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Journey Management: What It Is, Framework & Best Practices

Have you ever wondered how businesses ensure you have a smooth and satisfying experience when buying their products or services? That’s where customer Journey Management comes into play.

Effective customer journey management tools empower businesses to orchestrate, optimize, and analyze each stage of the journey, ensuring a seamless and delightful experience for their customers.

It might sound like a complicated term, but don’t worry. We’re here to break it down for you in the simplest way possible.

What is Journey Management?

Journey Management refers to strategically guiding customers through their interactions with a business. From the initial point of contact to the final purchase or post-purchase support. It involves understanding and optimizing every touchpoint a customer has with a brand, ensuring a seamless and enjoyable experience.

Effectively implementing journey management helps businesses identify and address pain points, ultimately working to improve the customer experience at every touchpoint.

This approach goes beyond individual transactions. It focuses on creating a holistic view of the customer’s journey, considering various channels and interactions. Businesses can tailor their strategies to meet customer needs at each stage, fostering loyalty and satisfaction. 

Importance of Journey Management

Journey management is crucial for businesses in today’s highly competitive and customer-centric environment. Here are some key reasons highlighting the importance of journey management:

1. Holistic Customer Understanding

• Benefit: Journey management provides a comprehensive view of the customer experience, allowing businesses to understand how customers interact at each touchpoint.
• Impact: Enables businesses to make data-driven decisions to enhance the customer journey.

2. Optimized Customer Experience

• Benefit: By identifying pain points and optimizing touchpoints, businesses can create a seamless and enjoyable customer experience by identifying pain points and optimizing touchpoints by identifying pain points and optimizing touchpoints.
• Impact: Enhanced customer satisfaction, loyalty, and positive word-of-mouth.

3. Proactive Issue Resolution

• Benefit: Journey management helps identify and address issues in real time.
• Impact: Improve customer support efficiency, reduce churn, and foster customer trust.

4. Personalization Opportunities

• Benefit: Understanding customer behavior allows businesses to tailor interactions and offers.
• Impact: Increases the likelihood of repeat business and customer loyalty.

5. Strategic Business Alignment

• Benefit: Aligns customer journey improvements with broader business goals.
• Impact: Ensures that customer experience enhancements contribute to overall business success.

6. Increased Operational Efficiency

• Benefit: Optimization of processes and touchpoints leads to more efficient operations.
• Impact: Reduces operational costs and enhances resource utilization.

7. Competitive Advantage

• Benefit: Businesses that actively manage customer journeys gain a competitive edge.
• Impact: Attracts and retains customers in a market where experience is a key differentiator.

8. Data-Driven Decision-Making

• Benefit: Utilizes customer data and analytics to inform decision-making.
• Impact: Improves the accuracy and effectiveness of business strategies.

9. Adaptability to Customer Expectations

• Benefit: Helps businesses stay aligned with evolving customer expectations.
• Impact: Positions the business as responsive and customer-focused.

10. Continuous Improvement

• Benefit: Journey management is an iterative process, allowing for ongoing improvements.
• Impact: Creates a culture of continuous improvement, adapting to changing market dynamics.

Stages of customer journey management?

The customer journey typically consists of several stages, each with unique characteristics. While the exact stages may vary depending on the industry and business model, a generalized framework includes:

• Awareness: Customers become aware of the brand, product, or service.
• Consideration: Customers actively evaluate the offerings, comparing them with alternatives.
• Purchase: The customer decides to purchase and completes the transaction.
• Post-Purchase: The customer assesses their experience and ongoing support after the purchase.
• Advocacy: Satisfied customers become advocates, recommending the brand to others.

Customer Journey Management Framework

A Customer Journey Management Framework is a structured approach businesses adopt to understand, optimize, and enhance customer experience across various touchpoints. 

It involves a series of interconnected processes to ensure customer interactions are seamless, memorable, and aligned with the overall business strategy. Here’s a breakdown of the key components of a Customer Journey Management Framework:

1. Customer Journey Mapping:

Create theoretical representations of the steps a customer takes to achieve their goals, whether purchasing, seeking support, or engaging with the brand.

• Define Audience Personas: Understand your target audience’s characteristics, preferences, and behaviors.
• Outline Journeys: Identify customers’ experiences and map the steps and touchpoints involved.

2. Customer Journey Orchestration:

Design standardized processes and workflows that ensure cohesive and compelling customer journeys across various departments.

Key Elements:

• Collaborative Teams: Form teams comprising marketing, product, and service personnel to work together on creating compelling customer journeys.
• Proactive Coordination: Ensure all teams know customer interactions, allowing coordinated efforts to enhance the overall experience.

3. Customer Journey Optimization:

Continuously evaluate and improve customer journeys based on data, analytics, and customer feedback.

Cyclical Process:

• Identify Pain Points: Use data and customer feedback to pinpoint areas in the customer journey that need improvement.
• Implement Changes: Take active steps to optimize touchpoints and address pain points.
• Monitor Success: Regularly assess the success of optimization initiatives and make further improvements as needed.

4. Customer Journey Analytics:

Leverage data-driven insights to understand customer behavior, track Key Performance Indicators (KPIs), and identify areas for improvement.

Data Sources:

• Customer Behavior Tracking: Utilize tools to track and analyze customer behavior across various platforms and touchpoints.
• AI and NLP: Implement Artificial Intelligence and Natural Language Processing to understand customer sentiment, intent, and effort.

Difference between customer journey governance vs. management vs. operations?

Customer journey governance, management, and operations are distinct aspects of handling the overall customer experience within an organization. Let’s break down the differences between these terms:

How QuestionPro CX can Help in Journey Management

QuestionPro CX plays a crucial role in effective Journey Management, providing tools and features contributing to a seamless and enhanced customer experience. Here’s how QuestionPro CX can assist in Journey Management: 

1. Customer Experience Design

• Create unique and engaging customer experiences at every touchpoint.
• Tailor strategies to meet evolving customer expectations.

2. Closed Loop Feedback

• Utilize a ticketing system to close the feedback loop.
• Reduce churn rates and convert detractors into promoters.

3. Customer Journey Mapping

• SuiteCX by QuestionPro offers customizable and secure journey mapping.
• Integrate survey data, persona development, and improvement planning for a comprehensive understanding.

4. NPS+ Survey Question

• Empower customers with the NPS+ survey question, combining NPS, root cause, and comment types.
• Identify what works for promoters and address issues promptly.

5. Flexible Dashboard and Reporting

• Distribute data effortlessly throughout the organization with customizable dashboards.
• Benefit from a powerful reporting widget for NPS tracking, Churn Risk analysis, and Customer Innovation Idea reporting.

6. Closed Loop Implementation

• Capture the customer journey at various touchpoints.
• Leverage real-time insights to enhance the overall customer experience.

7. Extensive Toolbelt and Integrations

• Access various tools, including sentiment analysis, advanced dashboards, workflow setup, and disposition metrics.
• Seamlessly integrate with popular platforms such as Salesforce, Zapier, Microsoft Dynamics, Twitter, Tableau, PowerBI, Domo, and more.

8. Customer Advocacy

• Turn customers into advocates through a holistic approach to feedback and improvement.
• Enhance customer satisfaction, loyalty, retention, and relationship management.

Effective journey Management is crucial for businesses aiming to thrive in today’s competitive landscape. By understanding and optimizing the successful customer journey, companies can create memorable experiences that lead to customer satisfaction, loyalty, and increased revenue. 

With the proper framework and best practices in place, businesses can navigate the intricate paths of customer interactions, ensuring success in the long run. Embrace Journey Management, and watch your customer relationships flourish.

QuestionPro CX provides a comprehensive and innovative toolset, facilitating the journey of turning customers into advocates while ensuring a data-driven and customer-centric approach throughout the customer experience.

LEARN MORE         FREE TRIAL

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BUS300: Operations Management

Three Experts on Quality Management

Read this article to better understand the history of quality management and the impact of these three men on the approaches to quality management. You might call these men the founders of the quality process. Their contribution to this organizational focus on quality needs to be understood.

Basic Principles

Juran proposes a strategic and structured (i.e.,project- by-project) approach to achieving quality. Concepts he developed to support his philosophy include (1) the "Spiral of Progress in Quality," (2) the "Breakthrough Sequence," (3) the "Project-by-Project Approach," (4) the "Juran Trilogy," and (5) the principle of the "Vital Few and Trivial Many".

The "Spiral of Progress in Quality"

Juran stresses that "any organization produces and distributes its products through a series of specialized activities carried out by specialized departments". These activities (actions) are depicted by the "spiral of progress in quality". The spiral shows actions necessary before a product or service can be introduced to the market (Figure 8).

"Each specialized department in the spiral [e.g., customer service, marketing, purchasing] is given the responsibility to carry out its assigned special function. In addition, each specialized department is also assigned a share of the responsibility of carrying out certain company-wide functions such as human relations, finance, and quality". Quality results from the interrelationship of all departments within the spiral. Juran talks about "quality function" to describe activities through which the departments around the spiral can attain quality.

Quality improvement projects are carried out throughout the organization. The approach includes:

• Identifying the activities that could meet die company's goals of fitness for use.
• Assigning the activities to the various departments and organizations around the spiral.
• Providing die facilities and tools needed to conduct these activities.
• Conducting the assigned activities within the designated departments.
• Ensuring that these activities are properly carried out
• Coordinating the departmental activities.

"Breakthrough Sequence"

Juran's philosophy addresses improvement and innovation in terms of "breakthrough". He defines break-through as a "dynamic, decisive movement to new, higher levels of performance". His breakthrough sequence involves activities that, if carried out properly, will result in improvements in quality and will eventually result in unprecedented performance that will help the organization launch innovative products. Breakthroughs can lead to: (1) attainment of quality leadership, (2) solution to an excessive number of field problems, and (3) improvement of the organization's public image.

