patient journey what is

Patient journey 101: Definition, benefits, and strategies

Last updated

22 August 2023

Reviewed by

Melissa Udekwu, BSN., RN., LNC

Today’s patients are highly informed and empowered. They know they have choices in their healthcare, which can put healthcare providers under a lot of pressure to provide solutions and meet their patients’ expectations.

Just like any customer, patients embark on a journey that begins before they ever contact the provider. This makes understanding the journey and where improvements can be made extremely important. Mapping the patient journey can help practitioners provide better care, retain a solid customer base, and ultimately identify ways to improve patient health.

• What is the patient journey?

The patient journey is best described as the sequence of experiences a patient has from admission to discharge. This includes all the touchpoints between the patient and provider from beginning to end.

The patient journey continues through consultation, where they meet the potential caregiver. That portion of the journey includes interactions with a doctor and support staff, how long they wait to be seen, and the steps taken for diagnosis and treatment.

The patient’s post-care journey includes follow-ups from the healthcare provider, post-treatment care, and billing. For example, if the patient has questions about post-surgery care or how to read their invoice, how quickly their questions are answered and their problems resolved will impact their satisfaction.

Mapping the patient journey helps healthcare providers improve patient satisfaction at every step of the way. By collecting data at each stage and conducting an in-depth analysis, providers can identify patient concerns and make the necessary improvements to meet their patient satisfaction goals.

What is another name for the patient journey?

The term “patient funnel” describes the journey patients take from first learning about a healthcare provider or healthcare product to actually making an appointment or purchase. This “funnel” can be applied to any type of business, describing the stages a customer goes through to obtain a service.

• Understanding the stages of the patient journey

Each stage of the patient journey is essential to a positive patient experience . Gathering and analyzing data can alert healthcare providers to potential issues throughout the journey.

Data collection at each of the following stages will give healthcare providers the information they need to make the necessary improvements:

1. Awareness

Awareness is where the patient journey begins. This is when they first research symptoms and identify the need to see a medical professional.

They may consider at-home remedies and get advice from friends, social media, or websites. Once they identify the need for a healthcare provider, they continue their research via review sites, advertising campaigns, and seeking referrals from friends and family.

Determining the way patients become aware they need healthcare and the sources they use for research is important. The data collected at this stage could suggest your organization has an insufficient social media presence, inadequate advertising, or a website in need of an update.

To remedy these shortcomings, you might consider adding informational blogs to your website, performing a social media analysis, or closely monitoring customer reviews.

This stage in the patient journey is where the patient schedules services with the healthcare provider.

This engagement is essential for acquiring new patients and retaining current patients. Patients will contact you in several ways to schedule an appointment or get information. Most will call on the first attempt to schedule an appointment.

This is a crucial touchpoint in the journey. A new patient may become frustrated and move on if they find it difficult to access your services or are placed on hold for a long period or transferred numerous times.

Patient engagement occurs in other ways, such as your online patient portal, text messages, and emails. Your patients may interact differently, so it’s important to gather data that represents their preferred means of communication. Work to make the improvements required to correct access issues and ensure efficient communication.

The care stage can include everything from your patient’s interaction with the front desk to how long they have to wait in the examination room to see a doctor.

Check-in, check-out, admissions, discharge, billing, and of course, the actual visit with the healthcare provider are other touchpoints in the care stage.

There are a couple of ways to gather and analyze this data. Most organizations choose to analyze it holistically, even if it’s collected separately. For example, you might gather data about the patient’s interaction with the front desk, the clinical visit, and the discharge process, but you may want to analyze the care segment as a whole.

4. Treatment

Treatment may be administered in the office. For example, a patient diagnosed with hypertension may have medication prescribed. That medication is the treatment. Gathering information at this stage is critical to see how your patient views the healthcare provider’s follow-up or responses to inquiries.

In most cases, treatment extends beyond the initial clinical visit. For example, a patient might require additional tests to get a diagnosis. Providing the next steps to a patient in a timely manner and letting them know the test results is crucial to patient satisfaction .

5. Long term

A satisfied patient results in a long-term relationship and referrals to friends and family. Most of the data collected at this stage will be positive since the patient is continuing to use your services.

Gathering data after the treatment stage allows you to expand on the qualities that keep patients returning for your services in the long term.

• Benefits of patient journey mapping

The patient benefits from their healthcare provider understanding their journey and taking steps to improve it. Healthcare providers also reap several benefits, including the following:

1. Efficient patient care

When they understand the patient journey, healthcare providers can provide care more efficiently and spend less time and money on unnecessary, unwanted communications.

2. Proactive patient care

Proactive patient care is aimed at preventing rather than treating disease. For example, women who are over a certain age should have an annual mammogram, smokers may be tested for lung disease, and elderly women may need a bone density study. These preventative measures can help keep disease at bay, improve health outcomes, and build trust with patients.

3. Value-based patient care

Patients don’t want to feel they are being charged unfairly for their healthcare. Focusing on the individual patient promotes satisfaction and yields positive outcomes.

The Center for Medicare and Medicaid Services (CMS) has issued recent guidelines for participants that help offset the costs of high-quality care through a reward system.

4. Retention and referrals

Patients who are happy with their journey will keep returning for healthcare, and happy patients equal voluntary referrals. Many providers offer rewards to incentify referrals.

• How to get started with patient journey mapping

Follow the steps below to start the patient journey mapping process:

Establish your patient personas

Journey mapping is a great way to identify your patient’s characteristics so that their experience can be further enhanced.

Some of the following determinations can help you pinpoint your patient’s persona and establish protocols to provide a better service:

How do your patients prefer to communicate? Are they more comfortable with phone calls, texts, or other methods?

How are most patients finding your services? Are they being referred by friends or family members, or are they seeing advertisements?

Would the patient prefer in-person communication or telecommunication?

What are the patient’s expectations of care?

This data can be complex and widespread, but it can give you the information you need to more effectively and efficiently communicate with your patients.

Understand the entire patient lifecycle

Each patient is unique. Understanding the patient lifecycle can avoid confusion and miscommunication.

To positively engage the patient, you’ll need to gather data not only about communication methods but where they are in the patient journey, their health issue, and their familiarity with the healthcare provider’s procedures and treatment options.

Understand the moments of truth

With a few exceptions, most people seek healthcare services when they are ill or have a healthcare issue. These situations can cause patients to feel stressed and anxious. It’s these moments of interaction where compassion, knowledge, and understanding can provide relief and reassurance.

When patients see their healthcare provider, they are looking for solutions to problems. It’s the provider’s opportunity to identify these moments of truth and capitalize on them.

Get the data you need

Healthcare providers can collect vast amounts of data from patients, but the data collected rarely goes far enough in analyzing and determining solutions.

Your patients have high expectations regarding personalized treatment based on data. They want personalized, easy access to medical information and records, responsive treatments and follow-up, and communication in their preferred format.

You need more than clinical data to give patients what they want. You also need personal data that sets each patient apart and ensures a tailored experience.

For example, it might be challenging for parents of small children to contact the clinic and schedule appointments at certain times of the day. As a healthcare provider, you’ll need to be aware of the best times to contact this individual and offer simple methods for scheduling appointments.

Another example is patients with physical disabilities. You can take steps to improve their access to and experience at the healthcare facility.

Encourage referrals and loyalty

Although engagement on social media and online forums is becoming more and more common, the best way for new patients to find you is through referrals. Referrals stem from satisfactory experiences and trust.

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Patient Journey Mapping: What it is, Benefits and 5 Steps to Do it

In the rapidly evolving landscape of healthcare, patient-centered care has emerged as a crucial paradigm shift. As hospitals strive to deliver exceptional patient experiences and improve outcomes, understanding the patient journey has become paramount. 

A customer journey map is a powerful tool that shares patients’ path from their first encounter with a healthcare facility to their final discharge. By visualizing this complex expedition, hospitals can gain invaluable insights into patient needs, pain points, and opportunities for enhancement, thereby revolutionizing the delivery of care. 

The following article delves into the significance of patient journey maps for hospitals and their importance in optimizing patient experiences, streamlining processes, and ultimately elevating the standard of healthcare.

What is a Patient Journey Map?

A patient journey is a methodology that enables the analysis of a healthcare provider’s processes and value chain but from the patient’s viewpoint. This includes their possible solutions, pain points, emotions, touchpoints and user actions throughout the journey.

The patient journey map employs visual representation to gain deeper insights into how patients engage with a healthcare facility throughout their care journey. This unique approach is an evolution of the customer journey map , tailored specifically to the healthcare context. By employing this method, healthcare providers can unravel the intricacies of patient interactions, uncovering valuable information to enhance the quality of care provided.

The concept of the Patient Journey Map mirrors that of the Customer Journey Map, seeking to uncover areas of enhancement in patient care across various healthcare providers, including hospitals, fertility centers, and more.

Just as a skilled cartographer carefully crafts a map to navigate uncharted territories, patient journey maps chart the course of a patient’s experience, revealing hidden insights, unveiling opportunities for improvement, and ultimately guiding healthcare providers toward a destination of unparalleled patient satisfaction . 

What are the benefits of implementing a Patient Journey Map?

Engaging in the patient journey proves immensely valuable as it enables us to provide patients with an optimal experience, meeting the very expectations that arise when seeking healthcare services. 

The emotional aspect tied to the Patient Journey Map can be profoundly impactful, considering the inherent uncertainties often associated with visiting a healthcare facility.

Considering the unique personalities, fears, behaviors, and attitudes of different patient archetypes play a pivotal role in creating a tailored and pleasant experience for them. Thus, the patient journey map becomes a valuable tool benefiting both patients and healthcare service providers.

● Enhanced Communication with Patients:

By understanding the patient journey, healthcare providers can establish effective and continuous communication throughout the entire care process, addressing any doubts or uncertainties. Keeping patients well-informed and updated through appropriate channels reinforces the quality of care provided.

● Elimination of Blind Spots:

Clear comprehension of each stage of the patient journey helps bridge the gaps between patients and services. From the initial appointment request to discharge and follow-up, identifying and addressing potential blind spots ensures consistent and satisfactory solutions tailored to each patient’s unique situation.

● Streamlined Resolution of Pain Points:

Mapping the patient journey and defining archetypes enables a deeper understanding of patient concerns, particularly identifying which aspects of the service have the most negative impact. Pain points such as waiting times, unclear explanations, lack of empathy, or impersonalized treatments can be simplified and resolved more effectively.

Learn About: Complaint Resolution

● Process Optimization:

A well-defined patient journey optimizes workflow and allows for more efficient handling of all processes. Staff members become better equipped to anticipate and address patient issues promptly, offering alternatives that instill confidence and satisfaction.

● Continuous Improvement:

Implementing a Patient Experience model involves measuring patient experiences through a feedback system . Continuously updating the database with relevant information about patient journeys and their experiences leads to ongoing improvement in response times, customer service processes, and overall service quality .

What is a Patient Persona?

The patient persona represents an imaginary profile that encapsulates potential patients’ needs, goals, illnesses, conditions, emotions, behaviors, and knowledge. 

By creating patient personas, healthcare providers can enhance the accuracy and anticipation of care and diagnosis processes, ultimately improving the experience of individuals seeking healthcare services.

5 Steps to Build Your Own Patient Journey Map

1. define the experience to map:.

Before diving into the Patient Journey Map, it is crucial to determine the specific experience you intend to outline. By establishing your objectives and identifying the type of information you seek to gather and how it will be utilized, you can ensure a more efficient mapping process right from the start.

2. Identify your Ideal Patient:

The majority of data used to construct the customer patient care journey will come directly from patient-clients. Thus, a key step is identifying the patient persona, which can be singular or multiple. You must decide whether the map will encompass various patient profiles or if separate maps will be created for each target patient.

To create the patient persona(s), gather feedback directly from patients and analyze their behaviors and data. Pose questions such as:

• What initially led the patient to seek your services?
• Which competitors did they research?
• How did they discover your website or company?
• What factors differentiated your brand from others? What influenced their decision (or lack thereof) to choose your services?
• What are their expectations when interacting with your company?
• Can they articulate what they appreciate about your company and what frustrates them?
• Have they ever contacted customer service? If so, how was their experience?

Once you have defined the patient persona(s), you can identify the distinct stages of the customer journey when engaging with your company.

3. Divide the Phases of the Customer Journey:

Throughout the customer-patient care journey, patient-clients progress through several discernible stages.

Phase #1: Pre-Visit

● DISCOVERY:

The patient journey initiates with a phase characterized by learning and concern. Patients embark on their healthcare journey upon recognizing a need or developing a concern related to a health issue.

For instance, if an individual experiences symptoms associated with being overweight, they may begin researching options for scheduling an appointment with a medical specialist. At this point, potential patients discover their specific needs and commence the process of investigating suitable solutions. They may turn to the internet, seek recommendations from friends and family, or explore other avenues. During this stage, it is recommended healthcare systems should provide educational support to aid individuals on their journey of understanding.

● CONSIDERATION:

Following their research, patients reach the consideration stage, having discovered your service. At this point, they possess some knowledge about your healthcare facility’s location and offerings, leading them to believe it could meet their needs. However, patients have also explored your competitors and are contemplating multiple options.

During the consideration stage, potential patients meticulously assess the information they come across, including service descriptions, pricing, contact pages, online inquiries, and reviews. They also evaluate the ease of accessing relevant information before scheduling an appointment and the availability of operating hours, among other factors.

Phase #3: Visit

● APPOINTMENT & ENGAGEMENT:

Having gathered sufficient information and progressed through the consideration phase, the patient ultimately chooses your service. This marks their first contact with the health center, which can occur in person, over the phone, via chat, email, or other means of communication.

During this stage, the patient schedules their appointment. The company must streamline the application process and maintain effective and proactive communication. It is crucial for this phase to be completed without complications.

● SERVICE DELIVERY:

Within the visit phase is the service delivery stage, where patients interact with various service providers at the health center. From the moment the patient enters the premises, the company must ensure an exceptional service experience.

Service delivery encompasses multiple micro-moments, necessitating comprehensive attention throughout the entire journey. Every interaction matters, from the reception care and waiting times to the core service itself—meeting the patient’s objective of being evaluated by a doctor or specialist.

Phase #3: After the Visit

● RETENTION:

The Patient journey doesn’t conclude after the initial visit. A crucial third phase occurs post-encounter, where efforts should be dedicated to fostering patient retention and encouraging their return for subsequent visits. Building strategies that monitor the patient experience is essential in designing loyalty programs to ensure patients return for future services.

● RECOMMENDATION:

Part of the post-visit phase involves patient recommendations, which heavily depend on the overall patient journey experience provided by the company. If patients have had a positive service encounter, they are likely to recommend it to others, benefiting your business. 

However, it is important to remember that negative experiences are equally shared, and if patients are dissatisfied, they may spread negative feedback. 

Promptly addressing any negative comments is crucial to resolving issues and preventing unfavorable recommendations.

Phase #4: Identify Touchpoints

An additional vital step in mapping the customer-patient care journey is identifying the various touchpoints between the patient and the healthcare facility. These interactions occur at different stages throughout the patient journey, and understanding these touchpoints aids in developing strategies that facilitate effective communication.

