated anxieties about shadowing did not materialize in participant accounts, although for some it was a deeply emotional experience, intensified by being with patients who were at the end of life. Shadowing not only impacted on participants personally, but also promoted better insights into the experience of patients, thus focusing their improvement efforts. Participants reported that patients and families who were shadowed welcomed additional caring attention.
With the right preparation and support, patient shadowing is a technique that engages and motivates health-care staff to improve patient-centred care.