There are barriers that affect opportunities for break-through. As with any other change, breakthrough can be resisted by managers who traditionally concentrate on control. Through control, managers maintain the present levels of performance or prevent adverse change. Control activities, such as problem solving, have a short-term focus; they are necessary to hold on to gains, but will not lead to improvement and innovation. Breakthrough activities arc needed to achieve higher levels of performance and innovation and to exceed customer satisfaction.

According to Juran, breakthrough and control are part of a continuing cycle of gains and plateaus in performance. and he considers that all managerial activity is directed at either breakthrough or control. According to Juran, all breakthroughs follow the same sequence:

• Policy making.
• Setting objectives for breakthrough.
• Breakthrough in attitudes.
• Use of Pareto principle.
• Organizing for breakthrough in knowledge.
• Creation of steering arm.
• Creation of diagnostic arm.
• Breakthrough in cultural pattern.  
• Transition to the new level.

Figure 8. The "spiral of progress in quality" (Juran & Gryna, 1988).

"Project-by-Project Approach"

The quality improvement methodology, as depicted by Juran, requires project-by-project implementation. Two kinds of teams are formed, the steering arm and the diagnostic arm, to work on analyzing problems (Figure 9). A committee of managers is formed to solicit project nominations from all employees, to select that year's projects, and to appoint teams to address each one. Typically, large numbers of project teams must be formed, depending on bow many projects have been selected. His approach requires that members of the team develop skills in team leadership and team participation and acquire knowledge of problem-solving tools. Also, all employees need to participate in the improvement process and have the skills needed to make improvements.

The main thrust of these teams is to solve problems, but Juran distinguishes between "putting patches" on problems and finding and removing the causes of problems. He calls the process of analyzing problems the "journey from symptom to cause". Examination of the symptom must be the starting point of the action team. The symptom is the evidence that something is wrong. Once the symptom has been identified, the objective of the team is to come up with a solution. However, the members will first need to discover the cause.

Juran developed two "journeys" to describe how the teams interact with each other in this process - the journey from symptom to cause, which he named the diagnostic journey, and the journey from cause to remedy, called the remedial journey. Both journeys are different in purpose and require teams of people from different levels and departments (e.g., first-line supervisors, customer service) within the organization with different skills.

The teams' outcomes are documented and presented to the rest of the organization in an annual audit The process of soliciting nominations for next year's projects is then repeated.

Figure 9. The diagnostic and remedial journeys (Juran, 1988).

The "Juran Trilogy"

The "Juran trilogy" provides a systematic approach to carrying out Juran's methodology for managing for quality. Essential to implementation, however, is active leadership, starting at the top.

This trilogy (Figure 10) states that management for quality consists of three interrelated quality-oriented processes - quality planning, quality control, and quality improvement. Quality planning involves developing a process that will achieve the established goals. People working in the planning phase are responsible for determining who their customers are and identifying customer needs and execrations. Quality control is concerned with holding onto gains and not letting waste increase. The control process addresses the sporadic spikes in variation; if necessary, the people working in this process create teams to determine the causes of any abnormal variation in die process. Those involved in the quality improvement process are concerned with lowering the cost of poor quality in existing processes, but, more importantly, are responsible for using the lessons learned for seeking innovative ways to achieve better levels of performance. In this respect, Juran's approach addresses continuous improvement.

Each process in the trilogy (planning, control, and improvement) is "universal" (inherent in organizations focusing on quality). Relevant activities include identifying customers, establishing measurements, and diagnosing causes. Juran compares the activities of the trilogy with those of financial operations. Money is the language of management and, in his terms, quality planning is analogous to budgeting, quality control to cost control, and quality improvement to cost reduction.

Figure 10. The "Juran trilogy" (Juran, 1981).

The "Vital Few and the Trivial Many"

Because Juran emphasizes prioritization of problems to be solved, the Pareto diagram is an especially useful tool to him. The diagram is based upon the principle developed in 1897 by the Italian economist Vilfredo Pareto. Pareto conducted studies of wealth distribution. He found that the vast majority of wealth in his society was held by a remarkably small percentage of the population. In general, the Pareto principle states that a few factors account for the largest percentage of a total.

Juran applied this concept to the industrial world to classify problems of quality (Figure 11). According to Juran, most of the cost of poor quality can be attributed to a very small number of causes called "the vital few". The other defects, called the "trivial many" and, lately, the "useful many," can be ignored for a time.

The Pareto diagram depicts columns arranged in descending order. The diagram in Figure 11 illustrates causes from many sources of variation. According to this graph, one should concentrate on cause "A" first because it is responsible for most of the defects and will result in the biggest payoff (Ishikawa, 1982). It should be noted, however, that frequency should not be the only characteristic to consider when beginning a Pareto analysis. Sometimes frequently occurring defects are not the most serious, and common sense needs to prevail in those situations when selecting initial causes for improvement.

The "project-by-project" approach is at the heart of Juran's philosophy. Using the concepts of the "spiral of progress" and die "breakthrough sequence," managers are able to target and improve specific areas.

Quality is defined by fitness for use and customer requirements. As with Crosby, the monetary cost of quality is the focus of measurement He puts emphasis on company-wide goals and the deployment of specific goals. Juran targets training toward quality management practices and problem-solving techniques. His approach focuses on quality planning, quality control, and quality improvement processes as a way to manage for quality

Figure 11. The Pareto diagram.

• Quality Management

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What is Quality Management? A Complete Guide

• Written by Contributing Writer
• Updated on September 29, 2023

The importance of quality cannot be overstated when it comes to businesses, their success and their longevity. When there is quality, it translates to value for customers, streamlined processes, and continual growth.

We often hear the term “quality control” in the context of how a business produces goods or services to the satisfaction of its customers consistently. However, there’s a larger concept at play, which covers quality control and other quality-related strategies. It’s called quality management.

So, what is quality management?

If you’re a project manager or aspiring to be one, you’ll want to understand how quality management works. This article comprehensively examines what it is, how it works, the methods, and everything you need to know about quality management.

We’ll also discuss how you can better understand quality and other project management concepts through a Lean Six Sigma course .

Quality Management: Definition & Examples

In short, it involves management tasks and roles focused on defining and executing quality policies through strategies like quality planning, assurance, and control.

Let’s understand this through an example.

Consider running a bakery on your street. Sales are good, but you notice some areas for enhancement. The nearby shop has fresher flour, and your oven isn’t heating evenly. You decide to upgrade. You monitor the results and plan further refinements.

In essence, this illustrates quality management (QM). It’s the act of assessing and refining quality throughout an organization. It is the act of combining quality assurance (QA) with process enhancement.

QM sets objectives, identifies shortcomings, and makes necessary adjustments. In short, it’s the strategy to improve operations and bridge experience gaps.

Also Read: What Is Lean Management, and Why Is It Worth Mastering?

History of Quality Management in a Nutshell

Quality Management started with Walter Shewhart at Bell Laboratories in the early 20th century. He introduced statistical quality control (SQC), focusing on process improvement over the end product.

During World War II, the U.S. applied SQC for military production. However, post-war civilian manufacturers lagged in adopting these improvements. Then, engineers Deming and Juran traveled to war-torn Japan. Their approach emphasized ‘Total Quality,’ a holistic approach to improvement. Their efforts transformed Japan into a manufacturing titan.

By the 1980s, recognizing Japan’s success and shortcomings, the U.S. adopted Total Quality Management (TQM). 1987, the ISO 9000 standard was introduced, becoming a global quality benchmark.

As the 21st century rolled in, with globalization and technology at the forefront, approaches like Motorola’s Six Sigma emerged, emphasizing near-perfect outputs.

Today, quality management isn’t limited to manufacturing; it’s a universal pursuit, spanning sectors from healthcare to cutting-edge technologies like Blockchain.

What is Quality Management: Four Stages

The four Quality Management (QM) stages are often described as part of the Plan-Do-Check-Act (PDCA) cycle, also known as the Deming Cycle or Shewhart Cycle.

Here’s a brief overview:

This is the initial stage where you identify an opportunity and plan for change. This involves setting objectives, defining processes to meet the objectives, and determining the resources needed.

In this stage, you implement the plan on a small scale, ideally in a controlled environment. This is where the changes are tested, and data is collected for the next step.

Here, you assess your test results, comparing them against the expected outcomes to determine any differences. You’ll analyze the data collected during the “Do” phase to understand whether the change has led to improvements.

You take corrective action Based on the “Check” phase results. If the implemented change leads to the desired improvement, you can scale up the implementation. If not, you must revisit the “Plan” phase to identify new or refined solutions.

This cycle keeps repeating, always aiming to make things better. When one cycle finishes, it helps set up the next, ensuring we’re always checking and improving our methods for the best results.

Also Read: What Is Process Mapping & How to Create It?

Most Popular Quality Management Methods

Four essential quality management methods stand out. Each offers unique benefits and challenges; the best fit depends on a company’s structure, needs, and goals.

Standardized Systems

Set by the government, these standards, like ISO certifications, are mandatory for certain products (e.g., baby car seats). Some firms adopt these standards voluntarily to enhance their reputation or align with their vision.

Total Quality Management (TQM)

This aims to boost quality throughout a company. It assesses the firm’s overarching quality goals and then evaluates every process and factor affecting quality for improvement.

A detailed, data-centered approach, Six Sigma focuses on defining, measuring, analyzing, enhancing, and maintaining quality. Predominantly used by large manufacturers, it necessitates thorough training. For deeper insights, consider enrolling in a boot camp.

Continuous Quality Improvement (CQI)

As the name suggests, the enhancement never stops. Recognizing perfection is a journey, CQI prioritizes people over processes, using the Plan, Do, Check, Act framework to improve quality.

What are the Main Quality Management Principles?