• Seeking information about healthcare centers: discovering the existence of the healthcare provider and the services it offers.

Investigation:

• Reviewing patient-client feedback: researching comments and feedback from other patients about their visit experiences at the health center.
• Exploring promotions: searching for economic benefits such as discounts, promotions, and bundled service packages.

Acquisition :

• Appointment Request: Contact or visit the health center to schedule an appointment.
• Provision of Personal Data: The health center will request personal information to finalize the appointment booking.
• Appointment Confirmation: After providing the required data, the appointment for the agreed date and time is confirmed.
• Patient Reception: The patient arrives at the health center at their scheduled appointment time.
• Waiting Room: The staff guides the patient to the designated waiting area.
• Consultation: The patient’s turn to be attended by the specialist.
• Payment: The process of settling the payment for the service, which may occur at any point during the service phase, depending on the health center’s policies.
• Patient Recommendations: Patients offer positive or negative feedback about the health center and its services.
• Loyalty Program: Incentives such as offers, promotions, discounts, or a points system to encourage future visits.

Recommendation:

• Complaint: If the patient has had a negative experience, they may file a complaint with the health center.
• Online Reviews: Patients share comments or criticisms about the service by posting reviews on the internet.

4. Identify Contact Channels

Patients engage with the health center through various channels throughout the patient journey. These channels, such as the health center itself, can be physical or online, including social media, email, applications, websites, and online forms.

Identifying the most utilized contact channels at each stage of the customer-patient care journey is crucial. This allows for the development of tailored strategies for each channel, meeting patient expectations at each phase.

Working on the patient journey is crucial for healthcare providers to deliver a high-quality experience to patients. By mapping their interactions, providers gain a deeper understanding of their patient personas, allowing them better to comprehend patient needs, desires, and circumstances to provide the desired care.

Patient Journey Map Example 

To better understand what a Patient Journey Map is, we have created this fictitious example using one of the most reputable medical institutions in the healthcare sector, the Massachusetts General Hospital, as a reference.

In this example, we have included some generic touchpoints that are usually the most common in the interaction between a hospital and a patient.

Through this example, it would be possible to visualize the points of interaction between both parties and the perception that patients have of them, which can be positive or negative. This serves as a clear indicator for making adjustments and learning from what has been done well.

The Office of Patient Experience plays a vital role in facilitating initiatives to assess and enhance the quality of care experienced by patients and their families. They are responsible for evaluating each of these touchpoints and ensuring that appropriate actions are taken.

The Mass General Hospital is a benchmark not only in terms of service level but also in the implementation of methodologies and actions that guarantee the satisfaction of their patients. A clear example of this can be seen in the results of their annual HCAHPS survey, where they score above the national average in various aspects.

Willingness to Recommend Hospital Scores below show the percentage of patients who would “definitely recommend” Mass General to their friends and family.

To see the complete study, we invite you to visit their website and learn about it.

More Examples of Patient Journey Maps

Seeking inspiration to craft your own Patient Journey Map? Your search ends here!

Explore a collection of remarkable examples from top-notch brands, unveiling their initiatives that delight customers and foster loyalty.

Get set to revolutionize your own Patient Journey!

Mass General Hospital is renowned for providing exceptional care and taking special care in understanding the perspective of its patients. They achieve this through different tools, such as satisfaction surveys, internal and external feedback, and  HCAHPS surveys .

Mayo Clinic is characterized by its focus on patient satisfaction and its extensive technical deployment to gather user and prospect feedback.

Cleveland Clinic is often ranked among the best hospitals in the United States. This recognition is not only due to its incredible facilities, global expansion, and well-prepared staff but also because of its remarkable focus on the experience they provide to its patients and clients.

Singapore General Hospital is one of the largest and oldest hospitals in Singapore. It has been a major healthcare institution providing a wide range of medical services and treatments since 1821.

Johns Hopkins Medicine has long recognized the significance of a positive patient and family experience during hospitalization, which is why they maintain a specific focus on  patient satisfaction  to achieve an optimal experience.

How can you enhance your Patient Journey Map based on your acquired knowledge?

The insights and recommendations shared above are likely to have sparked ideas about the potential impact of these initiatives across various industries, not just healthcare.

The first crucial step is to embrace a customer-centric approach, keeping their needs and expectations at the forefront. By doing so, the actions you take will have a meaningful impact on your customers and yield multiple benefits for your business.

At QuestionPro, we offer a range of tools and features specifically designed to help you achieve this objective.

QuestionPro SuiteCX is a Customer Journey Mapping Software that simplifies the process of creating your customer journey. 

With a vast selection of templates and the ability to personalize user/buyer personas while incorporating your own data, you can conduct precise visual analyses at every touchpoint throughout your patient journey.

Start delighting your customers today!

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The Patient Journey: What it is and Why it Matters

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Healthcare is under enormous pressure today.

Patient expectations about their service and experience have changed over the years. Patients have more choices about their care, and they’re more empowered with information about what they want their care experience to be. They expect you to interact with them on their terms, not yours. And with COVID-19 turning so much of our lives digital, this trend has only accelerated.

Having a robust marketing automation approach is critical to addressing these challenges in today’s environment. Meeting — and exceeding — patient expectations comes down to managing your patient’s engagement journey. 

How can patient journeys improve care?

What patient journeys can do is turn the healthcare experience from a primarily reactive experience to a proactive one.

By building out journeys for your patient personas, you can close gaps in care, establishing robust preventative routines that ultimately help your patients stay as healthy as possible for as long as possible.

Engaging consumers and patients where they are builds trust and confidence that keeps patients in the system and encourages them to refer their friends and family to your practice. According to the Beryl Institute , 70% of patients will share a positive experience with others. But your bigger risk is that 76% will share a negative one. And with a negative experience, 43% of patients won’t go back to that provider, with 37% finding a different doctor altogether.

What is the patient journey?

A patient journey represents the entire sequence of events that a patient experiences within a given healthcare system or across providers, from scheduling an appointment for a regular checkup to receiving treatment for an illness or injury. 

A patient journey is an ongoing process that incorporates all parts of the healthcare ecosystem, from hospitals to physicians, specialty care, and outpatient therapy.

While it is easy to think about a patient’s journey as those interactions you have with them before, during, and after an appointment, there are actually many other touchpoints that drive their overall journey. A comprehensive patient engagement strategy touches on all aspects of a patient’s relationship with a healthcare provider, including:

• Onboarding and Access 
• Diagnosis and Treatment
• Adherence to Lifestyle or Behavioral Changes
• Ongoing and Proactive Health (Wellness)
• Referrals and Loyalty

How do I create the patient engagement journey?

Every single interaction with a patient is part of the patient engagement journey and a moment of truth for the health system or provider to add value.

In today’s value-based healthcare world, having that personalized experience is more important than ever. A patient engagement journey organizes those communication touchpoints and ensures you’re delivering the right information at the right time to the right person, and leveraging the appropriate communication channel. Millennials and Generation Z, for example, may be more likely to prefer a text, email, or chat to a phone call.

It’s about knowing your patients’ preferences — like that they prefer to be texted during the day while they’re at work or if they prefer an office vs. telehealth visit — and what’s going to make it easier for them, like sending automatic reminders the week and day before an appointment.

Whether it’s making sure you follow up with cardiac patients about weighing themselves daily after surgery to catch any water retention issues or asking colonoscopy patients whether or not they’ve been following post surgery protocols after discharge, it’s about continuity of care once a patient leaves the office or hospital so they have a quality outcome. From there, patients can more proactively drive their own wellness plan.

Here are important areas to focus on when creating your patient engagement journey:

Establish your patient personas

You need to know the different types of patients that are coming into your organization. You want to figure out:

• What are the most relevant needs of your patients?
• What are their communication and care preferences?
• How do they want to engage with you?
• What information do you already know about them?

To be able to craft the best possible patient experience, you first have to know more about your patients.

For example, there’s a well-known healthcare persona out there called the “Medical Mom” (which can, of course, be any individual taking care of themselves, their kids, their spouses, and may also be the caretaker for aging parents). 

Let’s say this individual has three children, and they book annual physicals at their pediatrician, which happens to have offices in the same building as their own primary care physician. Wouldn’t it be nice if the office sent them one email reminder to schedule all five appointments, rather than five different emails? And when they do call, scheduling those appointments back-to-back so everyone is in and out in one afternoon?

A spreadsheet is not going to be able to do that for you. Collecting and managing the data required to drive complex, interconnected patient journeys requires more than a spreadsheet. In order to succeed, you’ll need to pay close attention to the entire patient lifecycle.

Understand the entire patient lifecycle

An appointment reminder is a great start to engaging a patient, but it’s just one event in an ongoing patient lifecycle that begins with preventative care and includes diagnostics, delivery of care, and post-operations.

For example, how many patients show up for routine blood work at their physician office and you find out they haven’t fasted for the appropriate amount of time? Sending a patient home is frustrating for them and it’s frustrating for you. If the appointment is at 2:00 PM, then that appointment reminder should have been sent at dinnertime the previous evening, reminding them that they can’t eat anything after a 6:00 AM breakfast the next morning.

You’ll want to tailor your communications based on whether the patient is new or existing, what their preferences are, and whether they have any specific or chronic health issues. From there, you need to…

Understand the moments of truth

The healthcare system is complicated, even for those who have been a part of it for decades. The key to building a great foundation for your patient engagement strategy is to put yourself in a typical patient’s shoes. Most patients don’t engage with the healthcare industry unless they’re feeling sick. That means they’re rarely at their best, and they’re not only anxious about getting better, but about the costs associated with that.

The best healthcare providers understand the moments of truth — opportunities for a positive touchpoint that can alleviate their stress and anxiety and help them get on the road to recovery. Every time you interact with a patient is an opportunity for a moment of truth, whether that be in person or via other channels of communication.  It’s not only about establishing accurate moments of truth, but capitalizing on them.

It’s up to you to understand the places people need to be, how you want to communicate to them, and make every one of those touchpoints a positive experience. It doesn’t matter whether they’re physically in your office or not. Your patient engagement journey is what guides your patients to making the best possible decisions on their care so they get better. 

The easier you make it for them to engage with you, the higher quality their care will be.  Ultimately, you want your patients to be evangelists for your services based on their positive experiences. To do that, you’ll need to…

Get the data you need

Your patients expect personalization.

Personalization in healthcare used to mean created tailored treatment plans and clinical protocols. That’s still important, but patients expect more personalization around the entire experience, from access to communication to quality outcomes. It’s like turning on a light switch in your home: a patient just expects the light to turn on. 

Personalization today means being able to see at-a-glance a patient’s healthcare record, communication preferences, and social determinants that may be impacting their overall health to give you a 360-degree picture .

To do this, you need more than clinical data.

You may have patients that constantly miss their appointments. By storing questions that go beyond health risks — say, that they’re a smoker — but to understand that they don’t have a car to get to the appointment in the first place is becoming a more important part of the process. Part of empathetic, compassionate care is understanding these environmental factors that can help patients get the care they need, whether that’s calling a Senior Shuttle, caregiver, or arranging a telehealth appointment instead.

Once you have the data, you can…

Encourage referrals and loyalty

The first place people look for a new doctor isn’t the Internet. It’s their friends and family. In an ideal world, every patient you have should be able to say, “Oh, I loved my experience with…”

Doing that starts with the technology you have. Before a patient ever comes in for treatment, you need to make sure they have a seamless experience that builds trust and encourages referrals and loyalty. 

How do I get started with patient journey mapping?

It’s time to move away from the mindset to simply fill the top of the funnel with as many new potential patients and contacts with caregivers as possible. While this is still a requirement, it is just as crucial for organizations to get better at managing and growing relationships at every phase of the patient journey. Providers must engage with consumers in the marketplace to introduce them to their services of course, but it is of growing importance that they offer support throughout the entire diagnostic and treatment process. 

As a Salesforce Platinum Partner with deep industry expertise, we have created a Foundation for Patient Engagement package — a complete strategy that starts with Health Cloud and facilitates a 360-degree view of the patient , as well as a comprehensive communication strategy, CTI integration, and the use cases driving patient acquisition, engagement, and loyalty.

Learn more about building your patient journey with Silverline.

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Patient journey mapping: what it is, its benefits, and how to do it

We've all been patients at some point, but our journeys were not the same. Patient journey mapping holds the key to unraveling this mystery, providing a strategic lens into the diverse pathways individuals tread throughout their healthcare experiences.

In this article, we'll explore the pivotal role of patient journey mapping in the healthcare industry, uncovering its profound benefits for both providers and patients. From amplifying patient satisfaction to streamlining operational processes, the impact is transformative.

But how does one embark on this journey of understanding and improvement? We'll guide you through the essential steps and considerations, offering insights into the art of crafting a meaningful healthcare patient journey map.

Join us as we peel back the layers of patient experience journey mapping. This powerful tool not only illuminates the complexities of healthcare but also empowers providers to reshape and enhance the patient experience.

• 1.1 Difference from other customer journeys
• 2 Patient journey mapping benefits
• 3 Patient journey stages
• 4.1 Clinical journey maps
• 4.2 Service delivery maps
• 4.3 Digital journey maps
• 4.4 Chronic disease management maps
• 4.5 Emergency care journey maps
• 4.6 Pediatric patient journey maps
• 4.7 Palliative care maps
• 5 How to do patient journey mapping?
• 6.1 Patient-centered care
• 6.2 Streamlined access to care
• 6.3 Effective communication
• 6.4 Education and empowerment
• 6.5 Care coordination
• 6.6 Technology integration
• 6.7 Feedback and continuous improvement
• 6.8 Cultural competency
• 6.9 Emotional support
• 6.10 Efficient billing and financial assistance
• 7 Templates
• 8 Wrapping up 

What is a patient journey?

A patient journey is the entire process a person goes through when seeking and receiving a healthcare service. It covers everything from first noticing symptoms or realizing the need for care and medical attention to finally resolving the health issue. The journey involves patient interactions with healthcare professionals, diagnostic procedures, treatment activities, and follow-up care.

Mapping and understanding the patient journey can help boost the quality of hospital care and improve patient satisfaction. By pinpointing challenges, patient communication gaps, and areas for enhancement, care providers can refine their services to better cater to patients' needs. It also contributes to promoting patient-centered care, shifting the focus beyond just treating diseases to considering the overall well-being and experience of the patient.

Difference from other customer journeys

While the concept of patient journey mapping is similar to customer journey mapping , there are unique aspects specific to the healthcare domain. This is how a patient journey differs from any other customer journey:

• Emotional intensity. Health-related experiences often involve heightened emotions, including fear, anxiety, uncertainty, a sense of losing control, and a dependence on others. The emotional aspect is more pronounced in patient journeys compared to customer journeys in most industries.
• Complexity and uncertainty. Healthcare journeys often involve multiple stakeholders, various diagnostic and treatment options, and inherent uncertainties. Navigating these complexities requires a different approach compared to more straightforward consumer experiences. Comparing buying eyeglasses online and visiting a doctor — both are experiences, but how different they are!
• Regulatory and ethical considerations. Healthcare is heavily regulated, and ethical considerations play a significant role there. Patient journeys must align with regulatory standards and ethical principles that other industries don’t have.

