BC Patient Safety Quality Council ForumPatient Journey Mapping
Scott ShearerApril Lawrence
Overview Engagement and Patient Journey
Mapping Patient Journey Mapping Patient Journey Mapping Example Patient Journey Mapping in BC
2
Objectives Learn improvement occurs with
engagement Learn when patient journey map is the
right tool Learn basic steps to develop patient
journey map
3
Engagement for Improvement
1) Don’t listen very much to users and we do the designing for them.
2) Listen to our users then go off and do the designing for them.
3) Listen to our users and then go off with them to do the designing together.
Paul Bate, 20074
Engagement
Inform provide
balanced information to
increase understanding
ConsultSolicit
feedback on proposals,
alternatives and/or
decisions
InvolveWork with
patient/public to understand and consider
concerns, preferences and
values
CollaboratePartner with the public/patient in
each aspect of decision-making,
including identifying
alternatives and preferred solutions
Empower Delegate
responsibility for identifying
issues, solutions and actions to patients or the
public
Engagement Tools
6
Engagement Tools
7
Patient Journey Mapping
Is there really a difference between patient and provider experience?
It’s all the same interaction, right?
8
Is there really a difference between patient and provider experience? It’s all the same interaction, right?
9
Is there really a difference between patient and provider experience? It’s all the same interaction, right?
10
Key Message
Providers usually see only a small part of the whole patient process
11
PJM helps us understand the whole process
Patient Journey Mapping
Bringing together patients and all the key providers across their journey for a full day session.
They map out, step by step, what actually happens for a patient. Then they discuss where improvement is needed and what can be done about it.
“Journey” is defined explicitly from the patient perspective.
12
Patient Journey Mapping Patient Journey Mapping:
Visualizes complexity of journey Identifies the touch points in the patients care Looks at how care is received Patient voice paramount
Focus on patient experience
13
4 Key Map Components
14
The Journey
Who does What
Parallel Processes
Time
When to Use Patient Journey Mapping
16
To Discover and Improve...
What is actually happening (especially across transitions)
What the patient experience is
Where the patient thinks the problems are
What the patient thinks we can do about it
17
Patient Journey Mapping Works Best When…
It is early in a flexible process
Resources are devoted to the day
Provider willingness is at a reasonable level
There is a commitment to follow up with actual improvement efforts
18
When Not to UsePatient Journey Mapping
When decisions are already made When the will to engage patients is not present When resources of time and funds cannot be
dedicated to it At the end of project
But then what…..
19
….Never too Late to Engage!
Patient Impact
+ Provider Willingness
+ Decision Latitude
= Appropriate Level of Engagement
20
Engagement
Inform provide
balanced information to
increase understanding
ConsultSolicit
feedback on proposals,
alternatives and/or
decisions
InvolveWork with
patient/public to understand and consider
concerns, preferences and values
Empower Delegate
responsibility for identifying
issues, solutions and
actions to patients or the
public
What is required to do Patient Journey Mapping?
Basic Needs:Funding
Logistics Sessionals
TimeContacts and ConnectionsCommitment and Understanding
22
Steps to Patient Journey Mapping
• Determine Population of Focus• Determine the Scope of the Journey• Key Stakeholders• Set the Date• Orient and Prepare participants• Conduct the Mapping Day• Validate the Map and Report• Use the map for improvement!
23
3 Stages of the Journey
24
A trip requires Planning
Getting Underway
Stage 1 - Planning the Journey
Stage 2 - Making the Map
Stage 3 - Planning for Improvement
The Destination
Stage 1
Planning the Journey
Planning……..The 3-R’s
1. Right Plan: Identify pt. group, aim, objectives, scope, measures Planning the Day Orientation of Team Communication
2. Right People Delegate Project Coordinator/s Selecting Team members Engaging Patient Partners
3. Right Resources
26
Stage 2
Mapping The Journey
Patient StoryMary went to see her Doctor, complaining she was exhausted, under a lot of stress and feeling like something might be wrong.
• Mary is 45, overweight, non-smoker• Married, husband unemployed with alcohol issues • Has 3 grown children -1 son and 2 step sons• Working poor -part time waitress• Lives out of town • Was diagnosed with Type 2 diabetes
Patient feels unwell
Makes appt with Dr
Time:
Pt feels unwellMakes appt
with DrTime:
Pt feels unwellMakes appt
with DrTime: 1-7 days
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Lab hours Mon – Fri 730-1530No appt
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Lab hours Mon – Fri 730-1530No appt
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
DNE fte .6MWF 800-
1600
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
1600
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Look at
group
classes
night as
well
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Look at
group
classes
night as
well
Sees GP every 3 months
Pt feels unwellMakes appt
with DrTime: 1-7 days
Sees GP given
request for lab work
Makes f/u appt
Lab hours Mon – Fri 730-1530No appt
Working
pts have
difficulty
getting to
lab due to
hours
Sees GP again
Told has diabetes
Referral to DNE/Dtn
Is GP in
IHN?
Sees Nurse in office for
intro to diabetes edReferral to DNE/Dtn
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
1600
Dtc fte .4TTh 800-
1600
Working pts have difficulty getting to education due to hours
DNE fte .6MWF 800-
16007-14 days
Dtc fte .4TTh 800-
160014-21 days
Cla
sses
done 1
:1
Look at
group
classes
night as
well
Sees GP every 3 months
No standing orders at lab
Sees GP Given request for lab
work and makes follow up appt at
same time
Lab hours Mon – Fri 730-1530
Don’t take appts
Sees GP againTold has diabetes
Is GP in
IHN?
Sees Nurse in office for intro to diabetes ed
Yes
Referred to DNE/Dtn
No
DNE fte .6MWF 800-
16007-14 days
Dtn fte .4TTh 800-
160014-21 days
Pt feels unwellMakes appt with Dr
Time: 1-7 daysSees GP every 3
months
Stage 3
Improving
Improving………The Patient Story
• What could be done to improve the journey?
Patient Journey Mapping in BC…What has Worked Well and What has Not.
63
What has Worked Well….
• Engaging patient partners• Invaluable learning into patient experience• Promotes patient driven care• Building relationships• Patients and providers improving care together• Patients feel valued• Staff excitement
64
What Has Not Worked Well……
• Preparing for the mapping session• Provider resistance• Improvement ideas not utilized in HA plans• More is not better• No plan or support for follow through• No coordination with community for follow up• PJM not always the right engagement tool
65
Remember……………
• No creative work is going to take place if a critical mass is still trying to protect territory or existing positions.
• So be careful about bringing large groups of together without adequate groundwork and preparation. NHS Leaders Guide: Building and Nurturing Improvement Culture
66