Quality management revolves around several guiding principles. Adopted by the International Standard for Quality Management, these principles enable organizations to refine their processes for optimal results:

Prioritizing Customers

Every organization’s main goal should be to understand and surpass the needs and expectations of its customers. By recognizing and fulfilling both current and future customer needs, businesses ensure customer loyalty, leading to increased revenue. Effective and efficient processes enhance quality, satisfying more customers.

Importance of Leadership

The success of any organization is directly linked to its leadership. Effective leaders foster unity, setting clear goals that engage employees and stakeholders. A positive organizational culture helps employees achieve their potential and work towards company goals. Engaging employees in goal-setting often leads to heightened productivity and commitment.

Engaging Employees

Active employee involvement is crucial. All staff should be empowered to contribute value regardless of their employment status or role. Constant skill improvement and consistent performance should be promoted. Empowerment, decision-making involvement, and recognition motivate employees, ensuring they feel valued and responsible for their contributions.

Adopting a Process-Centric Mindset

Organizational performance hinges on efficient and effective processes. Recognizing that superior processes lead to consistency, efficiency, and ongoing improvement is vital. Organizations thrive when they can effectively manage inputs and the processes that yield outputs.

Commitment to Ongoing Improvement

An enduring focus on improvement can transform organizations, enhancing flexibility, performance, and adaptability. A proactive stance on creating and evolving processes is crucial to stay competitive.

Data-Driven Decision Making

Grounding decisions in analyzed and validated data offers a clearer understanding of the market dynamics. Such a factual approach ensures businesses can execute strategies that yield desired outcomes while providing a basis for past decisions. It aids in understanding the interconnected nature of actions and their consequences.

Building Strong Relationships

Effective relationship management, especially with suppliers and stakeholders, is paramount. Recognizing that various parties can influence an organization’s trajectory ensures better supply chain management. By cultivating and maintaining these relationships, businesses enhance their chances of long-term success and collaboration.

Also Read: What Is Lean Six Sigma? A Comprehensive Guide to Understanding the Methodology

What is a Quality Management System (QMS)?

Let us look at how the principles of quality management are implemented through the QMS or Quality Management System.

A Quality Management System (QMS) ensures that products are made to meet quality standards. It monitors products from start to finish, ensuring they align with industry and regulatory norms.

QMS can be manual or software-driven and comprises two main parts: quality assurance and quality control.

While quality assurance focuses on inspecting processes during production, quality control evaluates the end products using customer feedback and on-site inspections. Quality assurance maintains consistent quality during production, and quality control verifies the final product’s quality.

The Importance of Quality Management Systems in Business

Why do businesses need QMS? Here is a breakdown of what it means to the business processes:

Product Oversight

The QMS constantly monitors products, beginning with acquiring raw materials and continuing to ship finished goods. It’s vigilant about tracking the quantity of products made and promptly identifying faulty ones.

Vendor Product Evaluation

This aspect of the QMS ensures that products sourced from vendors align with predetermined quality benchmarks. Vendor products can be quickly identified and returned if they fall short of these standards.

Scheduled Evaluations

Regular assessments are scheduled for staff, products, and equipment, ensuring ongoing quality compliance.

Error Tracking and Rectification

One vital feature of a QMS is its ability to spot and record current errors within the system. Beyond identifying them, it establishes strategies to both rectify present issues and devise mechanisms to prevent similar problems in the future.

Supplier Performance Assessment

A QMS employs key performance indicators (KPIs) to evaluate suppliers’ efficiency and reliability critically.

Policy and Procedure Updates

An effective QMS stays updated with any changes to company policies and procedures.

Moreover, it provides detailed and actionable reports on all facets of the quality management process.

Things to Remember When Choosing a Quality Management System

When choosing a QMS, numerous options can be overwhelming. Here’s a condensed guide to making an informed decision.

Industry Experience

It’s essential to check if the QMS provider has experience in your sector. They should have worked with similar businesses and be conversant with your specific quality requirements. Moreover, they should offer reliable references and display deep industry knowledge in software, installation, and training.

Functionality Needs

Determine if the software aligns with your business requirements. Key functionalities to consider include:

• Meeting industry-specific quality compliance standards
• Integration capabilities with other systems
• Tracking non-conformities and offering a comprehensive audit trail
• Features like Correct and Preventative Action (CAPA) management to address root causes
• AQL and RQL sampling throughout processes
• Efficient document control to log all quality endeavors
• Display of KPIs for supplier performance evaluation
• Flexibility to gather data from various sources, including mobile devices or the web

Real-time visibility into quality events is crucial. A robust QMS provides insights across the enterprise, allowing proactive issue resolution. It should offer the ability to monitor vendors and employees for compliance and training needs.

Master Quality Management for Better Project Outcomes

Quality management is paramount in every industry. For project managers, it’s critical to ensure streamlined processes that lead to the desired level of quality and performance.

If you want formal training in quality management, enrolling in a professional Lean Six Sigma certification can be a great starting point.

You might also like to read:

Six Sigma Principles: A Comprehensive Guide to Implementing and Optimizing Your Processes

Six Sigma vs. Lean Six Sigma: Which Methodology Is Right for Your Business?

What is Lean Methodology?

Six Sigma in Healthcare: Concept, Benefits and Examples

The Top 24 Lean Six Sigma Interview Questions for 2023

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Juran’s steps for Quality Improvement

Juran, like Deming, was invited to Japan in 1954 by the Union of Japanese Scientists and Engineers (JUSE). His work pioneered the management dimensions of planning, organizing, and controlling and focussed on the responsibility of management to achieve quality and the need for setting goals.

Juran defines quality as fitness for use in terms of design, conformance, availability, safety, and field use. His approach is based customer, top-down management and technical methods.

The Juran Trilogy is an improvement cycle that is meant to reduce the cost of poor quality by planning quality into the product / process.

• Quality Planning : In the planning stage, it is critical to define who the customers are and to define their needs (voice of the customer). Once the customer needs are identified, define the requirements for the product / process / service / system, etc., and develop them for operations along with the respective stakeholder expectations. Planning activities are done through a multidisciplinary team, with the involvement of key stakeholders.
• Quality Control : During the control phase, determine what needs to be measured (what forms of data and from which processes?), and set a goal for performance. Obtain feedback by measuring actual performance, and act on the gap between performance and the goal. In Statistical Process Control (SPC), there are several tools that could be used in the control phase of the Juran Trilogy: such as the 7 QC tools and other statistical process control methods.
• Quality Improvement : There are four different strategies to improvement that could be applied for improvements:
• Repair: reactive approach - fix what is broken
• Refinement: proactive approach - continually improve a process that isn’t broken
• Renovation: improvement through innovation or technological advancement
• Reinvention: most demanding approach – abandon the current practices and start over with a clean slate.

Quality improvement can be an arduous journey for organizations, as they are up against various constraints that include customer / stakeholder expectations and interests, some of which could be inherently conflicting.

Juran advocated a ten-step process for quality improvement programmes.

• Build awareness of need and opportunity for improvement
• Survey the employees / personnel, find why errors / mistakes / deviations are made
• After a week, select the top ten reasons
• Decide how to make sure those mistake-causing steps aren't repeated
• Keep track of the number of mistakes being made, make sure they are decreasing
• Set goals for improvement
• Establish specific goals to be reached
• Establish plans for reaching the goals
• Assign clear responsibility for meeting the goals
• Base the rewards on results achieved
• Organize to reach the goals
• Establish quality councils
• Identify problems
• Select projects
• Appoint teams
• Designate facilitators
• Provide training
• Investment in education and training will fetch rewards
• Carry out projects to solve problems
• Large, break-through improvements through interdepartmental or even cross-functional teams
• Tackle the chronic problems for break-through improvements
• Vital few problems create the breakthroughs
• Report progress
• Progress expected and the actual progress achieved
• Act to improve the operational status to reduce variance
• Information on progress provides confidence on quality improvement projects
• Give recognition
• Morale booster
• Communicate results
• Lesson learnt
• Awareness of the approach taken, possibility to learn and improve further
• Improvement outlook for people in other areas, to emulate success
• Track progress
• Report achievements, short-falls
• Maintain momentum by making annual improvement part of the regular processes
• People oriented

Juran’s steps for improvements in quality have been widely accepted, practiced and evolved over time to suit different organizations and segments.

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The Real World Quality Journey

Q&A with David Isaacson, Senior Director, Product Marketing | ETQ

Tell us about yourself and your role with ETQ.

As a senior marketing leader, I focus on developing market strategies and product positioning for ETQ’s cloud-based solutions. I’ve been involved with delivering SaaS solutions to a variety of industries, always with an emphasis of providing value to customers to help them with accomplish their goals. Analytics has also played a key role, and our customers are able to adopt a data-driven approach to making quality decisions. 

What are you seeing driving a greater emphasis on quality among manufacturing firms?

To understand the role quality can play on company success, you really don’t have to look any further than the impact rising product defects and recalls have on manufacturers in terms of financial loss, weakened brand image and reputation, and the time and resources required to fix them. In fact, according to a recent study we commissioned on The State of Quality Management, 96% of manufacturers polled said they experienced a product recall in the last three-to-five years. Yet, out of the manufacturers that had a recall, the majority of those that had a Quality Management System (QMS) in place were able to quickly rebound from it. However, it’s not only defects and recalls that are driving the emphasis on quality. Growing regulatory compliance mandates, from the likes of the FDA, OSHA and other bodies, are better managed and traceable when a sound quality program is in place.  

Tell us about Quality 4.0 and how is it related to Industry 4.0? 

Quality 4.0 is a natural extension of Industry 4.0, which signaled a major shift in the role of automation, integration and the digitization of manufacturing. Quality 4.0 blends technology with traditional methods of quality, in order to help manufacturers achieve operational excellence.  It leverages technology to collect data enterprise-wide, from various sources to provide visibility into the complete product lifecycle and manage workflows, processes and protocols. It also leverages analytics to find meaning behind the data and use it to anticipate or solve business challenges.  