• Clinical decision points. Patient journeys involve critical clinical decision points, such as diagnosis and treatment choices. These decisions not only impact the patient's health but also influence the overall trajectory of the journey.
• Care continuum. Patient journeys often extend beyond a single episode of care. They may involve long-term management, follow-up appointments, and ongoing support, creating a continuous care continuum.
• Interdisciplinary collaboration. Healthcare is often delivered by a team of professionals from different disciplines. The patient journey may involve collaboration among physicians, nurses, specialists, and other healthcare providers.

Patient journey mapping benefits

Mapping a patient journey offers a range of benefits that contribute to improving the overall quality of healthcare delivery. Here are some key advantages:

• Visualization of the entire patient journey helps healthcare providers identify critical patient journey touchpoints that impact patient satisfaction and experience and require immediate attention. By paying more attention to these touchpoints, you ensure a more positive overall journey.
• Gaps in care and challenges are highlighted among healthcare professionals. Addressing these issues ensures a more seamless and collaborative approach to patient care.
• Pain points and barriers become evident, enabling healthcare providers to proactively address issues that may hinder effective care delivery.
• Understanding individual patient journeys allows for more personalized ongoing care plans. Tailoring interventions to specific needs and preferences improves patient engagement and outcomes.
• By mapping a patient journey, you can identify resource-intensive stages and areas where efficiency can be improved, enabling a healthcare organization to allocate resources more effectively.
• It's a great way to identify opportunities for smoother transitions between different stages of care, ensuring continuity and preventing gaps in treatment.
• It becomes clear where patient involvement in the decision-making process can contribute to their healthcare journey.

Example: Tom, recovering from surgery, feels more empowered as his healthcare team provides clear post-operative care instructions, making him an active participant in his recovery.

In summary, patient journey mapping provides a comprehensive framework for healthcare improvement, addressing specific challenges at each stage and leading to tangible enhancements in patient experience, communication, and overall care delivery.

Patient journey stages

Patient journeys can differ, and if we take a broad perspective, some key stages would include:

Awareness 

This stage involves the patient recognizing symptoms and becoming aware of a potential health issue.

• Key considerations: Pay attention to how patients identify and interpret their symptoms, as well as the information sources they consult.

Example: John notices persistent joint pain and, through online research, suspects it might be arthritis. His journey begins with a heightened awareness of his symptoms.

Seeking information

Patients actively look for information to understand their symptoms, potential causes, and the importance of consulting a healthcare professional.

• Key considerations: Review the information sources patients use and how well they understand the need for professional medical advice.
• Example: Emily researches her persistent cough online, learning about various respiratory conditions and recognizing the importance of seeing a doctor for an accurate diagnosis.

First contact

This marks the initial interaction with the healthcare system, typically through scheduling an appointment with a primary care physician.

• Key considerations: Assess the ease of access to healthcare services and the patient's initial experience with medical professionals.
• Example: Alex schedules an appointment with his family doctor to discuss recent changes in his vision, initiating his journey within the healthcare system.

Diagnostic process

Patients undergo diagnostic tests to identify the root cause of their symptoms.

• Key considerations: Examine the efficiency of the diagnostic process and the clarity of communication about the tests.
• Example: Maria undergoes blood tests and imaging to determine the cause of her abdominal pain, marking the diagnostic phase of her journey.

Treatment planning

Patients receive a diagnosis, and healthcare providers collaborate on creating a personalized treatment plan.

• Key considerations: Evaluate how well the diagnosis is communicated and involve patients in treatment decisions.
• Example: Emily receives a diagnosis of rheumatoid arthritis. Her healthcare team takes the time to explain the condition, discusses various treatment options, and actively involves her in deciding on a comprehensive plan that combines medication, physical therapy, and lifestyle adjustments.

Treatment and clinical care service

Patients initiate the recommended treatment plan, experiencing the day-to-day challenges and improvements associated with their patient journey in a hospital.

• Key considerations: Monitor treatment adherence, side effects, and the patient's overall experience during this active phase.
• Example: Sarah starts chemotherapy for her cancer, navigating the treatment process with the support of her healthcare team.

Psychological support

Patients deal with the emotional toll of managing a health condition, including anxiety, frustration, or isolation.

• Key considerations: Acknowledge and address the emotional aspects of the journey, providing resources for mental health support.
• Example: James copes with the emotional challenges of managing chronic pain, seeking counseling to navigate the psychological impact.

Regular checkups

Patients undergo routine checkups to monitor their health status and adjust treatment plans as needed.

• Key considerations: Ensure consistent communication and scheduling of regular checkups to track progress and address any emerging issues.
• Example: Sarah, diagnosed with hypertension, attends regular checkups where the healthcare team monitors blood pressure, discusses lifestyle adjustments, and ensures medication efficacy. The routine checkups create a proactive approach to managing her condition.

Patients provide feedback on their experiences, allowing healthcare providers to refine and tailor their care.

• Key considerations: Establish mechanisms for patients to share feedback easily and transparently, encouraging an open dialogue.
• Example: John shares his experiences with a new treatment plan, providing feedback on its effectiveness, side effects, and overall impact on his daily life. This feedback loop allows the healthcare team to make timely adjustments and improve the patient's journey.

The stages may vary based on diverse scenarios and individual health circumstances. For instance, when a patient undergoes surgery or faces an acute medical event, the trajectory of their journey can diverge significantly from a more routine healthcare experience. 

Factors such as the need for emergency care, hospitalization, and specialized interventions can introduce unique stages and considerations. Additionally, variations may arise due to the specific nature of medical conditions, treatments, and the individual preferences and needs of patients. 

Recognizing this variability is crucial for comprehensive journey mapping, allowing for a more nuanced understanding of the patient experience across different healthcare contexts.

Types of healthcare journey maps

Healthcare journey maps can take various forms depending on their focus, purpose, and the specific aspects of the patient experience they aim to understand. 

Here are a few types of healthcare journey maps:

Clinical journey maps

Focus: Emphasize the clinical aspects of a patient's experience, including diagnosis, treatment, and recovery.

Purpose: Help healthcare providers understand the medical processes and interventions involved in the patient's journey.

Example: A clinical journey map for a cancer patient would detail the steps from initial symptoms to diagnosis, treatment modalities, and post-treatment care.

Service delivery maps

Focus: Highlight the various touchpoints and services a patient encounters throughout their healthcare journey. Then, detail the back and front processes your team does or has to do during each stage. 

Purpose: Enable healthcare organizations to assess the efficiency and effectiveness of service delivery.

Example: Mapping the service delivery for a patient undergoing surgery, including preoperative consultations, surgical procedures, and post-operative care.

Digital journey maps

Focus: Examine the patient's interaction with digital tools and technologies, such as online portals, mobile apps, and telehealth platforms.

Purpose: Help improve the digital aspects of patient engagement and communication.

Example: Mapping the patient's journey when using a telehealth platform for virtual consultations, prescription refills, and accessing medical records.

Chronic disease management maps

Focus: Explore the long-term journey of patients managing chronic conditions.

Purpose: Aid in understanding the challenges and opportunities for supporting patients in their ongoing self-management.

Example: A journey map for a diabetes patient would encompass regular monitoring, medication management, lifestyle adjustments, and periodic checkups.

Emergency care journey maps

Focus: Examine the patient’s experience during emergencies, from the onset of symptoms to emergency room admission and follow-up care.

Purpose: Help optimize response times, communication, and the overall emergency care process.

Example: Mapping the journey of a patient experiencing chest pain, from the initial call to emergency services to the triage process and subsequent cardiac care.

Pediatric patient journey maps

Focus: Tailored specifically for the unique needs and considerations of pediatric patients and their families.

Purpose: Address the emotional and practical aspects of pediatric healthcare experiences.

Example: Such a map is good for a child undergoing surgery to consider the role of parents, age-appropriate communication, and post-operative care.

Palliative care maps

Focus: Center on the patient's journey when facing serious illness, with a focus on providing comfort and support.

Purpose: Enhance the quality of life for patients and their families during end-of-life care.

Example: This kind of journey map suits a patient receiving palliative care when considering symptom management, emotional support, and coordination of services.

The mentioned types of maps cover different patient scenarios and clinical cases. There can also be "AS-IS" and "TO-BE" maps, reflecting the current state of the journey and the desired one, respectively.

All these types of healthcare journey maps offer a nuanced understanding of the diverse aspects of patient experiences, allowing healthcare providers and organizations to tailor their services to meet the unique needs of different patient populations.

How to do patient journey mapping?

Mapping a patient's journey is a thorough process that needs careful planning, teamwork, and analysis. Here's a guide on how to do it:

• Define the objectives

Clearly articulate the goals of the patient journey mapping exercise. Determine what aspects of the patient experience you want to understand and improve. All involved parties should be aware of these goals and agree with them.

• Assemble a cross-functional team

Form a team that includes representatives from various departments, including healthcare providers, administrative staff, patient advocates, and anyone involved in the patient experience.

• Do research

Conduct thorough research to gather quantitative and qualitative data related to the patient experience. This may involve analyzing patient records, studying existing feedback, diving into analytics and market research, and reviewing relevant literature on best practices in healthcare.

• Select a patient segment

Identify a specific patient segment or persona to focus on. This could be based on demographics, health conditions, or specific healthcare services. 

Tip: You can leverage your segments or patient personas to craft an empathy map , which is particularly valuable in healthcare.

• Conduct stakeholder interviews

Interview stakeholders, including healthcare professionals and administrative staff. Gather insights into their perspectives on the patient journey, pain points, and opportunities for improvement.

• Define the stages

Outline the patient journey by mapping out each stage and interaction with the healthcare system. This can include pre-visit, during a visit, and post-visit experiences.

Tip: To speed up the process, run a journey mapping workshop with your team. It will help with the next step, too. 

• Create the patient journey map

Develop a visual representation of the patient journey. This can be a timeline or infographic that illustrates each stage, touchpoint, and the emotional experience of the patient.

• Identify pain points and opportunities

Analyze the collected data to pinpoint pain points, areas of friction, and opportunities for improvement. Consider emotional, logistical, and clinical aspects of the patient experience.

• Review and validate

Consider collaborative journey mapping . Share the draft patient journey map with stakeholders, including frontline staff and patients, to validate its accuracy. Incorporate feedback to ensure a comprehensive and realistic representation.

• Develop actionable plans

Generate specific, actionable plans based on the identified pain points and opportunities. Each initiative should be feasible, considering resources and organizational constraints.

• Prioritize and implement changes

Prioritize the recommendations based on impact and feasibility. Begin implementing changes that address the identified issues, whether they involve process improvements, staff training, or technology enhancements.

• Monitor and iterate

Continuously monitor the impact of implemented changes. Gather feedback from both staff and patients to understand the effectiveness of the improvements. Iterate on the patient journey map and make recommendations as needed.

• Measure your success 

You can also establish KPIs to measure the success of any improvements made based on the patient journey mapping insights. These could include patient satisfaction scores, reduced wait times, or improved communication metrics.

•  Document insights (optional)

And keep a record of the lessons learned during the patient journey mapping process. This documentation can inform future initiatives and contribute to ongoing efforts to enhance the patient experience.

• Promote a culture of continuous improvement

Foster a culture within the organization that values continuous improvement in patient care. Encourage ongoing feedback and regularly revisit your journey map to ensure its relevance over time.

By following these steps, healthcare organizations can gain valuable insights into the patient experience, leading to targeted improvements that enhance healthcare quality and patient satisfaction.

How to improve the patient journey?

Striving for a seamless patient journey involves enhancing the overall experience that individuals have when seeking and receiving healthcare services. Here are some strategies to consider:

Patient-centered care

• Prioritize patient needs and preferences.
• Emphasize education and empower patients to actively participate in their healthcare journey.
• Foster open communication and active listening.

Streamlined access to care

• Reduce wait times for appointments and procedures.
• Implement online scheduling and appointment reminders.
• Provide options for virtual consultations when appropriate.

Effective communication

• Ensure clear and understandable communication with patients.
• Provide information about treatment plans, medications, and follow-up care.
• Confirm that patients are well-informed about the potential risks and benefits of treatment options.

Education and empowerment

• Offer educational resources to help patients understand their conditions and treatment options.
• Encourage patients to actively participate in their health management.
• Provide tools for self-monitoring and self-management when possible.

Care coordination

• Improve collaboration and communication among healthcare providers to strengthen care coordination, ensuring a more cohesive and seamless experience for patients throughout their healthcare journey.
• Define and implement standardized protocols for communication and handovers between care teams, reducing the risk of errors and ensuring continuity of care.
• Implement remote monitoring technologies to track patients' health remotely, enabling timely interventions and reducing the need for frequent in-person visits.

Technology integration

• Adopt electronic health records (EHRs) for efficient information sharing.
• Use telemedicine to enhance accessibility and convenience.
• Implement mobile health apps for appointment reminders, medication management, and health tracking.

Feedback and continuous improvement

• Conduct regular surveys to gather specific insights into patient satisfaction, allowing for a more nuanced understanding of their experiences.
• Establish easily accessible channels for patients to provide real-time feedback, ensuring that their voices are heard promptly.
• Respond promptly to patient feedback, address concerns, and communicate any changes or resolutions, fostering a sense of responsiveness and accountability.

Cultural competency

• Train healthcare staff to be culturally competent and sensitive to diverse patient needs.
• Promote diversity in healthcare staff to reflect the communities served, fostering a more inclusive and culturally sensitive environment.
• Recognize and celebrate cultural awareness events within the healthcare setting, fostering an inclusive atmosphere that appreciates the richness of diverse traditions.

Emotional support

• Address the emotional and psychological aspects of healthcare.
• Provide resources for mental health and emotional well-being.
• Consider support groups or counseling services.

Efficient billing and financial assistance

• Simplify billing processes and provide clear information about costs.
• Offer financial assistance programs for patients in need.
• Communicate transparently about insurance coverage and out-of-pocket expenses.

Staff training:

• Train healthcare staff in patient-centered communication and empathy.
• Ensure staff is knowledgeable about the resources available to patients.
• Foster a culture of empathy and compassion in the healthcare environment.

By focusing on these aspects, healthcare providers can contribute to a more positive and effective patient journey. Regularly reassessing and adapting strategies based on feedback and evolving healthcare trends is crucial for ongoing improvement.

UXPressia already has some healthcare journey map examples: 

• Surgical patient journey

This map focuses on the healthcare journey of a patient persona, Robin, from the moment when the patient understands that something is wrong to the recovery period. This journey is long and very detailed.

• Non-surgical patient journey

This map visualizes the journey of a patient, Lotta, who decides to undergo a checkup at a hospital. She schedules a visit, gets a consultation, takes some tests, and starts taking some medicine prescribed by her doctor.

More healthcare and well-being templates are available in our library.

