How to Create a Patient Journey Map

What is patient- and family-centred care?

“An approach that fosters respectful, compassionate, culturally appropriate and competent care that responds to the needs, values, beliefs and preferences of clients and family members.” - Accreditation Canada

What is Patient Journey Mapping?

“A visual representation of the relevant procedures and administrative processes that a patient experiences…Patient Journey Mapping is a view of health care taken from the patient’s perspective.” -NHS

Why Use Patient Journey Mapping?

Patient Journey Mapping:

Makes it easier to identify areas of improvement Amplifies the patient voice Depicts how care is RECEIVED not only how it’s given Captures the steps in a process from the patient perspective Makes patients the experts in their own care experiences Puts more focus on emotional needs and the need for satisfaction of care Allows for immediate feedback on care from the patient if the gaps identified are addressed

Ask yourself if you are able to affect the changes that might come up, otherwise consider an alternate method: focus group, written documentation of story, interviews. Don’t just use it because it’s trendy or as a way to document, choose Patient Journey Mapping because it is the tool that will best identify the areas that need improvement.

Is it the Right Tool?

Use the following list to determine whether Patient Journey Mapping is the right tool for your project:

Agree/DisagreeHealth Care partners are prepared to be open and respectful to hearing the patient perspectiveClear start and end points are identified and scope is definedMajor stakeholders are invested in the event and committed to taking action based on the patient perspectivePatients are directly affected by the steps in a process (ie., Patients being referred for surgery vs instrument availability)This would be a starting point for decisions that have not yet been madePatient- and family-centered care is embraced, not just a check box for accreditationTransition points are unclear and there is a history of patients falling through the

cracks

If you disagree with any of these statements, please consider an alternate tool.

Different methods

1. One on one, facilitator and patient.2. Multiple patients with a facilitator or a range of stakeholders including clinicians and patients.

Make sure clinicians are observers and not interacting with patient journey while in the room.If hosting a group, introduce patient participants socially ahead of time.

Steps in Mapping

1. In order to document a patient journey, a facilitator is suggested to keep the patient on task and dig deeper. The facilitator can also be the ‘scribe’ or another person could take on this task.

2. The facilitator respectfully asks questions in order to document, encourage additional information, and ensure it is accurately captured.

3. Define “start” and “end” of story – what experience/process do you want to know about?4. Use different coloured post-it notes and butcher paper.5. Generally have two to three hours set aside.6. Set ground rules if working with a group (i.e., staying on topic, goal focused).7. Debrief halfway through with stakeholders – is this useful? Did we miss anything?8. Have time for transcription at the end. This can be very time consuming. Plan to share in a Word

document if possible so it can be added to or changed in the future.

Tips

1. Be clear on what you want to improve? Always have an aim of documenting the journey and a reason.

2. Invite the main people you are mapping to attend and possibly a support person if he or she would like.

3. Give clarity on confidentiality to the patient. Will the patient remain confidential? Will his/her name not be shared with providers? Anonymity is often a very important issue to the patient.

4. Introduce the patients to each other prior to the meeting if the mapping is done in the group with the committee.

5. If health care providers attend, they should be spectators, and should not interact or interrupt. 6. Don’t include the patient if you’ve already decided on outcomes.7. Don’t focus on what is wrong with the system. What is the current-state map, and how does it

compare to our vision of a future-state? Identify clear, agreed pathways to care.8. Provide an information sheet and consent form for patients. Consent forms need to be adapted

each time to ensure they are specific to the mapping event, written to the language/reading level of the participants and make explicit what information will be used, how it will be shared and whether anonymity will be maintained.

9. Provide a media release form if photos are taken. Take photos early in the session.

10. Tune into the needs and culture of the community, and organize the journey mapping session so that it feels safe and acceptable to those who are participating

11. Have counselling or professional help available (could be on call, if deemed necessary).12. Be in a safe, comfortable room. Thoughtfulness on the part of organizers to make the

experience safe for the team and participants is really appreciated. Make it comfortable, think it out well.

13. Provide water/coffee.14. In the future, process map the organizational procedures that the patient interacted with for

future learnings. Patient process and parallel process could also be helpful. Most likely this would be done at a separate time.

Different Methods:

See sample process below. Different titles may be used

Patient Story Addictions problems started in _____

Looking for treatment

Seeing MH staff regularly

Impact on Family and Person

Patient states high school education would be helpful

Family had to find accommodations for patient

Feeling supported

Services Accessed RCMPAmbulance toEmergency

Treatment plan options, no referral to Mental Health Services

Northern Health Mental Health Life Skills Worker, Psychiatrist

Challenges and Opportunities

Focus on safety, not resources, by both ER and RCMP

Busy long weekend at ER, no other resources suggested

Medications

What to Improve Communication between high school and students. High school education done by public health?

RCMP educating parents/family or patient, ER educating family/parents or patient

What does communication mean? Resources, Department of Education, etc.

Referral process to Mental Health and Addictions

Booking Doctors appointments- can’t book ahead, must get up at 8am and phone. Patient having trouble sleeping

Patient Journey Map

Information Sheet for Participants

You are being invited to participate in Patient Journey Mapping.

The Patient Journey Map will be a map of the services and care you received from different organizations. This will help us learn what worked well and what can be improved.

We will be talking about what care you received when you were a client/patient. A person will be writing and or drawing what you tell us.

By accepting this invitation to join the Patient Journey Mapping, you are saying it is OK for your story to be shared with others. You will probably spend about one to two hours sharing your journey. There will be some people you already know in the room. There will be some people writing and drawing the map that you do not know.

Your name will not be on the map. We will try to make sure nothing is added to the map that would let people looking at it know who you are. You can stop participating in the project at any time. If you decide to stop participating, you can tell us whether or not you want your information included in the project.

Please sign the confidentiality agreement to confirm your attendance.

Thank you for being willing to share your story.

The map of a journey may look like one of the following pictures:

Pictorial, linear, what happened step by step.

People involved on X axis, time line on Y axis. Use different coloured sticky notes for different people, for instance the blue sticky could be the patient, for different locations or for ideas/problems. Take a photo or document the process at the end.

Sample Confidentiality Form (reminder this needs to be done for each event)

I give permission for ____________________________ to document the journey of _________________________ on ___________________(date) at ____________________(location) being a patient documentation will be done by the BC Patient Safety and Quality Council.

Date:_________________________________

Signature:_____________________________

Printed Name:__________________________

Witness:_______________________________

Printed Name:__________________________

Adapted From:

Child and Youth Mental Health Composite Mapping Lessons Learned, C. Southey, Provincial Collaborative Coach, CYMHSU Collaborative, 2016

BC Patient Safety and Quality Council: Quality Café Recording – To Map Or Not To Map: Is Patient Journey

Mapping Right For Me Jo-Ann Tisserand , Christina Southey and Liz Lamb

https://bcpsqc.ca/blog/knowledge/quality-cafe-to-map-or-not-to-map-is-patient-journey-mapping-

right-for-me/

PowerPoint slides for a Patient Journey Mapping mini-course. http://www.slideshare.net/bcpsqc/c6-

patient-journey-mapping-everything-youwanted-to-know-but-were-afraid-to-ask-minicourse-s-shearer-

and-a-lawrence

©C. Almost, 2018, please contact at cathyalmost@gmail.com