What are the key elements to Quality 4.0 and what steps should companies take to implement them?

Quality 4.0 embraces people, processes and technology. The first step on any quality journey is a cultural one. It requires viewing quality as a strategic business initiative, instead of an operational function. To do this, manufacturers must understand why quality matters. They need to uncover their pain points and weaknesses, get all stakeholders on board and set measurable outcomes. Subsequent phases are all about integration and optimization of processes to enable seamless process flows across different functions and systems. It requires building out the tech stack, as well as the quality team to enable these processes.  

After establishing the foundation for a successful quality program, companies can leverage it across the full product lifecycle and supply chain ecosystem to consistently uphold and exceed quality standards. 

What are the barriers to effective quality management?

A major challenge is that there is a shortage of IT talent to support effective quality programs and related new technologies. In addition, quality requires a major shift in mind-set, so change management is a prerequisite to its success. Reinforcing the quality mind-set from the top down can be difficult. Business leaders must work alongside quality managers and IT to support the initiative enterprise-wide. In addition, supply chains are becoming more complex and it’s becoming increasingly difficult to maintain quality standards across the full pipeline.

What should manufacturers look for in an effective quality management solution?

It’s key that the QMS you use is scalable to meet changing needs. It should allow you to manage the creation, distribution and archiving of all critical documents in a centralized and controlled framework. And, it should be flexible enough so you can leverage best practices, make them your own and quickly adapt to internal and external business challenges. In addition, new systems now offer advanced analytics and AI, which help you make data-driven decisions by collecting and analyzing key quality metrics such as manufacturing efficiency, customer satisfaction or supplier performance. The data collected, however, must be easily analyzed and actionable if it is to be used to improve future outcomes.

Can you provide an example of how a manufacturer implemented a successful quality program? 

A good example of the power of a QMS approach is with Herman Miller, an international office furniture manufacturer. The company is comprised of several business units and subsidiaries, which are geographically dispersed, and customers were not receiving a consistent level of quality and service across the company’s entire footprint. The company implemented a quality program and used our cloud-based QMS solution to automate its manual document control workflow, including its supply chain processes. The automated QMS system enabled them to discern, define and document best practices enterprise wide. As a result the company is able to consistently provide customers with continuously improving products and related services. The time it takes for a supplier to process a corrective action has been dramatically reduced from 30 days to 14 days and this means fewer mistakes, as well as fewer repairs and reshipments, leading to happier customers. 

David Isaacson, Senior Director of Product Marketing at ETQ, has over 25 years experience in software product marketing and product management. He has successfully brought SaaS products to market for a variety of industries and high-growth companies. David has worked for software companies such as Anaqua, VFA/Accruent, and Oracle, where he led the product management team responsible for integrating analytics into the Oracle database.

The content & opinions in this article are the author’s and do not necessarily represent the views of ManufacturingTomorrow

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Exploring Patient Journey Mapping and the Learning Health System: Scoping Review

Amanda l joseph.

1 School of Health Information Science, University of Victoria, Victoria, BC, Canada

2 Homewood Research Institute, Guelph, ON, Canada

Helen Monkman

Andre kushniruk, yuri quintana.

3 Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, United States

4 Harvard Medical School, Boston, MA, United States

Journey maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies may exist between journey maps and the concept of a learning health system (LHS). The overarching goal of an LHS is to use health care data to inform clinical practice and improve service delivery processes and patient outcomes.

The purpose of this review was to assess the literature and establish a relationship between journey mapping techniques and LHSs. Specifically, in this study, we explored the current state of the literature to answer the following research questions: (1) Is there a relationship between journey mapping techniques and an LHS in the literature? (2) Is there a way to integrate the data from journey mapping activities into an LHS? (3) How can the data gleaned from journey map activities be used to inform an LHS?

A scoping review was conducted by querying the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost). Two researchers applied the inclusion criteria and assessed all articles by title and abstract in the first screen, using Covidence. Following this, a full-text review of included articles was done, with relevant data extracted, tabulated, and assessed thematically.

The initial search yielded 694 studies. Of those, 179 duplicates were removed. Following this, 515 articles were assessed during the first screening phase, and 412 were excluded, as they did not meet the inclusion criteria. Next, 103 articles were read in full, and 95 were excluded, resulting in a final sample of 8 articles that satisfied the inclusion criteria. The article sample can be subsumed into 2 overarching themes: (1) the need to evolve service delivery models in health care, and (2) the potential value of using patient journey data in an LHS.

Conclusions

This scoping review demonstrated the gap in knowledge regarding integrating the data from journey mapping activities into an LHS. Our findings highlighted the importance of using the data from patient experiences to enrich an LHS and provide holistic care. To satisfy this gap, the authors intend to continue this investigation to establish the relationship between journey mapping and the concept of LHSs. This scoping review will serve as phase 1 of an investigative series. Phase 2 will entail the creation of a holistic framework to guide and streamline data integration from journey mapping activities into an LHS. Lastly, phase 3 will provide a proof of concept to demonstrate how patient journey mapping activities could be integrated into an LHS.

Introduction

What is a journey map.

Journey maps are visualization techniques that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis [ 1 , 2 ]. Thus, in a health care context, journey maps can illustrate complex service delivery bottlenecks and describe the user experience across the continuum of care. There are 5 journey mapping techniques ( Figure 1 ) that can each be used to illustrate a unique experience: (1) Mental (Cognitive) Model Map, (2) Experience Map, (3) Customer Journey Map, (4) Service Blueprint Map, and (5) Spatial Map [ 1 - 3 ]. Each mapping technique displays information distinctly and illustrates experiences in different contexts [ 1 , 2 ].

Five journey mapping techniques adapted from previous studies [ 1 - 3 ].

The benefit of these succinct visualizations lies in their ability to effectively illustrate intersections and relationships between organizations and consumers using products or services [ 4 ]. Therefore, journey maps can be used to help identify process pain points and highlight opportunities for improvement in various settings and contexts. Further, the visual findings of journey mapping activities can assist service providers and implementation scientists in effectively deploying resources to expand services or establish operational risks. As illustrated in Figure 1 , the 5 journey mapping techniques have similarities and interrelationships yet provide distinct visual analyses [ 2 ]. Therefore, the sequence in which the mapping activities should be conducted depends on the intended outcome of the mapping exercise [ 2 , 5 ]. For example, the Mental (Cognitive) Model Map technique provides a visual analysis of the cognitive processes an individual may experience in their interactions with an activity, organization, or service [ 1 - 3 ]. The Experience Map technique displays the overall human experience of an individual’s activities not specific to an organization, product, or service [ 1 - 3 ]. Contrastedly, the Customer Journey Map technique illustrates a consumer’s interactions using a specific service, organization, or product [ 1 - 3 ]. Following this, the Service Blueprint Map technique illustrates experiences from a systems view [ 1 - 3 ] and relationships between organizational processes, individuals, and service delivery [ 1 - 3 ]. Lastly, the Spatial Map technique provides a broad view of relationships between processes, service delivery, and individuals [ 1 - 3 ].

What is a Learning Health System?

A learning health system (LHS) is a concept that emerged from the Institute of Medicine’s Roundtable on Evidence-Based Medicine [ 6 ]. The vision of an LHS is to “generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care” [ 6 ]. Further, Rubin and Friedman describe the LHS “as the tapestry that emerges from weaving together efforts across: health information management, health IT, patient engagement, clinical care, research, and public health arenas aimed at utilizing data, information, and knowledge to improve health” [ 7 ]. Since its introduction in 2007, others have continued to adapt, redefine and expand on the concept and how it can be achieved. However, regardless of the varied definitions in the industry, the goals of an LHS are the same: “harness the power of data and analytics to learn from every patient, and feed the knowledge of ‘what works best’ back to clinicians, public health, and other stakeholders to create cycles of continuous improvement” [ 8 ].

The Continuous Knowledge Translation Loop of an LHS

An LHS can be conceptualized as a continuous learning microcosm that uses various data streams in the health care sector to improve service delivery and the human experience. As the health sector is multifaceted, there is a tremendous opportunity to more effectively use the often-fragmented data (ie, data stored in siloed and disparate health information systems) globally. An important aspect of an LHS lies in its potential to facilitate a continuous cycle of learning using health care data [ 8 ]. The strategic use of such data could allow external evidence from studies, reviews, and trials to inform practice and enrich the evidence base and, ultimately, the health system [ 9 ]. Further, the data, serving as a continuous feedback loop, could foster a mechanism in which evidence-based practices could be effectively used across the care continuum to catalyze systemic industry change. Specifically, the data gleaned from continuous data feeds could be aggregated and leveraged to improve service delivery in clinical practice and improve patient outcomes.

The Potential Value of Using Journey Map Data to Feed an LHS

As the health care sector operates on a 24/7 basis globally, an unquantifiable amount of data could be streamlined, examined, and used to improve efficiency in service delivery and holistically inform the health system. The fluid data cycle [ 8 ] outputs from each citizen (or patient), as they use various facets of the health system, could be captured and illustratively detailed via the 5 journey mapping techniques ( Figure 1 ). Thus, the experiences of citizens and health care providers interfacing with the health system could be assessed and evaluated from multiple vantages and perspectives to inform the greater health ecosystem. Therefore, the data gleaned from the 5 journey mapping techniques [ 1 - 3 ] could provide a robust source and live data feed for a broader LHS and data repository. Additionally, integrating lived human experiences (ie, patient, physician, and caregiver journey mapping activities) into the design of health information systems (HIS) and health information technology (HIT) holds tremendous potential value for the creation of safer and more usable systems [ 10 ].