Wrapping up 

In wrapping up, think of patient journey mapping as a powerful tool reshaping the healthcare landscape, with the patient's experience taking center stage. It's like creating a roadmap that intricately traces every step of a patient's interaction within the healthcare system. 

This deliberate mapping isn't just a plan; it's a compass guiding healthcare organizations toward key points where they can enhance patient satisfaction, simplify access to care, and cultivate a more compassionate and patient-focused healthcare environment. Investing in patient journey mapping is more than a strategy—it's a dedication to raising the bar in care quality, amplifying the patient's voice, and ensuring that every leg of the healthcare journey is characterized by empathy, understanding, and an unwavering pursuit of excellence in patient experience.

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Patient Journey Mapping: What it is and Why it Matters

How can healthcare organizations make every stage of the patient journey better?

How was your last experience in a healthcare facility? Think about every step of that patient care journey - the phone calls, in person meetings, wait times, communication and all of the healthcare professional/ patient interactions. It’s a lot.

Healthcare organizations are working diligently to improve patient satisfaction and quality of care by asking, “How can we make the patient experience better?” But that’s no mean feat, trying to capture the multitude of challenges patients face when navigating a healthcare journey. That makes improving it even more difficult.

A first, fundamental step to improving patient experience is understanding what that experience looks like today. This is where patient journey mapping comes into play. You can use patient journey maps to understand the highs and lows, pain points and gaps to begin pinpointing which interventions will be most impactful. Then you can assess which changes you have the power to make.

As a result, you’ll be better able to manage your patient’s journey, improve care pathways and meet—and exceed—patient expectations, needs, and wants.

What is Patient Journey Mapping?

Patient journey mapping works to identify and understand the details of all patient touchpoints within a specific healthcare experience. It helps you visualize the process patients go through to receive care, complete a treatment plan, and/or reach a desired outcome. When done correctly, patient journey maps make it easier for you to identify pain points, discover opportunities and re-align treatment and care approaches across the entire healthcare system.

What makes up a patient’s journey?

A patient’s journey represents the entire sequence of events or touchpoints that a patient experiences within a given health system, with a specific provider, or within a specific facility. These touchpoints are either virtual or in-person. They range from the mundane to the nerve-wracking or life-changing. They comprise events from scheduling an appointment online to reviewing post-surgery instructions with a doctor.

It’s key for healthcare professionals and clinicians to recognize the patient journey extends well beyond the most obvious in-person interactions at a treatment facility. The patient journey happens before, during and after a healthcare service: pre-visit, during-visit, and post-visit. These include but are not limited to:

• Finding the right service or practitioner
• Scheduling an appointment
• Submitting a list of current medications
• Arriving at the medical facility
• Identifying where to check-in.

These experiences can instil a sense of reassurance or unease before a patient even receives care. In essence, they set the tone and expectations for the physical visit. A frustrating or confusing experience during the pre-visit stage will impact the emotional state of the patient and family for the rest of their interactions.

During-visit

• Checking in at the front desk
• Waiting in the lobby to be called
• Discussion with nurses before speaking to a doctor
• Family waiting for updates in the lobby during a procedure
• Care from doctor and staff.

There are an infinite number of touchpoints during the delivery of healthcare. Each one will have a different level of impact on the patient’s experience.

• Post-care instructions at hospital
• Hospital discharge process
• Completing a patient feedback survey
• Paying for the medical treatment
• Post-surgery calls or online messages from the nurse or doctor.

The patient experience after a hospital visit plays a vital role in either reinforcing a positive experience or mitigating a negative one. Actions such as post-appointment follow-ups extend the care relationship and may help the likelihood of the patient sticking to the treatment plan

All these individual touchpoints are crucial to understand. Altogether, these positive and negative experiences — no matter how big or small — comprise the patient journey.

Who are the stakeholders?

The healthcare ecosystem is complex, involving multiple stakeholders and a wide range of internal and external factors, including:

• People (patients, their families and caregivers, doctors, nurses, administration, parking attendants, volunteers)
• Technology and systems (online registration, parking tickets, surgery updates, mobile app, website, social media)
• Facilities (hospital campus navigation, parking availability, building accessibility).

Investigation of all players and systems involved is essential to seeing the multidimensional layers impacting the experience. To do this, patient journey maps should include the perspectives of patients, providers, and staff - and those perspectives must be of the same journey. Often, an interaction that occurs from one point of view will show only one reality. However, further investigation will show the many contributing factors across the care delivery process. This is only apparent by examining multiple perspectives.

Once you understand the entire journey, with pain points, you’ll be able to identify patterns across patient personas and different demographics, and any gaps within the healthcare process. You can then begin asking important questions like:

• Which moments are most painful?
• Why do they happen?
• What must we change in order to improve the experience?
• Who must we impact?
• Which do we have the power to change?

Benefits of patient journey mapping

Patient journey mapping provides the opportunity to turn the healthcare experience from a primarily reactive experience to a proactive one. By building out care journeys for your patients, you can close any gaps in provision and establish robust preventative routines that ultimately help your patients stay healthier for as long as possible. Engaging consumers and patients based on where they are and what they want, builds trust and confidence. That retains patients in your system and encourages them to make friends and family referrals.

But how does the process work?

• Streamline patient processes and workflows: upgrading the usability and functionality of online patient portals, websites and mobile apps can put more control in the patients’ hands, increasing patient flow and cutting operational expenses.
• Increase staff efficiency : enhancing internal online tools and creating automation within systems can assist hospital staff in implementing protocols and schedules and help them anticipate and solve problems more easily. It can help to align the expected service delivery with the actual one.
• Clear routes and direction across medical facilities: hospitals can be incredibly complicated to navigate - whether it’s using the right entrance, finding parking or making your way to the cafeteria for a snack. Improving signage, making visible pathways, and using landmarks to help orient users can help patients and families readily access the resources they need.
• Improve communication between patients and providers: exchanging patient information and coordinating care can be a challenge for providers and a frustration for patients. This misalignment can be due to silos within organizations, incompatible technology systems or many other factors. Working to bridge the appropriate organizational or technological gap can help alleviate stress and anxiety.
• Develop seamless and timely patient and family updates: waiting while a family member is in surgery or communicating with a doctor to secure care for a child is typically an extremely stressful process. Families wait anxiously for updates which can be infrequent and lacking detail. Implementing a seamless system for families to communicate directly and receive regular updates, through an app or text, can help ease these pain points.
• Better ‘in-between visit’ care and check-ins with patients and families: communication between patients, including families and caregivers and providers can feel ‘hit or miss.’ Patients may be scrambling to answer phone calls or missing phone calls only to find themselves unable to get hold of the provider when they call back. Alternatively, providers are challenged to communicate critical information to a wide range of patients. Establishing better communication systems can improve patient engagement, build the patient’s confidence in the care they receive, and ease the care provider’s job.

In short, we’re talking happier patients who experience better communication and levels of empathy at every stage of the patient journey.

What tools and methods are used for creating a patient journey map in healthcare?

There are many ways to undertake patient journey mapping, but doing it well isn’t always as simple as it may seem. It’s not a single exercise, moving from A to B. It’s more complex, involving a series of tools.

Our team at Highland has helped a lot of our clients create their first journey map . Grab a bunch of sticky notes and pens to start your map. Our process tends to go like this:

• Chart the course -work out what you want to achieve (your goal); determine whose journey you’re mapping, the start and end points; create the persona(s); think about what the stages of the journey may be.
• Prepare to interview - list your potential questions being mindful that you want the interviewee to recount events rather than share opinions. Schedule interviews with a tool like Calendly. Look into other available data (such as patient feedback).
• Interviews and coding - we interview in pairs so that one can speak whilst the other takes notes. With permission, record the interviews. Afterwards, code the responses according to thoughts, actions, experience etc. We use a simple Google Sheet to do this.
• Building blocks - go through the interviews and notes. Start mapping. Use a specific color of sticky note for each Building Block and add points to the wall in their themes.
• Identify opportunities - “mine” the wall for opportunities, presenting ideas to the team. Together, prioritise the top three or four to tackle.

Repeat this whole process with another persona or goal to examine.

Explore this journey mapping process in more detail

The outcome of this process should be that healthcare professionals can look after patients better. Using patient data collection to underpin your decision-making can transform your organization’s culture to one of continuous improvement. By referring constantly to patient data, you can identify the key areas to amend and improve to better the patient experience. Satisfied customers, those who’ve experienced a near seamless patient journey, will rate your facility highly and they’ll be more likely to generate new referrals.

Improve your customer experience with Highland Solutions’ help

You may know your healthcare facility like the back of your hand, but you only know it from your informed perspective. Getting a 360º view of the patient experience is the first step to improving it. A huge challenge for healthcare leaders like you is to recognize, understand and address the fact that the overall experience is created by the cumulative interactions across the various touchpoints in the healthcare journey: pre-visit, during-visit, and post-visit.

Despite years of expertise, it’s easy for healthcare providers and leaders to develop blind spots for persistent issues in the care process. Partnering with a knowledgeable research team to conduct patient journey mapping will bring expertise and a fresh perspective to your quality of care. It’s not only about uncovering in-depth insights via patient journey maps, but also translating them into actionable strategies to help you bridge any gaps between current and emerging patient needs and the present state of your healthcare organization.

Once on the right track, you’ll be enabled to manage and grow relationships at every stage of the patient journey. The more patient-centric you become, the better experience you build, reaching a higher quality of patient care, patient retention and loyalty, and improved health outcomes and overall well-being.

Get in touch to find out more about how we can help you with patient journey mapping

“Working with Highland is a really powerful experience for a company to be able to gain insights. To have real conversations with patients unlocks new pathways, ones that may be uncomfortable and uncover change, but they empower you to move forward in a way that feels really constructive.”

Chris Whitworth, Vice President, Treatment

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Article Contents

Introduction, why patient journey mapping, how is patient journey mapping conducted, use of technology in patient journey mapping, future implications for patient journey mapping, conclusions, patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services.

Lemma N Bulto and Ellen Davies Shared first authorship.

Conflict of interest: none declared.

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Lemma N Bulto, Ellen Davies, Janet Kelly, Jeroen M Hendriks, Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services, European Journal of Cardiovascular Nursing , 2024;, zvae012, https://doi.org/10.1093/eurjcn/zvae012

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Patient journey mapping is an emerging field of research that uses various methods to map and report evidence relating to patient experiences and interactions with healthcare providers, services, and systems. This research often involves the development of visual, narrative, and descriptive maps or tables, which describe patient journeys and transitions into, through, and out of health services. This methods corner paper presents an overview of how patient journey mapping has been conducted within the health sector, providing cardiovascular examples. It introduces six key steps for conducting patient journey mapping and describes the opportunities and benefits of using patient journey mapping and future implications of using this approach.

Acquire an understanding of patient journey mapping and the methods and steps employed.

Examine practical and clinical examples in which patient journey mapping has been adopted in cardiac care to explore the perspectives and experiences of patients, family members, and healthcare professionals.

Quality and safety guidelines in healthcare services are increasingly encouraging and mandating engagement of patients, clients, and consumers in partnerships. 1 The aim of many of these partnerships is to consider how health services can be improved, in relation to accessibility, service delivery, discharge, and referral. 2 , 3 Patient journey mapping is a research approach increasingly being adopted to explore these experiences in healthcare. 3

a patient-oriented project that has been undertaken to better understand barriers, facilitators, experiences, interactions with services and/or outcomes for individuals and/or their carers, and family members as they enter, navigate, experience and exit one or more services in a health system by documenting elements of the journey to produce a visual or descriptive map. 3

It is an emerging field with a clear patient-centred focus, as opposed to studies that track patient flow, demand, and movement. As a general principle, patient journey mapping projects will provide evidence of patient perspectives and highlight experiences through the patient and consumer lens.

Patient journey mapping can provide significant insights that enable responsive and context-specific strategies for improving patient healthcare experiences and outcomes to be designed and implemented. 3–6 These improvements can occur at the individual patient, model of care, and/or health system level. As with other emerging methodologies, questions have been raised regarding exactly how patient journey mapping projects can best be designed, conducted, and reported. 3

In this methods paper, we provide an overview of patient journey mapping as an emergent field of research, including reasons that mapping patient journeys might be considered, methods that can be adopted, the principles that can guide patient journey mapping data collection and analysis, and considerations for reporting findings and recognizing the implications of findings. We summarize and draw on five cardiovascular patient journey mapping projects, as examples.

One of the most appealing elements of the patient journey mapping field of research is its focus on illuminating the lived experiences of patients and/or their family members, and the health professionals caring for them, methodically and purposefully. Patient journey mapping has an ability to provide detailed information about patient experiences, gaps in health services, and barriers and facilitators for access to health services. This information can be used independently, or alongside information from larger data sets, to adapt and improve models of care relevant to the population that is being investigated. 3

To date, the most frequent reason for adopting this approach is to inform health service redesign and improvement. 3 , 7 , 8 Other reasons have included: (i) to develop a deeper understanding of a person’s entire journey through health systems; 3 (ii) to identify delays in diagnosis or treatment (often described as bottlenecks); 9 (iii) to identify gaps in care and unmet needs; (iv) to evaluate continuity of care across health services and regions; 10 (v) to understand and evaluate the comprehensiveness of care; 11 (vi) to understand how people are navigating health systems and services; and (vii) to compare patient experiences with practice guidelines and standards of care.

Patient journey mapping approaches frequently use six broad steps that help facilitate the preparation and execution of research projects. These are outlined in the Central illustration . We acknowledge that not all patient journey mapping approaches will follow the order outlined in the Central illustration , but all steps need to be considered at some point throughout each project to ensure that research is undertaken rigorously, appropriately, and in alignment with best practice research principles.

Steps for conducing patient journey mapping.

Five cardiovascular patient journey mapping research examples have been included in Figure 1 , 12–16 to provide specific context and illustrate these six steps. For each of these examples, the problem or gap in practice or research, consultation processes, research question or aim, type of mapping, methods, and reporting of findings have been extracted. Each of these steps is then discussed, using these cardiovascular examples.

Examples of patient journey mapping projects.

Define the problem or gap in practice or research

Developing an understanding of a problem or gap in practice is essential for facilitating the design and development of quality research projects. In the examples outlined in Figure 1 , it is evident that clinical variation or system gaps have been explored using patient journey mapping. In the first two examples, populations known to have health vulnerabilities were explored—in Example 1, this related to comorbid substance use and physical illness, 13 and in Example 2, this related to geographical location. 13 Broader systems and societal gaps were explored in Examples 4 and 5, respectively, 15 , 16 and in Example 3, a new technologically driven solution for an existing model of care was tested for its ability to improve patient outcomes relating to hypertension. 14

Consultation, engagement, and partnership

Ideally, consultation with heathcare providers and/or patients would occur when the problem or gap in practice or research is being defined. This is a key principle of co-designed research. 17 Numerous existing frameworks for supporting patient involvement in research have been designed and were recently documented and explored in a systematic review by Greenhalgh et al . 18 While none of the five example studies included this step in the initial phase of the project, it is increasingly being undertaken in patient partnership projects internationally (e.g. in renal care). 17 If not in the project conceptualization phase, consultation may occur during the data collection or analysis phase, as demonstrated in Example 3, where a care pathway was co-created with participants. 14 We refer readers to Greenhalgh’s systematic review as a starting point for considering suitable frameworks for engaging participants in consultation, partnership, and co-design of patient journey mapping projects. 18

Design the research question/project aim

Conducting patient journey mapping research requires a thoughtful and systematic approach to adequately capture the complexity of the healthcare experience. First, the research objectives and questions should be clearly defined. Aspects of the patient journey that will be explored need to be identified. Then, a robust approach must be developed, taking into account whether qualitative, quantitative, or mixed methods are more appropriate for the objectives of the study.

