E9 Scott Shearer & April Lawrence - Patient Journey Mapping

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

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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:


with DrTime: 1-7 days



Sees GP given

request for lab work



Sees GP given




Sees GP given


Lab hours Mon – Fri 730-1530No appt



Sees GP given





Sees GP given



Working

pts have

difficulty

getting to

lab due to

hours



Sees GP given



Working

pts have

difficulty

getting to

lab due to

hours

Sees GP again

Told has diabetes



Sees GP given


Makes f/u appt


Working

pts have

difficulty

getting to

lab due to

hours

Sees GP again

Told has diabetes



Sees GP given


Makes f/u appt


Working

pts have

difficulty

getting to

lab due to

hours

Sees GP again

Told has diabetes



Sees GP given


Makes f/u appt


Working

pts have

difficulty

getting to

lab due to

hours

Sees GP again

Told has diabetes

Referral to DNE/Dtn



Sees GP given


Makes f/u appt


Working

pts have

difficulty

getting to

lab due to

hours

Sees GP again

Told has diabetes

Referral to DNE/Dtn



Sees GP given


Makes f/u 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 GP given


Makes f/u 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



Sees GP given


Makes f/u 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 GP given


Makes f/u 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?



Yes



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600

DNE fte .6MWF 800-

1600



Sees GP given


Makes f/u 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?



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



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


DNE fte .6MWF 800-

16007-14 days

Dtc fte .4TTh 800-

1600



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


DNE fte .6MWF 800-

16007-14 days

Dtc fte .4TTh 800-

160014-21 days



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


DNE fte .6MWF 800-

16007-14 days

Dtc fte .4TTh 800-

160014-21 days

Cla

sses

done 1

:1



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


DNE fte .6MWF 800-

16007-14 days

Dtc fte .4TTh 800-

160014-21 days

Cla

sses

done 1

:1



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


DNE fte .6MWF 800-

16007-14 days

Dtc fte .4TTh 800-

160014-21 days

Cla

sses

done 1

:1



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


DNE fte .6MWF 800-

16007-14 days

Dtc fte .4TTh 800-

160014-21 days

Cla

sses

done 1

:1



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


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 given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


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



Sees GP given


Makes f/u 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?



Yes

Referred to DNE/Dtn

No

DNE fte .6MWF 800-

1600

Dtc fte .4TTh 800-

1600


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

E9 Scott Shearer & April Lawrence - Patient Journey Mapping

Documents

patient journey mapping16

patient journey mapping

patient impact

patient feelspt

patient experience13

patient processpjm

patient partners3

patient storymary