This paper aims to conduct a scoping review assessing the current state of the literature to establish a relationship between journey mapping techniques and LHSs.

Research Questions

• Is there a relationship between journey mapping techniques and an LHS in the literature?
• Is there a way to integrate the data from journey mapping activities into an LHS?
• How can the data gleaned from journey mapping activities be used to inform an LHS?

A scoping review, guided by the Arksey and O’Malley framework [ 11 ], was carried out by querying the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost).The key terms used were as follows: (Learning Health System) OR (Delivery of Healthcare), (Journey Mapping) OR (Patient OR Care) AND (Journey), and (Informatics) OR (Patient Health Information). The article evaluation began with a first screening in which 2 researchers independently assessed all articles by title and abstract using Covidence (Veritas Health Innovation), and articles were included ( Figure 2 ) if they satisfied the following inclusion criteria:

Adaptation of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) data flow diagram detailing article selection during the screening process [ 12 ].

• English articles with abstracts published between the years 2010 and 2022.
• Articles that referenced journey maps or mapping activities and an LHS.
• Articles that described user experiences in health care (eg, patients, caregivers, and physicians) and the LHS.

Subsequently, the 2 researchers independently screened and read the full-text articles to establish inclusion ( Figure 2 ). Differences of opinion in article selection were resolved through discussion and team consensus. Lastly, the relevant data were extracted and tabulated for comparative analysis ( Table 1 ), and the final selection of articles was assessed thematically to establish trends and themes in the literature.

Data extraction table illustrating the themes represented by each paper in this scoping review.

a LHS: learning health system.

b ✓: denotes the themes represented in each paper.

The initial search yielded 694 studies. Of those, 179 duplicates were removed in Covidence. Following this, a first screening of the article sample was conducted, and 515 articles were assessed ( Figure 2 ). During the first screening phase, 412 articles were excluded, as they did not meet the inclusion criteria. Next, a full-text review of all 103 remaining articles was done. Of those, 95 were excluded, resulting in only 8 relevant articles that satisfied the inclusion criteria.

Thematic Analysis

After identifying relevant articles, each article was assessed thematically with data extracted and tabulated in Table 1 . The findings from these articles can be subsumed into 2 overarching themes: (1) the need to evolve service delivery models in health care, which was expressed in 5 articles; and (2) the potential value of using patient journey data in an LHS, which was described in 3 articles. These 2 thematic categories will be examined in the subsequent sections.

Theme 1: The Need to Evolve Service Delivery Models in Health Care

With 5 articles stressing the urgency to evolve service delivery models in health care settings, it was the most prominent theme of the literature sample. In the article “The Indiana university center for healthcare innovation and implementation science: bridging healthcare research and delivery to build a learning healthcare system” [ 13 ], Azar et al detail that an “estimated 75,000 deaths every year could be prevented if high-quality care was more efficiently and effectively implemented” [ 13 ]. The authors quote the United States National Institute of Health, in that this considerable problem is not due to a paucity of knowledge, but rather poor incorporation of health care discoveries into daily practice [ 13 ]. Azar et al [ 13 ] clarify that over the past 3 decades, medical knowledge has increased, with 11 systematic reviews and 74 clinical trials being published every day, yet only 14% of these new findings are actually implemented in health care settings and translated into practice [ 13 ]. Therefore, to mitigate the risks to human health, the authors propose a paradigm shift in how health systems and service delivery should be conceptualized. They present 2 contrasting perspectives: (1) a traditional model of service delivery and (2) an innovative and adaptive model of health care service delivery. In the traditional model, organizations are viewed as machines that perform predictable, repeated tasks with replaceable parts that operate in stable and nondynamic settings [ 13 ]. In the adaptive model, health care systems are viewed as complex, dynamic, adaptive, and evolving systems comprised of a network of semiautonomous individuals (ie, health care professionals) who interact in nonlinear ways [ 13 ]. As health care needs and interactions are interdependent, interconnect, and changing over time [ 13 ], the authors insinuate that it is vital to design health care services to support the fluidity of systemic evolution. Thus, their article expressed the criticality of designing and developing an adaptable agile learning system that integrates hospital systems, population health, individual patients, and health care personnel [ 13 ].

Fung et al [ 14 ] present a systems approach to redesigning care in their article “Regional process redesign of lung cancer care: a learning health system pilot project.” Their novel approach enables timely access to cancer treatment for patients with lung cancer to a centralized specialty service that addresses clinical and operational challenges [ 14 ]. However, the authors caution that, despite its potential value, there is limited evidence of successful implementation of the LHS vision [ 14 ]. Thus, to streamline and operationalize the LHS concept, they developed the Ottawa Health Transformation Model as a regional approach to guide service delivery change and to integrate the nuances of the patient journey with best practices [ 14 ]. Further, the article laments that all facets of care need to be examined to address the complexity of health systems and to improve patient experiences holistically rather than just isolated parts [ 14 ]. The article concludes with the caveat that the value of the LHS approach in relation to service delivery is the creation of a system that can facilitate best practice adoption and fluid innovation [ 14 ]. Similarly, in their concept analysis and systematic review, Gartner et al [ 15 ] detail that a performant health care system is crucial for every country and that the current siloed health care business practices must be evaluated and challenged [ 15 ]. The authors suggest that fragmented health care services can compromise patient care, inhibit sustainable service delivery, and result in suboptimal use of financial and human resources [ 15 ]. Further, the authors state that repeated calls to improve the overall performance and quality of global health care delivery have occurred since 2001 [ 15 ]. The calls for transformational change in health care have been made by well-established national and international organizations such as the Institute of Medicine [ 15 , 20 , 21 ]; The National Academies of Sciences, Engineering, and Medicine [ 15 , 22 ]; and The World Health Organization [ 15 , 23 , 24 ]. Gartner et al [ 15 ] suggest that understanding the patient journey through an LHS view can facilitate the improvement of health care service delivery through a feedback loop in which data can be used to identify problem areas to support continuous improvement [ 15 ]. Lastly, in a similar yet contrasting view, Sun et al [ 16 ] express in their paper “Health management via telemedicine: learning from the COVID-19 experience” that telemedicine provides numerous opportunities to improve care efficiency, accessibility, and patient outcomes [ 16 ]. However, they state that many challenges exist, such as the digital divide, usability, and technology interoperability [ 16 ]. Further, the authors detail that the delivery of telemedicine services must evolve to support continuity of care throughout the patient journey [ 16 ]; specifically, by including the seamless integration of data from the clinical workflow of multidisciplinary care teams to support the LHS [ 16 ]. Nonetheless, they clarified that the implementation of a telemedicine business model must be supported by rigorous evidence-based practices, including clinical trials [ 16 ]. They warned that such precautionary measures are necessary to facilitate the seamless integration of telemedicine into routine care, ensuring the quality and safety of virtual care delivery [ 16 ]. Lastly, Yu et al [ 17 ] recount that data are only important and useful when they can be transformed into knowledge. In a health care context, the importance of data is realized when data sets of individual patients can be aggregated with similar patient data to inform patient populations [ 17 ]. Further, the value of clinical data lies in its interpretation in a clinical context among continuing care providers and when it is shared with the patient or their caregivers [ 17 ]. Additionally, the data set of a citizen (ie, patient) becomes of greater importance when it is combined with that of other citizens and when it can be aggregated for comparative statistical analysis to inform the health system on the health status of a population or subset [ 17 ].

Theme 2: The Potential Value of Using Patient Journey Data in an LHS

The potential value of using patient journey data in an LHS was expressed in 3 articles. In the article “Patient journey mapping: current practices, challenges and future opportunities in healthcare,” Joseph et al [ 1 ] describe how the data gleaned from patient journey maps could improve the health system by identifying varying patient experiences. Additionally, Joseph et al [ 1 ] detail that journey mapping approaches hold a significant value in improving complex health care processes for patients and providers alike. Further, the authors express that closely integrating patient journey mapping techniques into the health care system could create an LHS [ 1 ]. In their study “Learning health system for breast cancer: pilot project experience,” Levine et al [ 18 ] report that clinicians need accurate and timely information on patient outcomes associated with various treatment modalities. Moreover, the authors describe that electronic health records are perceived to be helpful technologies, but access to patient data is often difficult [ 18 ]. However, despite the data accessibility challenges expressed in their study, the researchers were able to combine, read, and extract electronic health records data to view the patient journey [ 18 ]. Specifically, Levine et al [ 18 ] developed a prototype leveraging IBM Watson technology, with capabilities to validate artificial intelligence using natural language processing and to denote the clinical course of patients (ie, patient journey) in support of an LHS platform [ 18 ]. Their study findings illustrated a means by which the vision of an LHS could potentially be achieved by using artificial intelligence [ 18 ]. Despite the preliminary nature of their study, the authors were able to demonstrate that the hospital had the necessary data to formulate a view of the patient journey, which could be extracted and used in ways to support clinical decision-making [ 18 ]. Lastly, in their observational study, Sharma et al [ 19 ] used an incremental and iterative approach, engaging administrative and clinical domain experts to demonstrate that human actors, rather than IT, are the central focus of data movement [ 19 ]. The authors evaluated a kidney transplant referral pathway and established the relationship between human actors, organizations, the complexity of data administration, and data flow bottlenecks [ 19 ]. Their study illustrated the manual and often cumbersome tasks that clinical staff must perform to access and visualize health data from fragmented IT systems [ 19 ]. The authors express broadly that IT systems that are not interoperable can lead to data access challenges and complicate the clinical workflow and health care providers’ ability to effectively and efficiently perform their job functions [ 19 ]. They further reveal that in a kidney transplant referral context the lack of centralized and timely access to patient data can delay patients’ registration on the transplant list, as the time and effort to complete referral forms are greatly increased [ 19 ]. Sharma et al [ 19 ] propose that an LHS with linked patient data can improve population health outcomes and inform interventions by providing timely and intuitive access to health information.