For example, in the cardiac examples in Figure 1 , the broad aims included mapping existing pathways through health services where there were known problems 12 , 13 , 15 , 16 and documenting the co-creation of a new care pathway using quantitative, qualitative, or mixed methods. 14

In traditional studies, questions that might be addressed in the area of patient movement in health systems include data collected through the health systems databases, such as ‘What is the length of stay for x population’, or ‘What is the door to balloon time in this hospital?’ In contrast, patient mapping journey studies will approach asking questions about experiences that require data from patients and their family members, e.g. ‘What is the impact on you of your length of stay?’, ‘What was your experience in being assessed and undergoing treatment for your chest pain?’, ‘What was your experience supporting this patient during their cardiac admission and discharge?’

Select appropriate type of mapping

The methods chosen for mapping need to align with the identified purpose for mapping and the aim or question that was designed in Step 3. A range of research methods have been used in patient journey mapping projects involving various qualitative, quantitative, and mixed methods techniques and tools. 4 Some approaches use traditional forms of data collection, such as short-form and long-form patient interviews, focus groups, and direct patient observations. 18 , 19 Other approaches use patient journey mapping tools, designed and used with specific cultural groups, such as First Nations peoples using artwork, paintings, sand trays, and photovoice. 17 , 20 In the cardiovascular examples presented in Figure 1 , both qualitative and quantitative methods have been used, with interviews, patient record reviews, and observational techniques adopted to map patient journeys.

In a recent scoping review investigating patient journey mapping across all health care settings and specialities, six types of patient journey mapping were identified. 3 These included (i) mapping key experiences throughout a period of illness; (ii) mapping by location of health service; (iii) mapping by events that occurred throughout a period of illness; (iv) mapping roles, input, and experiences of key stakeholders throughout patient journeys; (v) mapping a journey from multiple perspectives; and (vi) mapping a timeline of events. 3 Combinations or variations of these may be used in cardiovascular settings in the future, depending on the research question, and the reasons mapping is being undertaken.

Recruit, collect data, and analyse data

The majority of health-focused patient journey mapping projects published to date have recruited <50 participants. 3 Projects with fewer participants tend to be qualitative in nature. In the cardiovascular examples provided in Figure 1 , participant numbers range from 7 14 to 260. 15 The 3 studies with <20 participants were qualitative, 12 , 14 , 16 and the 2 with 95 and 260 participants, respectively, were quantitative. 13 , 15 As seen in these and wider patient journey mapping examples, 3 participants may include patients, relatives, carers, healthcare professionals, or other stakeholders, as required, to meet the study objectives. These different participant perspectives may be analysed within each participant group and/or across the wider cohort to provide insights into experiences, and the contextual factors that shape these experiences.

The approach chosen for data collection and analysis will vary and depends on the research question. What differentiates data analysis in patient journey mapping studies from other qualitative or quantitative studies is the focus on describing, defining, or exploring the journey from a patient’s, rather than a health service, perspective. Dimensions that may, therefore, be highlighted in the analysis include timing of service access, duration of delays to service access, physical location of services relative to a patient’s home, comparison of care received vs. benchmarked care, placing focus on the patient perspective.

The mapping of individual patient journeys may take place during data collection with the use of mapping templates (tables, diagrams, and figures) and/or later in the analysis phase with the use of inductive or deductive analysis, mapping tables, or frameworks. These have been characterized and visually represented in a recent scoping review. 3 Representations of patient journeys can also be constructed through a secondary analysis of previously collected data. In these instances, qualitative data (i.e. interviews and focus group transcripts) have been re-analysed to understand whether a patient journey narrative can be extracted and reported. Undertaking these projects triggers a new research cycle involving the six steps outlined in the Central illustration . The difference in these instances is that the data are already collected for Step 5.

Report findings, disseminate findings, and take action on findings

A standardized, formal reporting guideline for patient journey mapping research does not currently exist. As argued in Davies et al ., 3 a dedicated reporting guide for patient journey mapping would be ill-advised, given the diversity of approaches and methods that have been adopted in this field. Our recommendation is for projects to be reported in accordance with formal guidelines that best align with the research methods that have been adopted. For example, COREQ may be used for patient journey mapping where qualitative methods have been used. 20 STROBE may be used for patient journey mapping where quantitative methods have been used. 21 Whichever methods have been adopted, reporting of projects should be transparent, rigorous, and contain enough detail to the extent that the principles of transparency, trustworthiness, and reproducibility are upheld. 3

Dissemination of research findings needs to include the research, healthcare, and broader communities. Dissemination methods may include academic publications, conference presentations, and communication with relevant stakeholders including healthcare professionals, policymakers, and patient advocacy groups. Based on the findings and identified insights, stakeholders can collaboratively design and implement interventions, programmes, or improvements in healthcare delivery that overcome the identified challenges directly and address and improve the overall patient experience. This cyclical process can hopefully produce research that not only informs but also leads to tangible improvements in healthcare practice and policy.

Patient journey mapping is typically a hands-on process, relying on surveys, interviews, and observational research. The technology that supports this research has, to date, included word processing software, and data analysis packages, such as NVivo, SPSS, and Stata. With the advent of more sophisticated technological tools, such as electronic health records, data analytics programmes, and patient tracking systems, healthcare providers and researchers can potentially use this technology to complement and enhance patient journey mapping research. 19 , 20 , 22 There are existing examples where technology has been harnessed in patient journey. Lee et al . used patient journey mapping to verify disease treatment data from the perspective of the patient, and then the authors developed a mobile prototype that organizes and visualizes personal health information according to the patient-centred journey map. They used a visualization approach for analysing medical information in personal health management and examined the medical information representation of seven mobile health apps that were used by patients and individuals. The apps provide easy access to patient health information; they primarily import data from the hospital database, without the need for patients to create their own medical records and information. 23

In another example, Wauben et al. 19 used radio frequency identification technology (a wireless system that is able to track a patient journey), as a component of their patient journey mapping project, to track surgical day care patients to increase patient flow, reduce wait times, and improve patient and staff satisfaction.

Patient journey mapping has emerged as a valuable research methodology in healthcare, providing a comprehensive and patient-centric approach to understanding the entire spectrum of a patient’s experience within the healthcare system. Future implications of this methodology are promising, particularly for transforming and redesigning healthcare delivery and improving patient outcomes. The impact may be most profound in the following key areas:

Personalized, patient-centred care : The methodology allows healthcare providers to gain deep insights into individual patient experiences. This information can be leveraged to deliver personalized, patient-centric care, based on the needs, values, and preferences of each patient, and aligned with guideline recommendations, healthcare professionals can tailor interventions and treatment plans to optimize patient and clinical outcomes.

Enhanced communication, collaboration, and co-design : Mapping patient interactions with health professionals and journeys within and across health services enables specific gaps in communication and collaboration to be highlighted and potentially informs responsive strategies for improvement. Ideally, these strategies would be co-designed with patients and health professionals, leading to improved care co-ordination and healthcare experience and outcomes.

Patient engagement and empowerment : When patients are invited to share their health journey experiences, and see visual or written representations of their journeys, they may come to understand their own health situation more deeply. Potentially, this may lead to increased health literacy, renewed adherence to treatment plans, and/or self-management of chronic conditions such as cardiovascular disease. Given these benefits, we recommend that patients be provided with the findings of research and quality improvement projects with which they are involved, to close the loop, and to ensure that the findings are appropriately disseminated.

Patient journey mapping is an emerging field of research. Methods used in patient journey mapping projects have varied quite significantly; however, there are common research processes that can be followed to produce high-quality, insightful, and valuable research outputs. Insights gained from patient journey mapping can facilitate the identification of areas for enhancement within healthcare systems and inform the design of patient-centric solutions that prioritize the quality of care and patient outcomes, and patient satisfaction. Using patient journey mapping research can enable healthcare providers to forge stronger patient–provider relationships and co-design improved health service quality, patient experiences, and outcomes.

None declared.

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• Published: 04 December 2019

“Patient Journeys”: improving care by patient involvement

• Matt Bolz-Johnson 1 ,
• Jelena Meek 2 &
• Nicoline Hoogerbrugge 2  

European Journal of Human Genetics volume  28 ,  pages 141–143 ( 2020 ) Cite this article

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“I will not be ashamed to say ‘ I don’t know’ , nor will I fail to call in my colleagues…”. For centuries this quotation from the Hippocratic oath, has been taken by medical doctors. But what if there are no other healthcare professionals to call in, and the person with the most experience of the disease is sitting right in front of you: ‘ your patient ’.

This scenario is uncomfortably common for patients living with a rare disease when seeking out health care. They are fraught by many hurdles along their health care pathway. From diagnosis to treatment and follow-up, their healthcare pathway is defined by a fog of uncertainties, lack of effective treatments and a multitude of dead-ends. This is the prevailing situation for many because for rare diseases expertise is limited and knowledge is scarce. Currently different initiatives to involve patients in developing clinical guidelines have been taken [ 1 ], however there is no common method that successfully integrates their experience and needs of living with a rare disease into development of healthcare services.

Even though listening to the expertise of a single patient is valuable and important, this will not resolve the uncertainties most rare disease patients are currently facing. To improve care for rare diseases we must draw on all the available knowledge, both from professional experts and patients, in order to improve care for every single patient in the world.

Patient experience and satisfaction have been demonstrated to be the single most important aspect in assessing the quality of healthcare [ 2 ], and has even been shown to be a predictor of survival rates [ 3 ]. Studies have evidenced that patient involvement in the design, evaluation and designation of healthcare services, improves the relevance and quality of the services, as well as improves their ability to meet patient needs [ 4 , 5 , 6 ]. Essentially, to be able to involve patients, the hurdles in communication and initial preconceptions between medical doctors and their patients need to be resolved [ 7 ].

To tackle the current hurdles in complex or rare diseases, European Reference Networks (ERN) have been implemented since March 2017. The goal of these networks is to connect experts across Europe, harnessing their collective experience and expertise, facilitating the knowledge to travel instead of the patient. ERN GENTURIS is the Network leading on genetic tumour risk syndromes (genturis), which are inherited disorders which strongly predispose to the development of tumours [ 8 ]. They share similar challenges: delay in diagnosis, lack of cancer prevention for patients and healthy relatives, and therapeutic. To overcome the hurdles every patient faces, ERN GENTURIS ( www.genturis.eu ) has developed an innovative visual approach for patient input into the Network, to share their expertise and experience: “Patient Journeys” (Fig.  1 ).

Example of a Patient Journey: PTEN Hamartoma Tumour Syndrome (also called Cowden Syndrome), including legend page ( www.genturis.eu )

The “Patient Journey” seeks to identify the needs that are common for all ‘ genturis syndromes ’, and those that are specific to individual syndromes. To achieve this, patient representatives completed a mapping exercise of the needs of each rare inherited syndrome they represent, across the different stages of the Patient Journey. The “Patient Journey” connects professional expert guidelines—with foreseen medical interventions, screening, treatment—with patient needs –both medical and psychological. Each “Patient Journey” is divided in several stages that are considered inherent to the specific disease. Each stage in the journey is referenced under three levels: clinical presentation, challenges and needs identified by patients, and their goal to improve care. The final Patient Journey is reviewed by both patients and professional experts. By visualizing this in a comprehensive manner, patients and their caregivers are able to discuss the individual needs of the patient, while keeping in mind the expertise of both professional and patient leads. Together they seek to achieve the same goal: improving care for every patient with a genetic tumour risk syndrome.

The Patient Journeys encourage experts to look into national guidelines. In addition, they identify a great need for evidence-based European guidelines, facilitating equal care to all rare patients. ERN GENTURIS has already developed Patient Journeys for the following rare diseases ( www.genturis.eu ):

PTEN hamartoma tumour syndrome (PHTS) (Fig.  1 )

Hereditary breast and ovarian cancer (HBOC)

Lynch syndrome

Neurofibromatosis Type 1

Neurofibromatosis Type 2

Schwannomatosis

A “Patient Journey” is a personal testimony that reflects the needs of patients in two key reference documents—an accessible visual overview, supported by a detailed information matrix. The journey shows in a comprehensive way the goals that are recognized by both patients and clinical experts. Therefore, it can be used by both these parties to explain the clinical pathway: professional experts can explain to newly identified patients how the clinical pathway generally looks like, whereas their patients can identify their specific needs within these pathways. Moreover, the Patient Journeys could serve as a guide for patients who may want to write, in collaboration with local clinicians, diaries of their journeys. Subsequently, these clinical diaries can be discussed with the clinician and patient representatives. Professionals coming across medical obstacles during the patient journey can contact professional experts in the ERN GENTURIS, while patients can contact the expert patient representatives from this ERN ( www.genturis.eu ). Finally, the “Patient Journeys” will be valuable in sharing knowledge with the clinical community as a whole.

Our aim is that medical doctors confronted with rare diseases, by using Patient Journeys, can also rely on the knowledge of the much broader community of expert professionals and expert patients.

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Acknowledgements

This work is generated within the European Reference Network on Genetic Tumour Risk Syndromes – FPA No. 739547. The authors thank all ERN GENTURIS Members and patient representatives for their work on the Patient Journeys (see www.genturis.eu ).

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Bolz-Johnson, M., Meek, J. & Hoogerbrugge, N. “Patient Journeys”: improving care by patient involvement. Eur J Hum Genet 28 , 141–143 (2020). https://doi.org/10.1038/s41431-019-0555-6

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DOI : https://doi.org/10.1038/s41431-019-0555-6

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• What is Patient Experience & Why It Is Importance ?

A Comprehensive Guide to Patient Journey Mapping

• Author: Wavetec
• Published: January 26, 2024

Is regulating patient experience at your healthcare service a challenging task? If your patients leave the hospital unsatisfied with the service, we have a solution for you!

Patient journey mapping is vital in understanding your patient’s experience at every step of interaction with the hospital, whether virtual or physical. This allows you to empathize with your patients, facilitate their experience, and contribute in uncertain and stressful times.

Parallel to the patient’s journey, healthcare systems face increasing challenges in patient management, regulating space constraints, limiting healthcare providers, and budgeting. By mapping the patient journey , you can pinpoint the shortfalls in your management services, improve facilities, and increase patient turnout.

The patient journey map must be curated in detail, accounting for various touchpoints and patient perceptions. The most accurate method of measuring healthcare quality is pairing patient journey maps with patient satisfaction scores, such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHPS) and a Net Promoter Score (NPS) .