Summary of Findings

Despite the comprehensive search, the research questions were only partly satisfied. The first research question, “Is there a relationship between journey mapping techniques and an LHS in the literature?” was demonstrated in both thematic categories. There is a relationship and a need for an innovative approach to health care design and service delivery. As shown in Table 1 , five articles exemplify the need to evolve service delivery models in various scenarios in health care. Three articles provide insight into the potential value of using patient journey data to inform an LHS. The second research question, “Is there a way to integrate the data from journey mapping activities into an LHS?” was not comprehensively addressed, and an actionable, scalable plan was not provided in the literature. The third question, “How can the data gleaned from journey mapping activities be used to inform an LHS?” was satisfied by the scoping review findings ( Table 1 ). Many articles provided examples of operational gaps and scenarios in which patient care could be compromised due to a lack of timely, interoperable, and accessible data.

Principal Findings

This study has presented a scoping review using articles from the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost). As evidenced by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram ( Figure 2 ), of 694 initially screened articles, only 8 satisfied the inclusion criteria. Within the articles that met the inclusion criteria, we identified 2 important themes: (1) five articles stressed the need to evolve service delivery models in health care, and (2) three articles described the potential value of using patient journey data in an LHS. Despite the robust search strategy and databases used, there was a dearth of literature discussing a relationship between journey mapping and LHSs. Therefore, the first research question, “Is there a relationship between the journey mapping techniques and an LHS in the literature?” was only partially satisfied. Despite the included articles [ 1 , 13 - 19 ] providing various scenarios and applications of the relationship potential and how journey mapping could support value-based and patient-centric care strategies for LHSs [ 25 ], more research is required in this arena. Further, given the current state of the literature, we could not address the second research question, “Is there a way to integrate the data from journey mapping activities into an LHS?” Although the urgency of timely access to centralized, high-quality, interoperable data was prominent in the literature, a comprehensive road map or framework was not provided to integrate the data specifically from journey mapping activities into an LHS. Lastly, the third question, “How can the data gleaned from journey map activities be used to inform an LHS?” was satisfied by the scoping review findings ( Table 1 ). Many articles provided examples of operational gaps and scenarios in which patient care could be negatively impacted by workflow bottlenecks or disruptive technologies. However, specifically how patient journey map data could be used to inform the continuous learning feedback loop of an LHS, which could inform evidence-based practices, was not provided. Further, the article sample did not provide detail on how the 5 journey mapping techniques ( Figure 1 ) could independently or collectively provide rich and diverse continuous data supply (ie, a continuous knowledge translation loop) for an LHS.

To address the shortcomings in the literature, the authors will continue this line of investigation to establish a relationship between the concept of an LHS and the 5 journey mapping techniques: (1) Mental (Cognitive) Model Map, (2) Experience Map, (3) Customer Journey Map, (4) Service Blueprint Map, and (5) Spatial Map [ 1 - 3 ]. Specifically, this scoping review will be phase 1 of an investigative series. Phase 2 will entail the creation of a holistic framework to guide and streamline data integration from journey mapping activities outputs into an LHS. Lastly, phase 3 will provide a proof of concept to demonstrate how journey mapping activities could be integrated into an LHS.

Limitations

As this is a preliminary study, the scoping review was limited to only digital articles in English; therefore, other relevant articles could have been omitted based on the study design. Future studies could include paper-based searches and searches in other languages. Moreover, journey maps are not widely or consistently used in the health care sector [ 1 , 2 ], which may have contributed to the study’s small sample of only 8 relevant articles. Similarly, although poised to improve health care sustainably through smart and efficient data use, LHS is a relatively novel and emerging concept in the health care landscape [ 6 ].

This paper expressed the criticality and urgent need of global health care transformation to support the sustainable delivery of health care services. Additionally, it was revealed that current health systems are not adequately using the health data in which they aggregate institutionally. Consequently, fragmented and siloed data are stored in disparate HIS and HITs on a global scale. Thus, there is a dire need to design and develop an agile and interoperable LHS that can integrate global data from health care organizations, populations (ie, citizens, patients, caregivers, physicians, and health care stakeholders), HIS, and HIT. Journey mapping activities provide an opportunity and a conduit to streamline data into uniform and usable formats. Thus, the knowledge gap related to integrating the data from journey mapping activities into an LHS highlighted the importance of using the data from patient experiences to enrich an LHS and provide holistic care. Moreover, the journey mapping visualizations of the 5 mapping techniques ( Figure 1 ) could identify operational issues such as staffing shortages, clinical workflow bottlenecks, and other factors that could negatively impact patient care [ 1 , 2 ]. The visualizations could also illustrate scenarios where health care service design and delivery could be stifled or affected from a clinical lens by physician burnout and cognitive impairment from alert fatigue [ 26 ]. Integrating the data from the 5 journey map techniques [ 1 - 3 ] into an LHS promises to improve health care service delivery and patient outcomes by providing a continuous supply of data to support patient-centric health care solutions that meet the goals of patients and providers.

Acknowledgments

ALJ received funding from the Natural Science and Engineering Research Council of Canada Visual and Automated Disease Analytics Program.

Abbreviations

Authors' Contributions: ALJ conceptualized the study design, conducted the literature search and data analysis, and created the first draft. HM assisted with the literature search and data analysis. AK and YQ contributed to the refinement of the paper. ALJ led the writing, with all the other co-authors commenting on subsequent drafts. All authors approved the publication of the final version.

Conflicts of Interest: AK is editor in chief of JMIR Human Factors. YQ is an editorial board member of JMIR Human Factors. The other authors declare no conflicts of interest.

The Patient Journey

• Open Access
• First Online: 15 December 2020

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• Elena Beleffi 5 ,
• Paola Mosconi 6 &
• Susan Sheridan 7  

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The wide implementation of patient safety improvement efforts continues to face many barriers including insufficient involvement of all stakeholders in healthcare, lack of individual and organizational learning when medical errors occur and scarce investments in patient safety. The promotion of systems-based approaches offers methods and tools to improve the safety of care. A multidisciplinary perspective must include the involvement of patients and citizens as fundamental contributors to the design, implementation, and delivery of health services.

The patient journey is a challenging example of using a systems approach. The inclusion of the patient’s viewpoint and experience about their health journey throughout the time of care and across all the care settings represents a key factor in improving patient safety. Patient engagement ensures that the design of healthcare services are aligned with the values, the preferences, and needs of the patient community and integrates the real-life experience and the skills of the people to enhance patient safety in the patient journey.

The utmost priority to implement patient engagement is the training of patients. Therefore, training for both patients/families/advocates and health professionals is the foundation on which to build active engagement of patients and consequently an effective and efficient patient journey.

The chapter offers examples of successful training courses designed to foster strategic alliances among healthcare professionals and researchers with patients and their organizations. Training of patients constitutes the first step to develop shared knowledge, co-produced projects, and the achievement of active multilevel participation of patients for the implementation of patient safety in the patient journey.

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• Patient journey
• Patient engagement
• Patient empowerment
• Patient safety
• Healthcare ergonomics
• Co-production
• Knowledge creation

1 Introduction

Almost 20 years after publication “To Err is Human: Building a Better Health System” (Kohn et al. 1999), patient safety is still not widely implemented. This report from the Institute of Medicine is the milestone that constituted a turning point for improving quality of care and patient safety identifying the need to rethink healthcare delivery to provide safe, effective, and efficient care.

The barriers of implementing patient safety as a driving force for change towards more effective healthcare include multiple factors: insufficient involvement of all stakeholders contributing to the care process, lack of willingness of organizations and individuals to learn from errors and scarce investments in patient safety improvement and research.

There is a growing need to promote systems approaches to finding solutions in healthcare to improve the safety of care, the quality of healthcare delivery, patients’ health and citizens’ well-being.

The discussion paper “Bringing a Systems Approach to Health” defines the systems approach as one “that applies scientific insights to understand the elements that influence health outcomes; models the relationships between those elements; and alters design, processes, or policies based on the resultant knowledge in order to produce better health at lower cost” [ 1 ].

A multidisciplinary approach must include the involvement of citizens and patients as fundamental contributors to the design, implementation, delivery, and evaluation of health services.

This means that citizen participation plays an essential role, bringing the unique point of view of patients and family members into the debate on patient safety and quality of care.

Patients and more generally citizens, when actively and systematically engaged, bring ideas and experiences which can support a collaborative and reciprocal learning process among the healthcare stakeholders. This produces knowledge that leads to improved practices, a real knowledge creation process where the dynamic participation of all actors in healthcare systems contribute to an active learning environment where the identification, the investigation, and the planning of solutions related to health incidents is a cyclic process enabling healthcare knowledge creation.

The added value of involving patients in healthcare is, respect to other more complex interventions, a low cost opportunity to take into consideration unconventional points of view creating and building knowledge and providing original insights and ideas that otherwise would not be considered.

Health professionals and patients’ skills and knowledge are acquired through individual experience or education and transferred to the health organizations in a perspective of co-production of healthcare. It is a merging of the efforts of those who produce and those who use the solutions to address health problems. It serves to establish a strengthened and long-term relationship in terms of trust and effectiveness and to distribute the responsibilities among all stakeholders [ 2 ].

In light of these arguments, the systems approach—inspired by the fundamentals of ergonomics and human factors (HFE)—creates new alliances between healthcare and engineering, of which patient journey is a challenging example [ 3 ].

Applying the systems approach to patient safety allows the analysis of the factors that characterize the encounters and the interactions between healthcare professionals and patients during the entire course of care. The observation of possible critical issues to the individual and specific encounter between clinician and patient is crucial in widening the scope of observation and research of the entire “journey” of the patient, taking into consideration the complexity of patient, their values and needs, their preferences, the economic and social context in which they live, and language and communication issues.

These observations and research should be carried out considering the interconnections and interactions together with the components of the processes; importance should be given to the context, and to manage the complexity, the value of a holistic approach.

2 The Patient Journey

A modern health system looks to the future in the context of the challenges imposed by the real world. It must manage the gap between guidelines and health protocols and what effectively happens and how reality is perceived by patients and family members.

It is more and more necessary to bring the patient’s point of view in the analysis of the care process, in the incident reporting and analysis, in the design and implementation of solutions and guidelines in healthcare.

Vincent and Amalberti in “Safer Healthcare” (2016) [ 4 ] stated that the incident analysis should broaden the class of events having consequences on patient safety. Incidents reported from the patient’s point of view should be included in addition to those suggested by health professionals. Additionally, when analyzing an incident, it should be done in the context of the patient journey rather than a single episode.

Instead of focusing on the individual encounter, it is necessary to extend the observation timeframe by applying the examination of contributing factors to each of the encounters that compose the patient journey (temporal series of encounters with healthcare facilities, a hospital unit, a specialist visit, a primary care clinic, a home health agency), considering both the negative and positive events and the points for improvement that were revealed (Fig. 10.1 ).

Analysis of safety along the patient journey

The adoption of this wider approach is unique in that it incorporates the patient’s perspective of safety and includes new features in the incident analysis such as asking patients to recount the episode of care, including patient and family in the investigation team when possible, asking patients the contributory factors from their point of observation and perception and involving patients and families in the reflections and comments on the disclosure process [ 4 ].

The episodes patients and families can highlight are often different from those that professionals are more accustomed to reporting. However, patients could be involved in further ways in incident reporting and assessment, and today patient-derived information constitutes a free and little used resource.

As per McCarthy’s definition, “patient journey mapping describes the patient experience, including tasks within encounters, the emotional journey, the physical journey, and the various touch points” [ 5 ]. Carayon and Woldridge define “patient journey as the spatio-temporal distribution of patients’ interactions with multiple care settings over time” [ 3 ], where at each point of touch with each healthcare service along the patient journey, the patient interacts with several system elements (task interaction, physical environment, interaction with tools and technologies, organization interaction, interaction with other organizations and other people, interaction with other people and teams within the organization) (Fig. 10.2 ).

The patient journey as a set of interactions and transitions

The patient journey represents the time sequence of what happens to the patient, especially during transitions of care, in particular considering that the health professional who takes care of the patient only sees the portion of care for which he is responsible and in which he has an active role. Conversely, the patient is the only person who has a continuously active and first-hand role during their health journey. They alone are in possession of information that characterizes the entire care experience.

Moreover, when patients navigate their journey, they contact and interface with multiple work systems at several time points, where the sequence of interactions in the work systems determine the outcome experienced by patients and families, healthcare professionals, and health organizations. (Fig. 10.3 ). Each local work system is influenced by a wider socio-organizational context, which can be formal healthcare organization (such as hospital, primary care facility, nursing home) or informal (home).

SEIPS 3.0 model: sociotechnical systems approach to patient journey and patient safety

Every point of the patient journey offers data on health outcomes and patient experience outcomes that should be used as feedback to redesign healthcare work systems in terms of adaptation, learning, improvement.

Patient’s experience represents an important resource in participatory collaborative design, especially in the patient journey where this experience is the result of multiple interactions across space and time.

3 Contextualizing Patient Safety in the Patient Journey

Many of the incidents or near-misses during healthcare are not due to serious errors, but to the combination of small failures, such as limited experience of a recently qualified doctor, use of obsolete equipment, an infection difficult to diagnose or inadequate communication within a team.

We know that the analysis of an incident requires looking back to the succession of events that have occurred and that led to the problematic episode, considering both active and latent errors, and all the aspects connected directly or indirectly. It is fundamental to examine the safety of the entire patient journey, all the encounters that make up the entire care process, to study the whole medical history of the patient in an attempt to reconstruct all the elements that characterize the “health journey”, not only from the viewpoint of the health professionals, but also from that of the patient and family.

In light of these arguments, new concepts, tools, models, and methods need to be embraced to support patient safety in the patient journey.

A significant contribution in terms of concepts, frameworks, and models is offered by Industrial and Systems Engineering, and often human factors and systems engineering (HF/SE) have an approach to include the preferences and the needs of stakeholders when designing solutions to address the critical aspects of a health process.

Human factors and ergonomics are described as “the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. Practitioners of ergonomics and ergonomists contribute to the design and evaluation of tasks, jobs, products, environments and systems in order to make them compatible with the needs, abilities and limitations of people. Ergonomics helps harmonize things that interact with people in terms of people’s needs, abilities and limitations” [ 6 ].

Process models have found widespread use in drug management, visit planning, care transition, to name a few, and can offer tools and methods to investigate interprofessional and physician–patient communication, interruptions and health information handover.

Drawing from the finding of Carayon’s studies [ 3 ], the Systems Engineering Initiative for Patient Safety (SEIPS) model gives a description of five work system elements which when applied to a definite patient journey model should outline who (person) is doing what (tasks) with tool and technologies, taking into consideration the physical and organizational environment where all these activities take place. All these factors have to be examined for both patients and workers and the process analysis and modelling have to consider what patients and families/caregivers, healthcare professionals and workers actually do ( work-as-done versus work-as-imaginated ).

Patients, families, and caregivers are deeply involved in the healthcare process due to the tasks they carry out in the intermediate sectors of care between encounters. Away from direct interactions with professionals, they have to perform multiple actions requiring understanding of what behaviour to adopt, which instructions to follow, how to administer a medication and how to communicate with hospital doctors, general practitioner, and home healthcare professionals [ 3 ].

Taking into account what has been highlighted so far, one of the leading and most challenging keys to success in improving patient safety is to adopt a systems approach to patient safety which includes the patient’s perspective about their health journey throughout the time of care and across all the care settings.

This assumption highlights that patients and their families are valuable resources and can play an important role in patient safety improvement efforts. Viewing health systems as “co-producing systems”, patients can engage as partners in co-producing patient safety improvement activities individually, in groups and collectively. Individual patient and family member participation/co-production of safer care is fundamental. Equally as important is the co-management and co-governance of healthcare services, in addition to the engagement of communities in policy definition and designing activities.

In fact, patient engagement directs the design of healthcare systems towards the preferences, the values, the real-life experiences, and—not less important—the skills of the people to enhance patient safety in the patient journey.

Such a change of perspective involves multiple dimensions of interactions and relationship between patients and professionals, encompassing cooperation, dialogue and listening, trust, reciprocity and peer-to-peer work [ 2 ].

It follows that on the one hand the healthcare organizations have to demonstrate the willingness to support health professionals to effectively engage patients in the patient journey to achieve the common goal of reducing the risk of patient harm or incidents as well as the willingness to integrate patients and family members as partners into quality and safety improvement efforts. On the other hand, it is necessary to motivate and encourage patients and families/caregivers to actively participate during the individual care process for safer care as well as partner in organizational patient safety improvement efforts to ensure safer care for others.

The working group Patient and Family Involvement for the delivery of Safe and Quality Care [ 7 ] stated that the utmost priority to realize the patient involvement is the training of patients, followed by the promotion of interdisciplinary training programmes for healthcare professionals to promote patient and family engagement, the implementation of multilevel structures that allow for participatory processes by patients and smarter allocation of resources in healthcare that supports involving citizens in patient safety improvement efforts for better healthcare.

This working group was part of the activities of the “1st International Meeting about Patient safety for new generations—Florence, 31st August and 1st September 2018” organized by the Centre for Clinical Risk Management and Patient Safety, Tuscany Region—WHO Collaborating Centre for in Human Factors and Communication for the Delivery of Safe and Quality care [ 7 ].

Therefore, training for both patients/families/advocates and health professionals is a pillar on which to build active engagement of patients and consequently an effective and efficient patient journey. From this perspective, the participation of patients (i.e. representatives of patients’ associations and organizations, patient and citizen advocates) in training courses—specifically designed for this target audience of trainees and aimed to encourage co-production of care—is an essential and effective activity to co-produce a better healthcare system in terms of quality and safety of care.

Sharing a common language, promoting citizens’ and patients’ awareness of importance of co-production of care, teaching the key role that patients can play in making treatments safer (investments in health literacy), learning to work together and within a network (locally, regionally, and nationally/internationally) on priority safety and quality of care issues: these are some of the main strengths of training courses aimed to be at the basis of active engagement of patients and citizens.

Examples of successful training courses include “PartecipaSalute” and “Accademia del Cittadino” organized in Italy by Laboratory for Medical Research and Consumers Involvement of the Istituto di Ricerche Farmacologiche Mario Negri IRCCS and the Centre for Clinical Risk Management and Patient Safety, Tuscany Region. The following paragraph describes this educational experience which is specifically designed for citizens and patients to improve their knowledge and skills in patient safety and quality of care, with the aim of co-producing better healthcare services.

4 From PartecipaSalute to the Accademia del Cittadino: The Importance of Training Courses to Empower Patients

Over the last few years in the field of health and research and with regard to participation and involvement of citizens and patients, we have witnessed the transition from a paternalist to a partnership model. Individual citizens and those citizens involved in patients’ associations or groups have acquired a new role: no longer passive but actively involved in decision-making regarding health, healthcare, and research in the health field [ 8 , 9 ].

This is a progressive step-by-step process based on the recognition and implementation of the key concepts such as health literacy and empowerment. Health literacy, more properly used at individual level is defined as the capacity to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment [ 10 ]. Empowerment, more used at the community level, is a process that, starting from the acquisition of accurate knowledge and skills, enables groups to express their needs and more actively participate to request better assistance, care, and research. At this level, the availability of organized independent and evidence-based training courses is essential to allow people to be able to critically appraise and use information about the effects of healthcare interventions. Consequently, they will have the skills to participate in the multidisciplinary working groups (composed of researchers, health professionals, patient and citizen advocates, institutional representatives).