Higher scores speak volumes about your healthcare services, increase patient retention, and promise returns.

What is Patient Journey Mapping?

Patient Journey Mapping is a strategic tool in healthcare that visually illustrates the entire patient experience, from initial contact to post-treatment follow-up. It involves mapping out key touchpoints and stages, such as appointment scheduling, diagnosis, treatment, and aftercare.

This process allows healthcare providers to understand the patient’s pathway through the healthcare system comprehensively.

Amidst the changing landscape of the healthcare industry, patients look for service providers that offer a personalized experience. Besides renowned healthcare providers, patients look for a human-centric environment that provides timely and efficient services.

Moreover, modern consumer requirements demand a digital transformation of healthcare services.

Healthcare managers can use patient journey maps to visualize the blind spots and pain points in a patient’s experience. A distinguished healthcare service sees journey mapping as a powerful tool that tells about a patient’s well-being and connects care providers with their emotional journeys.

You can make your practices to be more empathetic and make a difficult journey seamless.

The Benefits of Patient Journey Mapping

Investing in patient experience mapping carries benefits for both parties, care providers and patients. We have highlighted some benefits of journey mapping below:

Improved patient communication

Identifying unaddressed patient issues helps build a connection with the patient. Keeping them at the model’s center and informing them of changes before their visit reduces frustration and confusion.

Continuous patient care

With a streamlined workflow, staff members and care providers can remove uncertainties from a patient’s care journey. An integrated healthcare system removes loopholes, such as overbooked appointments, which otherwise lead to negative patient feelings.

Personalized care

Given the nature of the treatment plans and services offered by the healthcare industry, a one-shoe-fits-all theory does not apply to the consumers. By integrating patient data with business models, you can provide a customized experience to the patients.

Turn-out increases when patients receive automated appointment reminders and physician availability updates.

Improved Efficiency

Patient journey maps identify the demand for time management and sensitivity in healthcare. Feasibility arrangements such as pre-booking appointments, receiving digital laboratory reports, and online consultations boost patient satisfaction.

Patient retention and profitability

Patient feedback is crucial to introducing or revising policies, growth opportunities, and consistent revenues.

Seamless Patient Journey

With our intuitive interface, patients can easily register, check-in, and monitor their queue status. This reduces their anxiety, improves their overall experience, and fosters a positive perception of your healthcare facility.

7 Key Stages in the Patient Journey

Patient journey mapping differs for each hospital or clinic, depending on the care level. Most tertiary care hospitals identify three key stages when patients experience mapping .

Touchpoints of each step may differ slightly in pregnancies, emergency services, and outpatient departments.

Let’s read about the details of each stage below:

1. Awareness:

• This stage often begins with recognizing symptoms, changes in health, or routine checkups revealing potential issues.
• Patients may notice something is amiss, prompting them to seek further information or professional advice.

2. Consideration:

• Information gathering kicks into high gear. Patients may research their symptoms, explore potential causes, and consider various treatment options.
• Seeking advice from healthcare professionals, friends, or family members becomes a key part of this stage.

3. Decision:

• Armed with information, patients make decisions about their course of action. This could involve choosing a specific healthcare provider, deciding on a treatment plan, or committing to lifestyle changes.
• The decision-making process may also involve discussions with healthcare professionals to ensure alignment with the patient’s values and preferences.

4. Engagement:

• This is the active phase, where patients interact with healthcare providers, undergo diagnostic tests, and initiate the chosen treatment plan.
• Open communication between the patient and the healthcare team is crucial during this stage to address concerns, clarify expectations, and ensure a collaborative approach.

5. Treatment and Recovery:

• The chosen treatment plan is implemented, whether it’s medication, surgery, therapy, or a combination of interventions.
• Recovery involves monitoring progress, managing potential side effects, and adapting the treatment plan as needed.

6. Follow-Up and Maintenance:

• Post-treatment, patients often enter a phase of follow-up care. This can include regular check-ups, monitoring for recurrence, and adjusting treatment plans as necessary.
• Lifestyle changes and ongoing self-care may be emphasized to maintain health and prevent future issues.

7. End-of-Life Care (if applicable):

• In cases of terminal illness, this stage involves compassionate and supportive care. Palliative care aims to enhance quality of life, manage symptoms, and provide emotional and spiritual support.
• This stage emphasizes open communication about end-of-life preferences and ensures a dignified and comfortable experience for the patient and their loved ones.

Analyzing the Patient Journey Map

Once you have designed a patient journey map for your service, the correct way of utilizing the maps is to identify the pain points. Next, we enlist and discuss some common hurdles patients face that delay prompt care, including internal and external factors or barriers to healthcare.

1- Pre-visit

• The patient feels anxious about the medical condition.
• The website needs more information about the healthcare facility to make patients satisfied. Your website must be SEO-friendly and listed on Google to regulate patient management.
• During this stage, missed phone calls and confusing appointment scheduling tasks lead to care provision delays.
• Limited communication with consultants before visiting

2- At the healthcare facility

• Filling out the pre-appointment questionnaire is time-consuming and makes patients uneasy.
• Lengthy waiting times and mismanaged queues for appointments reduces patient satisfaction. Patients waiting at the facility can be guided using digital signage that communicates announcements, turns, and navigates around the healthcare facility.
• Explaining old symptoms and information to the same care provider at every visit frustrates patients.

3- Post-treatment plan

• Billing and initiating the hospital discharge process is often tedious.
• Receiving feedback from patients to measure patient satisfaction.
• Unable to monitor the patient at home and set up follow-up appointments creates mistrust between the patient and the doctor.

Gain valuable insights

Leverage our healthcare queue management system’s data to make informed decisions to improve the patient experience. We have seen up to a 35% increase in patient satisfaction.

Patient Journey Mapping Template

We have designed templates of patient journey maps to help you make the best one for your hospital system. As shown in the samples, patients visiting different departments have specific touchpoints. For example, a patient scheduling his appointment for the outpatient department will research the clinic and the primary caregiver.

However, the primary concern for patients requiring urgent care will be prompt ambulance services and treatment. Despite the differences, all patient journey maps are based on three key stages: pre-hospital care, in-hospital care, and post-treatment plans.

Patient Journey Improvement Solutions

If you want to enhance patient flow management and boost patient satisfaction at your hospital, we recommend using pre-engineered solutions. There are many ways to improve the quality of service you provide to your patients.

One such solution is the Wavetec patient flow system. Adopting a digital healthcare system can optimize patient-doctor interaction and improve investment returns.

We have put together the most impactful solutions your facility can sign-up for each stage of the patient journey map. Here’s what they are:

• Online appointment and booking
• Queue management – People counting, WhatsApp Queuing, Queue management applications, Digital Signage
• Patient application
• Self-check-in kiosks
• Integrated manager dashboards and analytics
• Customer feedback reports
• Curbside pickups

Let’s learn about each solution and how it will benefit your healthcare center.

1. Simplify Online Appointment Booking

Before visiting the facility, patients can schedule online appointments and ticketing on the website or patient application with their preferred physician. This service allows your patients to book seamlessly, check-in and receive wait time or canceled appointment notifications. Satisfying your customer before they arrive mitigates their already-high worry levels.

2. Patient Management

Waiting in queues for examination rooms and healthcare providers is a major source of concern for patients. You can reduce perceived wait times by giving patients a virtual waiting room. This can be done by signing up for WhatsApp Queuing and the Queue Management Mobile App. These services give patients virtual tickets and wait time notifications, allowing them to manage time effectively.

Walk-in patients and patients with pre-booked appointments can also use automated, self-service kiosks at the facility to check in or reschedule appointments. Patients can scan the displayed QR code or use biometrics technology to receive tickets via SMS, Email or WhatsApp.

You can manage the patient count in the waiting area using a real-time counter and digital signage . This helps emergency case patients to navigate the hospital without confusion.

3. Promoting Patient Satisfaction

Many patients must visit the healthcare facility multiple times to collect laboratory reports, prescriptions, and medications. You can facilitate this tedious process by providing delivery and curbside pickup options. This regulates unnecessary traffic at your hospital and saves time for patients.

Investing in Patient Applications is a great marketing tool and a one-stop solution to patient worries. Individuals can learn more about your facility’s services, access laboratory reports, initiate billing, and receive updates and reminder notifications. This is particularly useful in conducting telehealth rotations with expecting mothers and palliative care patients who cannot visit the facility often.

4. Patient Feedback

Receiving your consumer’s feedback and solving their queries ensures a successful approach to patient journey mapping. Wavetec has designed a customer feedback solution to measure customer satisfaction and follow up on your staff’s performance.

Additionally, you can get a management portal for the hospital staff and care providers. This can be integrated with patient data to give healthcare providers complete information.

Softwares such as Spectra include dashboard analytics and reports on the performance of each department to help you identify the shortfalls. This will help you build a congregated team that runs operations smoothly in the patient’s best interest.

Studies have shown that facilities using solution experience up to a 50% decrease in missed appointments, optimizing resource utilization and increasing revenue.

The modern healthcare system requires providers to be more involved in providing a seamless patient experience. In this blog, we highlight the role of patient journey mapping to help you identify touchpoints in a patient’s journey. Before, during, and after treatment, it is crucial to comprehend the patient’s viewpoint to ensure proper care.

Patient journey solutions are, therefore, integral in distinguishing your healthcare facility. Investing in patient applications, queue management software, receiving customer feedback, and analyzing it is vital in improving your standing.

Adopt our solutions, transform the healthcare industry, and make your approach more empathetic!

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Patient Journey Mapping: What Is It & Why Does It Matter

Without a doubt, patient satisfaction is the cornerstone of any medical practice’s success.

After all, it improves patient retention and increases the likelihood of patients recommending your healthcare practice to their family and friends.

But, let’s be honest, providing patient satisfaction is easier said than done. With your patients likely having different expectations, ensuring that each and everyone is satisfied with your services can be quite a challenge.

Well, with patient journey mapping, meeting patient expectations and improving the patient experience becomes much easier!

Not sure what patient journey actually is or how to use patient journey mapping to enhance your medical practice?

We’ve got you covered. In this article, you will learn:

What is the Patient Journey?

Why is patient journey mapping important, advantages of patient journey mapping, what does a patient’s journey consist of, what are the steps of a successful patient journey.

Put simply, a patient journey defines the entire experience a patient goes through during their medical treatment at your healthcare facility.

As such, the patient journey covers the whole medical process (virtual and in-person), from developing symptoms and scheduling a doctor’s appointment to completing the medical treatment and beyond.

Patient journey mapping, in turn, gives a detailed overview of all the stages a patient goes through during their entire interaction with a specific healthcare facility. In turn, this helps healthcare providers to improve patient experience and increase patient satisfaction.

Medesk helps to manage the work with patients. The platform tracks the entire history of interaction with them: from the attraction channel to the profit received.

Patient journey mapping is vital to the success of your medical practice as it helps you to:

• Manage and meet patient expectations .
• Identify your medical practice’s weak spots, which allows you to effectively improve your medical practice.
• Get valuable insight and evaluate your medical practice from the patient’s perspective.
• Create a personalized, hyper-targeted patient experience.
• Effectively allocate your budget to improve your medical practice’s efficiency and performance.
• Deliver successful treatment outcomes by improving your healthcare quality.
• Increase patient engagement and patient satisfaction, leading to better patient retention .

Patient journey mapping has numerous advantages for healthcare providers and patients alike, including:

• Seamless, comprehensive, and continuous patient care . Patient journey mapping allows you to identify gaps and blind spots that bring down the quality of your healthcare services such as ineffective use of medical technology.
• Effective communication between healthcare providers and patients . Patient journey mapping allows you to improve communications by helping you spot and solve communication issues, such as inconsistency, lack of clarity, insufficient medical updates, and more.
• Clinical workflow optimization . Patient journey mapping can help you assess and optimize your clinical workflow and processes to deliver high-quality care for your patients, improve treatment outcomes, and increase patient satisfaction.
• Healthcare efficiency . By optimizing your clinical workflow, providing staff with clear instructions, and improving communication between patients and healthcare providers, patient journey mapping helps to improve your medical practice’s efficiency and performance.
• Patient retention . Patient journey mapping can effectively improve patient retention rates by promoting clear communication, improving treatment outcomes, and ensuring an excellent patient experience. In turn, patient journey mapping builds trust and loyalty, which can encourage patients to refer your medical practice to family and friends.
• Improved staff performance . Patient journey mapping can help you to optimize internal processes and online tools, allowing for more automation. This way, patient journey mapping can improve your staff performance and efficiency.
• Stress and anxiety reduction . By helping to bridge communication gaps, optimize workflows, and more, patient journey mapping helps to alleviate stress and anxiety. For example, patient journey mapping can improve your patient and family update system, allowing patients and family members to get medical updates via text.
• Effective patient flow management . Patient journey mapping allows medical practices to optimize and manage patient flow by ensuring smooth admission, procedure scheduling, and discharging processes.

As we mentioned above, the patient journey covers the entire patient experience.

That being said, the patient journey doesn’t simply refer to the typical interaction between a patient and a healthcare provider. Instead, it also encompasses the patient experience before and after their visit to the healthcare facility.

In essence, the patient journey consists of three main stages, which include:

• Pre-visit stage
• During-visit stage
• Post-visit stage

So, let’s take a closer look at each of them.

Pre-visit Stage

The pre-visit stage is the beginning of a patient journey, which can include:

• Noticing symptoms and self-assessing the health condition
• Researching symptoms, healthcare services, and more
• Browsing the Internet to find a healthcare practitioner
• Scheduling an appointment (in-person, online, or via phone call)
• Navigating the healthcare facility upon initial arrival

Put simply, the beginning of the patient journey sets the tone and expectations for the whole patient experience.

A confusing and complicated pre-visit experience, for example, can lead the patient to experience stress, discomfort, confusion, frustration, and anxiety.

For this reason, it’s important to make sure that the patient journey begins with a positive pre-visit experience, as it can impact the patient’s emotional state and well-being and thus affect the patient’s future interaction with the healthcare facility.

During-visit Stage

The during-visit stage covers the entire patient experience at your healthcare facility upon the patient’s arrival, including activities such as:

• Checking in, either at the front desk or at a self-service kiosk.
• Waiting for the appointment in the waiting room.
• Interacting and communicating with the staff, including front-desk, nurses, doctors, etc.
• Receiving healthcare treatment.
• Updating family members on the patient’s condition and treatment.

By making sure that your patients have a positive experience during their visit, you can improve patient satisfaction, reduce patient dropout rates, and improve treatment outcomes.

Post-visit Stage

Although the post-visit stage often gets the least attention, this last stage of the patient journey is crucial to improving patient retention.

The post-visit stage includes the following:

• Instructing patients on aftercare
• Discharging patients from the hospital
• Receiving and analyzing patient feedback
• Paying for the healthcare services
• Follow-up appointments

Essentially, optimizing the post-visit stage of the patient journey ensures patient retention, successful treatment outcomes, patient satisfaction, and an overall positive patient experience.

Using practice management software is one of the most important steps you can take to ensure a successful patient journey.

That’s because a well-designed practice management software comes with many tools and features that can tremendously improve each stage of the patient journey, such as:

• An online booking tool that can facilitate appointment booking and scheduling procedures, thus creating a positive experience before the visit.
• A medical billing tool can automate the payment procedures, which improves the patient experience during the visit.
• An integrated telemedicine software can be used to conduct follow-up appointments remotely, which promotes a successful patient journey after the visit by helping patients save time.

You will be able to conduct online patient appointments directly in Medesk. There is no need to use personal numbers, employee contacts or third-party programs. Within the platform, all actions and connections are performed on behalf of your clinic.

Not to mention, using practice management software optimizes your medical practice’s overall performance and efficiency, which can significantly boost patient satisfaction.

That being said, here are four additional steps you can take to ensure a successful patient journey at each stage:

• Optimize your healthcare website . For a positive pre-visit experience, take advantage of healthcare SEO . Optimizing your medical website for search engines allows your patients to easily find information about your healthcare services, medical practitioners, and more.
• Improve hospital wayfinding . Place hospital maps and navigation signs (e.g. for entrances, exits, parking, cafeteria, etc.) to help your patients find their way around your hospital. This can alleviate stress and save time , thus improving the patient experience.
• Upgrade your waiting room . For most patients, waiting is the most stressful part of visiting the doctor’s office . To provide a better waiting experience for your patients and their families during their visit, consider improving your waiting room .
• Collect and analyze patient feedback . Patient feedback surveys can reveal opportunities for improvement. For example, if many patients are unhappy with your receptionist’s communication , consider trying medical staff training .

Learn more about actual preferences of your patients and make right decisions via Management Reporting Module at Medesk.

And that’s all!

By now, you should have a better understanding of patient journey mapping.

Before you go, however, let’s quickly go over some of the key points of this article:

• The patient journey represents the entire experience a patient has at your medical practice, including before, during, and after receiving medical treatment.
• Patient journey mapping allows healthcare practitioners to get insight into their medical practice from the patient’s perspective, which helps to make necessary improvements.
• Patient journey mapping brings numerous advantages to both medical practices and patients, some of which include improved communication between healthcare providers and patients, optimized clinical workflows, and improved patient retention.
• Using practice management software can improve all stages of the patient journey.
• Improving hospital navigation, optimizing your practice’s website, collecting patient feedback, and upgrading your waiting room can help to ensure a successful patient journey.

Should You Charge Your Patient’s a No-Show Fee? Pros & Cons

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Process mapping the patient journey: an introduction

• Related content
• Peer review
• Timothy M Trebble , consultant gastroenterologist 1 ,
• Navjyot Hansi , CMT 2 1 ,
• Theresa Hydes , CMT 1 1 ,
• Melissa A Smith , specialist registrar 2 ,
• Marc Baker , senior faculty member 3
• 1 Department of Gastroenterology, Portsmouth Hospitals Trust, Portsmouth PO6 3LY
• 2 Department of Gastroenterology, Guy’s and St Thomas’ NHS Foundation Trust, London
• 3 Lean Enterprise Academy, Ross-on-Wye, Hertfordshire
• Correspondence to: T M Trebble tim.trebble{at}porthosp.nhs.uk
• Accepted 15 July 2010

Process mapping enables the reconfiguring of the patient journey from the patient’s perspective in order to improve quality of care and release resources. This paper provides a practical framework for using this versatile and simple technique in hospital.

Healthcare process mapping is a new and important form of clinical audit that examines how we manage the patient journey, using the patient’s perspective to identify problems and suggest improvements. 1 2 We outline the steps involved in mapping the patient’s journey, as we believe that a basic understanding of this versatile and simple technique, and when and how to use it, is valuable to clinicians who are developing clinical services.

What information does process mapping provide and what is it used for?

Process mapping allows us to “see” and understand the patient’s experience 3 by separating the management of a specific condition or treatment into a series of consecutive events or steps (activities, interventions, or staff interactions, for example). The sequence of these steps between two points (from admission to the accident and emergency department to discharge from the ward) can be viewed as a patient pathway or process of care. 4

Improving the patient pathway involves the coordination of multidisciplinary practice, aiming to maximise clinical efficacy and efficiency by eliminating ineffective and unnecessary care. 5 The data provided by process mapping can be used to redesign the patient pathway 4 6 to improve the quality or efficiency of clinical management and to alter the focus of care towards activities most valued by the patient.

Process mapping has shown clinical benefit across a variety of specialties, multidisciplinary teams, and healthcare systems. 7 8 9 The NHS Institute for Innovation and Improvement proposes a range of practical benefits using this approach (box 1). 6

Box 1 Benefits of process mapping 6

A starting point for an improvement project specific for your own place of work

Creating a culture of ownership, responsibility and accountability for your team

Illustrates a patient pathway or process, understanding it from a patient’s perspective

An aid to plan changes more effectively

Collecting ideas, often from staff who understand the system but who rarely contribute to change

An interactive event that engages staff

An end product (a process map) that is easy to understand and highly visual

Several management systems are available to support process mapping and pathway redesign. 10 11 A common technique, derived originally from the Japanese car maker Toyota, is known as lean thinking transformation. 3 12 This considers each step in a patient pathway in terms of the relative contribution towards the patient’s outcome, taken from the patient’s perspective: it improves the patient’s health, wellbeing, and experience (value adding) or it does not (non-value or “waste”) (box 2). 14 15 16

Box 2 The eight types of waste in health care 13

Defects —Drug prescription errors; incomplete surgical equipment

Overproduction —Inappropriate scheduling

Transportation —Distance between related departments

Waiting —By patients or staff

Inventory —Excess stores, that expire

Motion —Poor ergonomics

Overprocessing —A sledgehammer to crack a nut

Human potential —Not making the most of staff skills

Process mapping can be used to identify and characterise value and non-value steps in the patient pathway (also known as value stream mapping). Using lean thinking transformation to redesign the pathway aims to enhance the contribution of value steps and remove non-value steps. 17 In most processes, non-value steps account for nine times more effort than steps that add value. 18

Reviewing the patient journey is always beneficial, and therefore a process mapping exercise can be undertaken at any time. However, common indications include a need to improve patients’ satisfaction or quality or financial aspects of a particular clinical service.

How to organise a process mapping exercise

Process mapping requires a planned approach, as even apparently straightforward patient journeys can be complex, with many interdependent steps. 4 A process mapping exercise should be an enjoyable and creative experience for staff. In common with other audit techniques, it must avoid being confrontational or judgmental or used to “name, shame, and blame.” 8 19

Preparation and planning

A good first step is to form a team of four or five key staff, ideally including a member with previous experience of lean thinking transformation. The group should decide on a plan for the project and its scope; this can be visualised by using a flow diagram (fig 1 ⇓ ). Producing a rough initial draft of the patient journey can be useful for providing an overview of the exercise.

Fig 1 Steps involved in a process mapping exercise

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The medical literature or questionnaire studies of patients’ expectations and outcomes should be reviewed to identify value adding steps involved in the management of the clinical condition or intervention from the patient’s perspective. 1 3

Data collection

Data collection should include information on each step under routine clinical circumstances in the usual clinical environment. Information is needed on waiting episodes and bottlenecks (any step within the patient pathway that slows the overall rate of a patient’s progress, normally through reduced capacity or availability 20 ). Using estimates of minimum and maximum time for each step reduces the influence of day to day variations that may skew the data. Limiting the number of steps (to below 60) aids subsequent analysis.

The techniques used for data collection (table 1 ⇓ ) each have advantages and disadvantages; a combination of approaches can be applied, contributing different qualitative or quantitative information. The commonly used technique of walking the patient journey includes interviews with patients and staff and direct observation of the patient journey and clinical environment. It allows the investigator to “see” the patient journey at first hand. Involving junior (or student) doctors or nurses as interviewers may increase the openness of opinions from staff, and time needed for data collection can be reduced by allotting members of the team to investigate different stages in the patient’s journey.

 Data collection in process mapping

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Mapping the information

The process map should comprehensively represent the patient journey. It is common practice to draw the map by hand onto paper (often several metres long), either directly or on repositionable notes (fig 2 ⇓ ).

Fig 2 Section of a current state map of the endoscopy patient journey

Information relating to the steps or representing movement of information (request forms, results, etc) can be added. It is useful to obtain any missing information at this stage, either from staff within the meeting or by revisiting the clinical environment.

Analysing the data and problem solving

The map can be analysed by using a series of simple questions (box 3). The additional information can be added to the process map for visual representation. This can be helped by producing a workflow diagram—a map of the clinical environment, including information on patient, staff, and information movement (fig 3 ⇓ ). 18

Box 3 How to analyse a process map 6

How many steps are involved?

How many staff-staff interactions (handoffs)?

What is the time for each step and between each step?

What is the total time between start and finish (lead time)?

When does a patient join a queue, and is it a regular occurrence?

How many non-value steps are there?

What do patients complain about?

What are the problems for staff?

Fig 3 Workflow diagram of current state endoscopy pathway

Redesigning the patient journey

Lean thinking transformation involves redesigning the patient journey. 21 22 This will eliminate, combine and simplify non-value steps, 23 limit the impact of rate limiting steps (such as bottlenecks), and emphasise the value adding steps, making the process more patient-centred. 6 It is often useful to trial the new pathway and review its effect on patient management and satisfaction before attempting more sustained implementation.

Worked example: How to undertake a process mapping exercise

South Coast NHS Trust, a large district general hospital, plans to improve patient access to local services by offering unsedated endoscopy in two peripheral units. A consultant gastroenterologist has been asked to lead a process mapping exercise of the current patient journey to develop a fast track, high quality patient pathway.

In the absence of local data, he reviews the published literature and identifies key factors to the patient experience that include levels of discomfort during the procedure, time to discuss the findings with the endoscopist, and time spent waiting. 24 25 26 27 He recruits a team: an experienced performance manager, a sister from the endoscopy department, and two junior doctors.

The team drafts a map of the current endoscopy journey, using repositionable notes on the wall. This allows team members to identify the start (admission to the unit) and completion (discharge) points and the locations thought to be involved in the patient journey.

They decide to use a “walk the journey” format, interviewing staff in their clinical environments and allowing direct observation of the patient’s management.

The junior doctors visit the endoscopy unit over two days, building up rapport with the staff to ensure that they feel comfortable with being observed and interviewed (on a semistructured but informal basis). On each day they start at the point of admission at the reception office and follow the patient journey to completion.

They observe the process from staff and patient’s perspectives, sitting in on the booking process and the endoscopy procedure. They identify the sequence of steps and assess each for its duration (minimum and maximum times) and the factors that influence this. For some of the steps, they use a digital watch and notepad to check and record times. They also note staff-patient and staff-staff interactions and their function, and the recording and movement of relevant information.

Details for each step are entered into a simple table (table 2 ⇓ ), with relevant notes and symbols for bottlenecks and patients’ waits.

 Patient journey for non-sedated upper gastrointestinal endoscopy

When data collection is complete, the doctor organises a meeting with the team. The individual steps of the patient journey are mapped on a single long section of paper with coloured temporary markers (fig 2 ⇑ ); additional information is added in different colours. A workflow diagram is drawn to show the physical route of the patient journey (fig 3 ⇑ ).

The performance manager calculates that the total patient journey takes a minimum of 50 minutes to a maximum of 345 minutes. This variation mainly reflects waiting times before a number of bottleneck steps.

Only five steps (14 to 17 and 22, table 2 ⇑ ) are considered both to add value and needed on the day of the procedure (providing patient information and consent can be obtained before the patient attends the department). These represent from 13 to 47 minutes. At its least efficient, therefore, only 4% of the patient journey (13 of 345 minutes) is spent in activities that contribute directly towards the patient’s outcome.

The team redesigns the patient journey (fig 4 ⇓ ) to increase time spent on value adding aspects but reduce waiting times, bottlenecks, and travelling distances. For example, time for discussing the results of the procedure is increased but the location is moved from the end of the journey (a bottleneck) to shortly after the procedure in the anteroom, reducing the patient’s waiting time and staff’s travelling distances.

Fig 4 Workflow diagram of future state endoscopy pathway

Implementing changes and sustaining improvements

The endoscopy staff are consulted on the new patient pathway, which is then piloted. After successful review two months later, including a patient satisfaction questionnaire, the new patient pathway is formally adopted in the peripheral units.

Further reading

Practical applications.

NHS Institute for Innovation and Improvement ( https://www.institute.nhs.uk )—comprehensive online resource providing practical guidance on process mapping and service improvement

Lean Enterprise Academy ( http://www.leanuk.org )—independent body dedicated to lean thinking in industry and healthcare, through training and academic discussion; its publication, Making Hospitals Work 23 is a practical guide to lean transformation in the hospital environment

Manufacturing Institute ( http://www.manufacturinginstitute.co.uk )—undertakes courses on process mapping and lean thinking transformation within health care and industrial practice

Theoretical basis

Bircheno J. The new lean toolbox . 4th ed. Buckingham: PICSIE Books, 2008

Mould G, Bowers J, Ghattas M. The evolution of the pathway and its role in improving patient care. Qual Saf Health Care 2010 [online publication 29 April]

Layton A, Moss F, Morgan G. Mapping out the patient’s journey: experiences of developing pathways of care. Qual Health Care 1998; 7 (suppl):S30-6

Graban M. Lean hospitals, improving quality, patient safety and employee satisfaction . New York: Taylor & Francis, 2009

Womack JP, Jones DT. Lean thinking . 2nd ed. London: Simon & Schuster, 2003

Cite this as: BMJ 2010;341:c4078

Contributors: TMT designed the protocol and drafted the manuscript; TMT, MB, JH, and TH collected and analysed the data; all authors critically reviewed and contributed towards revision and production of the manuscript. TMT is guarantor.

Competing interests: MB is a senior faculty member carrying out research for the Lean Enterprise Academy and undertakes paid consultancies both individually and from Lean Enterprise Academy, and training fees for providing lean thinking in healthcare.

Provenance and peer review: Not commissioned; externally peer reviewed.

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Patient Journey

What is a patient journey.

Patient journey is a term referring to a patient’s experience throughout an episode of care, beginning at admission and concluding with hospital discharge.

The renewed focus on patient experience in recent years stems from growing trends in healthcare consumerization and value-based care initiatives . To remain competitive, providers are beginning to consider patients more as customers and, consequently, are working to improve the overall healthcare experience and keep patients within their networks.

Why is the patient journey important in healthcare?

Patient journey mapping allows healthcare providers and other industry stakeholders to gain a better understanding of the patient experience and to find new ways to improve all points of the patient journey.

By understanding the patient journey, providers can build a hyper-targeted experience that addresses the unique needs of each patient and delivers more successful patient outcomes. Improved patient experiences can also save providers money — for example, by reducing the average time to diagnosis.