In the late 1990s, the Istituto di Ricerche Farmacologiche Mario Negri IRCCS held the first training courses of this kind focused at breast cancer associations. Some years later, within the project PartecipaSalute—a not-for-profit research project designed to foster a strategic alliance among healthcare professionals, patients, and their organizations—an ad hoc training programme for representatives of citizens’ and patients’ organizations was defined with a multimodule format [ 11 , 12 ]. This was an innovative approach, at least in the Italian setting in that period.

PartecipaSalute training programme has combined different experiences: the Mario Negri Institute IRCCS experience in collaborative research activities with patients’ associations, the Italian Cochrane Centre with the activities aimed at promoting the principles of evidence-based medicine, and Zadig long-term experience in health communication. The above promoters jointly developed the PartecipaSalute training programme on the belief that data are more important than opinions, and that every decision should be supported by well-conducted research data.

The spread of this belief to patients and citizens with the purpose of stronger involvement was a key point of PartecipaSalute training courses.

Therefore, patient, family, and community knowledge of the principles of how evidence is developed through clinical research is essential to make or support decisions in the health debate, to promote better clinical research, or to convey correct information. The strength of the PartecipaSalute programme was based on the exchange of experiences in an interactive way aimed at creating opportunities for discussion, overcoming the teacher–learner model. Each session started with an interactive discussion of a real situation—such as a screening, vaccination, therapy—and after sharing data, opinions or articles from media, evidence was presented and discussed, underlining significant methodological aspects. The programme offered the opportunity to debate the value and significance of the methodology offering critical appraisal tools. Each participant was invited to take an active part, starting from direct personal or associative experience. Table 10.1 presents the topics considered in the first three editions of the training programme. The participation was free, and different types of materials were provided including an ad hoc manual published by PartecipaSalute, copies of the PowerPoint presentation and articles.

Considering the characteristics of the programme and its modular structure, the PartecipaSalute training programme could be adapted to specific contexts. In fact, the experience of PartecipaSalute was adopted at the regional level by Regione Toscana (Centre for Clinical Risk Management and Patient Safety and the Quality of healthcare and Clinical pathways of Health Department, Tuscany Region) developing a more specific training programme called PartecipaSalute-Accademia del Cittadino (Academy of Citizen), focused on patient safety and risk management. In particular, after some modules on methods related to evidence-based medicine, uncertainties in medicine and information and communication in health, the training was mainly dedicated to regional and local activities on clinical risk management, the role of patients’ associations to improve patient safety and to support the implementation of best practices, the analysis and data of adverse events and risk assessment in terms of quality and safety in the care processes (Table 10.2 ).

The PartecipaSalute-Accademia del Cittadino joint training programme has been implemented in three editions over the last decade and has trained about 100 members of patient and citizen advocates representing 38 patients’ associations. The courses ranged from 5 to 3 modules of 2 days each in residential mode to allow participants to get to know each other and create a network of associations committed to be engaged in clinical research, quality, and healthcare safety issues.

The entire educational experience was characterized by the use of participatory training methods, based on working groups, practical exercises, lectures from experts with opportunities for discussions. As a result of this training course model, the participants were recognized as “expert patients” and were regularly involved in basic activities for promoting patient safety as auditors on significant events and helping to define policies on patient safety at the Tuscany regional level. In addition, they have participated in patient safety walkarounds in hospitals and in developing eight cartoons intended to promote the education of citizens for the prevention of the most diffused risks (such as prevention of infections, prevention of falls and handovers).

Feedback on the satisfaction on tutors, topics discussed and knowledge gained was regularly requested from participants through questionnaires distributed before and after the programme. In general, positive feedback was received; participants appreciated the interactive methods of work, the clarity of the language, and the effort to make difficult problems easy to understand. An ad hoc questionnaire was provided to the participants regarding the methodology of clinical research, always showing an improvement in the self-evaluated knowledge before and after the course. Feedback of the results of the evaluation was also shared with each participant. Most of participants reported their experience to other members of the organization. In particular, in the case of the Regione Toscana training, the possibility of immediately transferring what was learned in the course in all the activities in collaboration with the health institutions, policy makers, and health professionals—such as working groups on patient safety best practices, participation to audits, development of tools to improve health literacy—was appreciated.

Some limitations emerged from these experiences. The selection of participants is the first issue, not only because the training course is accessible to a small number of participants (in general no more than 30 participants), but also because the groups comprised of middle-aged and retired participants, with few younger ones. Additionally, there were few individual patient or family member representatives from patient associations. The majority of those representing patient associations were in managerial or leadership positions. Furthermore, it is difficult to choose between small, local, or bigger regional associations. Residential training courses also restricted the participation for geographical reasons.

The PartecipaSalute and ParteciaSalute-Accademia del Cittadino training experiences show that patients and citizens are willing to get actively involved in healthcare and the research debate. There is a real desire to improve their knowledge and skills on health and research issues and allow some general considerations regarding the active engagement of citizens representing associations and advocacy groups.

In conclusion, it is very important to invest in a process of empowerment aimed to have well-trained activists involved vigorously and constructively in the debate, design, and assessment of health and research. Switching from tokenism to active participation is necessary to effectively partner with patients and the general population to design, plan, and co-produce safer more effective healthcare, while also supporting better more patient-centred research [ 13 , 14 ].

Also, the training courses are feasible and useful, as has recently been discovered also by pharma or other groups that organize courses mainly focused on drugs and drug development, thus directing the participation of the groups more to market needs than to public health.

Furthermore, this training initiative facilitates the networking among associations in part overcoming the difficulties that derive from personalization and division among the associations representing citizens and patients.

Finally, this illustrates the importance of the design and promotion of training courses with institutions, such as the Regione Toscana, in order to be able to implement projects of real collaboration between institutions, healthcare professionals, and consumers’ and patients’ representatives.

5 Recommendations

A systemic approach to health can provide valuable models for wider implementation of patient safety. A multidisciplinary approach includes the involvement of citizens and patients as unique stakeholders in the design, implementation, delivery, and assessment of health services.

Involving patients in healthcare is an opportunity to bring uncommon points of view into policy making and to create shared knowledge between healthcare professionals and patients.

The implementation of patients’ and families’/caregivers’ perspectives in the patient journey is the golden opportunity to leverage crucial input, such as experiential knowledge, safer care, patient motivation, and trust and social cohesion into the co-production of safety solutions in healthcare. This represents a way to get closer to person-centred care, to create opportunities for patients to meet and share information and knowledge, to develop structures and policies for patient involvement at different levels (with healthcare systems, universities, and policy makers).

However, little has been done to overcome some healthcare systems barriers: the power imbalance between the doctor and patient, language differences, the lack of diffusion of non-technical skills and, last but not least, the lack of evidence about the value of patient involvement.

To be widely implemented, patient engagement in the patient journey requires courageous leadership, organizational efforts, a wider culture of safety of care, the implementation of multilevel structures for the engagement of patients and resources from smarter spending in healthcare.

Education is the landmark to integrate meaningful patient and citizen engagement in healthcare. Training of patients is the fundamental starting point to develop shared knowledge, co-produce projects, and implement an active multilevel participation of patients and families for the improvement of quality and safety of care.

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Beleffi, E., Mosconi, P., Sheridan, S. (2021). The Patient Journey. In: Donaldson, L., Ricciardi, W., Sheridan, S., Tartaglia, R. (eds) Textbook of Patient Safety and Clinical Risk Management . Springer, Cham. https://doi.org/10.1007/978-3-030-59403-9_10

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Meaning of journey in English

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journey noun [C] ( TRIP )

• She gave the children some candy to chew on during the long car journey.
• The journey was quite quick because the road was clear .
• I expect you'd like to rest after your long journey.
• We did the journey to Wales in five hours .
• The train journey took us through a valley past rolling hills .
• break-journey
• circumnavigation

journey noun [C] ( EXPERIENCES )

• advance the cause
• advancement
• formatively
• from A to B idiom
• progressive
• progressively
• punctuated equilibrium

journey noun [C] ( BOOK )

• absorptive capacity
• acquisition
• hit the books idiom
• mug (something) up
• non-academic
• recognition
• subspecialty
• swot up (something)
• uncredentialed
• around Robin Hood's barn idiom
• baggage drop
• communication
• first class
• peripatetically
• public transportation
• super-commuting

journey | Intermediate English

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Definition of journey

 (Entry 1 of 2)

Definition of journey  (Entry 2 of 2)

intransitive verb

transitive verb

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The Latin adjective diurnus means “pertaining to a day, daily”; English diurnal stems ultimately from this word. When Latin developed into French, diurnus became a noun, jour, meaning simply “day” The medieval French derivative journee meant either “day” or “something done during the day,” such as work or travel. Middle English borrowed journee as journey in both senses, but only the sense “a day’s travel” survived into modern usage. In modern English, journey now refers to a trip without regard to the amount of time it takes. The verb journey developed from the noun and is first attested in the 14th century.

• peregrination
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Examples of journey in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'journey.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

Noun and Verb

Middle English, from Anglo-French jurnee day, day's journey, from jur day, from Late Latin diurnum , from Latin, neuter of diurnus — see journal entry 1

13th century, in the meaning defined at sense 2

14th century, in the meaning defined at intransitive sense

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“Journey.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/journey. Accessed 25 Apr. 2024.

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Kids definition of journey.

Kids Definition of journey  (Entry 2 of 2)

Middle English journey "a trip, travel," from early French journee "day's work, day's journey," from jour "day," derived from Latin diurnus "of a day, daily," from dies "day" — related to diary , journal

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