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The patient journey: What it is and how it’s vital for success

10 min read In the digital age, the patient experience has become more complex but also more critical as it relates to patient retention, reimbursement, and patient satisfaction. In order to thrive in today’s healthcare landscape, it’s important to look at the patient journey when aiming to improve the patient experience.

Does your healthcare organisation ask patients for feedback following clinical encounters? This is a common approach used to improve the patient experience . You may gather key insights about a specific encounter, but you’ll miss out on an untapped system of important patient interactions throughout the care journey.

Improving patient experiences requires looking at the entire healthcare ecosystem. Patients communicate with their healthcare providers through a variety of channels, while interacting with a wide range of departments and individuals along the way.

To stand out in the market and provide an optimal experience for your patients, hospitals and health systems should look beyond clinical service delivery and begin patient journey mapping.

The patient journey is the entire sequence of events that begins when the patient first develops a need for clinical care and engages with your organisation. It follows the patient’s steps as they navigate your healthcare system, from initial scheduling to treatment to continuous care.

Learn how you can collect data and drive action along your patient journey

The patient journey vs. the patient experience

Why is the patient journey important? Each touchpoint of the patient engagement journey, from a simple visit to your website to checking in for an appointment, has downstream effects that can help or hinder meeting patient needs.

As the patient experience evolves, it’s important to expand how you are listening to your patients in order to close gaps and make continuous improvements.

In recent years, emphasis on the patient experience has become the focus of regulatory programs and payment incentives. Many quality measures today center around collecting patient feedback on the healthcare experience.

To satisfy these measures and drive quality improvement efforts, many organizations turn to post-transactional  patient satisfaction surveys. The feedback from these surveys often measures only a limited set of touchpoints while overlooking other critical data from the full patient journey.

A holistic view

Patient experience programs often hone in on clinical service delivery, and many regulatory programs focus solely on numerical scores to measure improvement. These approaches may fail to identify pain points occurring in dozens of patient interactions within a healthcare system.

A holistic view of the patient journey is the key to modernising and strengthening your efforts to meet your patients’ needs. By breaking down silos into separate patient events, you can begin to identify blind spots where hidden challenges exist in your patient experiences.

By the time your patients engage with their care providers, they’ve likely interacted with your organisation a number of times. These interactions can occur digitally, over the phone, or in person. Navigating your website, verifying insurance coverage, and scheduling an appointment are all examples of pain points that may be creating barriers to care.

It’s easy to assume any given touchpoint is more or less important than another. The fact is that each one provides unique value to the patient’s experience. Each of them plays a role in helping the patient achieve their goals.

Patient engagement with your organisation doesn’t begin when the patient is examined by the healthcare provider, or even when they enter your medical facility. From initial awareness  to ongoing care, the patient journey encompasses every separate interaction throughout the process of seeking, receiving, and continuing care within a health system.

There are several stages of the patient journey you should consider.

What triggers the patient’s need for care, and how does the patient learn about your organisation?

• Quality ratings and online reputation
• Campaign management
• Community involvement

Consideration

What drives a patient to choose your organisation over another?

• Coverage and benefits
• Healthcare provider search

What impacts your patient’s ability to receive care or support from your organisation?

• Patient portal
• Call centre
• Price transparency

Service delivery

What is your patient’s experience with their clinical care?

• Interaction with healthcare professionals
• Check-in and check-out
• Discharge process

Ongoing care

What type of patient engagement occurs after a visit?

• Wellness and care management
• Social determinants of health
• Population health

All of these examples influence the way in which your patients make decisions. It’s essential to understand which touchpoints along the patient’s journey are the most impactful or leave the largest gaps in care. There are patient expectations surrounding each type of interaction.

Patient journey mapping

How do you move beyond patient feedback on service delivery and focus instead on the end-to-end patient journey? Patient journey mapping can provide context around what your patients experience as they move through the various channels of your organisation.

A patient journey map is a visual representation of the steps the patient takes as they engage with your organisation in order to receive care. Patient journey maps should capture pre-visit and post-visit touchpoints in addition to those that occur when the patient is onsite at your medical facility.

Your patient journey may be broad and applicable to your entire patient base, or it may be specific to certain specialties, patient personas , demographics, or health events.

Start with an inventory of all the touchpoints for which you currently collect patient feedback. Next, determine what’s missing. Envision moving through your organisation from your patient’s point of view. Your patient journey map should include Interactions that take place pre-visit and post-visit, which are not always captured by traditional or regulatory surveys.

Benefits of patient journey mapping

There are many benefits to capturing key moments along the whole patient journey.

• A patient journey map allows you to walk in your patient’s shoes and think the way they think as they engage with your organisation. Patient journey mapping looks at patient experiences from the outside in.
• Mapping your patient journeys helps you to hone in on the areas where you may not be listening to your patients, but should be.
• You can uncover inconsistencies, gaps in care, and common pain points with patient journey mapping. These are difficult to identify when you collect feedback only on service delivery. Collecting data around these areas can aid in process optimisation and improve patient satisfaction.
• A patient journey map can give you a cross-functional view of your patient experience so you can engage all teams and stakeholders in gathering and understanding patient insights.
• Patient journey mapping provides context around behaviour and attitudes as patients move throughout the channels of your organisation. Are patients having to repeat paperwork? Do patients understand their follow-up care instructions? Are your patients able to easily navigate your patient portal? Patient journey mapping can help to answer these types of questions.
• Mapping the patient journey can transform your patient care approach from a reactive one to a proactive one.

Using patient journey data

Once you can visualise the end-to-end patient journey within your organisation, it’s time to listen to your patients and start gathering data.

Gather the right data

Collect data on all the touchpoints of the patient journey.  Understand how your patients are interacting with every aspect of your organisation, including non-clinical interactions such as your website, scheduling, and billing. Involve multiple stakeholders during this process, including managers, doctors, nurses, other healthcare professionals, and administrative staff.

It’s important to capture all steps involved in each of these stages. For example, when looking for potential pain points surrounding the patient portal, consider how the patient sets up an account, logs in, navigates the interface, gets technical assistance, and so forth.

Also, consider patient expectations and usage–what are they using the portal to accomplish? Look for potential gaps in these experiences, such as paying a bill, contacting the provider with a question, reviewing test results, or scheduling an appointment.

Understanding the patient’s goals and actions along all the different paths of your patient journeys is essential to gathering the data you need to take action.

Understand the data

Gain insights using analytics , benchmarking, and visualisations to identify gaps and discover opportunities at each step of the patient’s journey. Trends along the various touchpoints can help you to discover pain points and identify opportunities.

It’s also important to engage all the right stakeholders when reviewing the data you collect. Involving the right teams and people is essential to understanding gaps and improving experiences.

Take action

Use the insights from all touchpoints along your patient journey to develop solutions to improve your patient experience.

A closed-loop system  is ideal for taking action to close gaps along the patient journey. For example, if a patient gives a low score on a survey for your online scheduling tool, you could follow up with the patient to ensure they were able to schedule an appointment.

Using the data you collect to drive specific actions and feed into processes is vital to creating a seamless patient journey.

Why Qualtrics?

At Qualtrics, we want to enable you to listen to and understand your patients across all aspects of their journey, all within a single platform. Omnichannel distribution lets you gather feedback from patients from where they are at during each touchpoint, with powerful built-in analytics for uncovering meaningful insights.

The Qualtrics XM Platform™ provides a single source for all of your patient journey data. Real-time feedback displayed in role- and location-based dashboards helps deliver pertinent information to the right people, allowing you to take prompt action where needed.

Start collecting data and driving action along your patient journey

Related resources

Patient experience: your complete guide 12 min read, symptoms survey 10 min read, quality improvement in healthcare 11 min read, nurse satisfaction survey 11 min read, cahps surveys 6 min read, patient journey mapping 15 min read, nursing shortages 13 min read, request demo.

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• v.7(6); 2020 Dec

Understanding the Patient Experience: A Conceptual Framework

Patrick oben.

1 MercyOne Des Moines, Des Moines, IA, USA

The patient experience is now globally recognized as an independent dimension of health-care quality. However, although patients, providers, health-care managers, and policy-makers agree on its importance, there is no standardized definition of the patient experience. A clear understanding of the basic concepts that make up the foundation of the patient experience is more important than a statement defining the patient experience. The fundamental nature of health care involves people taking care of other people in unique times of distress. Thus, the human experience is at the very core of understanding what the patient experience is. This article reviews a framework of the basic human experience of patients as they progress from being unique, healthy individuals to a state of experiencing both disease and health-care services. This novel framework naturally leads to a basic understanding of the patient experience as a human experience of health-care services.

Introduction

Throughout the world, the patient experience is recognized as an independent dimension of health-care quality, along with clinical effectiveness and patient safety ( 1 , 2 ). Health-care organizations across the United States are focusing on how to “deliver a superior patient experience” ( 3 ). Quality is a key driver of these industry-wide changes, as are the shifts in health-care policy that have tied hospital and physician compensation to patient experience measures, the focus on patient engagement, and the emergence of the consumer mindset ( 2 , 4 ).

Despite the increasingly important role that the patient experience occupies in health-care clinical practice, research, quality improvement efforts, and policies, there is no universal understanding of what the “patient experience” is, as evidenced by the lack of a standardized definition ( 4 ). Therefore, patients, clinicians, policy makers, managers, and researchers have different interprets of the concept ( 5 ). Although this has been called the “era of the patient” ( 6 ), experts have said, “it’s no wonder that hospitals are struggling with the best way to provide it.” After all, if you can’t define what it is, you can’t provide it—and you certainly can’t measure it” ( 5 ). Thus, a clearer understanding of the patient experience will assist clinicians in improving that experience at the point of care, guide further research into the topic, and provide clear directions for quality improvement efforts and health-care policies.

There are several reasons for the lack of a formal definition or clear understanding of the patient experience. The patient experience is a multidimensional, multifaceted, and intimately connected concept with several subsections. Furthermore, framing definitions, even when concepts are well understood, is not a simple task. The Beryl Institute made a significant stride forward by providing a definition that highlights the integrated and multidimensional nature of the patient experience and the complexity of the framing task ( 4 , 7 ). They defined the patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions, across the continuum of care” ( 7 ). This definition identifies 4 critical themes for understanding the patient experience: personal interactions, organization’s culture, patient and family perceptions, and continuum of care.

By itself, a definition is a statement that seeks to convey the understanding of a concept. The greater our understanding of the patient experience, the easier it is to frame a definition. As we continue to create a standardized definition, it is important to step back from its multidimensional nature and review its most basic concepts. One fundamental source for this concept comes from an article in the 2001 Institute of Medicine, which states, “health care is not just another service industry. Its fundamental nature is characterized by people taking care of other people in times of need and stress” ( 8 ). A central role in health care is, therefore, the humanity of both the patient and care provider throughout the process of providing health care. Both the physician and patient are people ( 9 ).

This article seeks to provide a general overview of the patient experience from the platform of who we are as human beings, whether we are patients or providers. It provides a conceptual framework that traces the patient’s virtual journey from health, to the onset of disease, and through multiple encounters with health-care services. To fully appreciate the value of this conceptual framework, awareness of 2 important elements is required. First, although the patient experience concept is multidimensional and multifaceted, the health-care experience for the individual patient is unified; it is informed by a complex combination of the patient’s personal life, as well as their own and their family’s experiences within the health-care system at all levels of care.

Second, the word “patient” is used in this article with a specific meaning. There is intense debate about replacing the word patient with consumer, users, or clients; the argument for the change is that the word “patient” conveys the idea of passivity and does not correctly describe all patient populations, especially the “well patient” seeking preventive services ( 10 , 11 ).

In this article, we use the dictionary definition of patient: “a person receiving or registered to receive medical treatment” ( 12 ). However, the additional element of “suffering,” which captures a critical element of the human experience of disease, is also incorporated. Thus, patient refers to a person suffering from a disease before and after they begin receiving or are registered to receive medical treatment.

The Experience Journey of the Patient

A recurrent and prominent theme in discussions of the patient experience is centering the patient’s perception or perspective on the health care they receive ( 7 , 13 ). Health-care providers who seek to understand the patient’s perspective of their experience will obtain a greater understanding of the patient experience. Furthermore, it is important to note that the patient’s overall health and disease experience begins before they enter the health-care system. This holistic experience from the patient’s perspective is critical for a complete understanding of their experience within the health-care organization.

Phases and landmarks of the patient experience

When a patient contacts a health-care organization, assuming they are in a basic state of health, they begin a journey that consists of 3 phases or spheres of experiences with 2 critical landmarks. These phases and landmarks of the patient experience are illustrated in Figure 1 .

A conceptual framework for understanding the patient experience. The arrows indicate the direction patients take in their journey through health-care encounters, which is hypothetically to the right of the diagram. The person moves across the continuum, indicating that the patient or user of health-care services is the same unique human being they have always been. The arrow labeled “Patient” begins in the middle, indicating the person is not always a patient and becomes one with the onset of disease. The “User” arrow indicates that the person who has a disease only becomes a user of health-care services with their first interaction with the health-care system.

• The patient, just as the provider, is a unique individual. A baseline state of health is used for the purpose of simplicity, as illustrated in the right column in Figure 1 .
• The first landmark for the individual is the beginning of a process that moves them from the first column, person, to the middle column, patient. A patient, as we have stated, is a person who is suffering from a disease, but they are still the same unique person they have been.
• The second landmark occurs when this person suffering from a disease makes their first contact with medical care services regarding this disease. They become users or consumers of these services. While they interact with health-care organizations, they continue to be the same person they were before disease onset.

Importantly, the state of disease or the role of a person as a user of health-care services is dynamic. If the disease is cured, the individual who was a patient before is restored to the experience of health and is no longer a patient.

A Continuum and Unity

As Figure 1 demonstrates, the patient remains the same person they were before the disease onset, even after they contract a disease or begin utilizing medical services. The person’s interactions with health-care providers—and not their disease or their role as consumers—are the key to understanding the fundamental nature of the patient experience.

The patient experience does not rely solely on the events that occur between themselves and health-care providers; their complex human experiences also influence their perception of the situation. For instance, while the patient seeks to understand the plan of care as the provider explains it (experience with medical services), they might also experience discomfort from their symptoms (experiences of the disease) and anxiety over making sure their kids are picked up from daycare (experiences in general life).

A journey through this continuum leads to a solid understanding of what health care currently refers to as the patient experience. As shown in Figure 1 , this experience is also a human experience of a distinct occurrence or series of events called health-care service.

The Person: The Human Experience

The first column in Figure 1 lays the foundation for understanding the person who seeks medical care from health-care providers. Understanding the humanity of patients is the critical foundation upon which any successful patient-centered experience efforts should be built. The prominent role of our humanity distinguishes health care from other service industries ( 8 ). In “Harrison’s Principles of Internal Medicine,” Jameson et al stated, “Tact, sympathy, and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs disordered functions, damaged organs, and disturbed emotions. [The patient] is human, fearful and hopeful, seeking relief, help and reassurance” ( 14 ).

The patient is a human, and humanity harbors the secret to the elements of care that creates a superior patient experience. In a speech to Harvard Medical Students in 1926, Francis Peabody stated, “one of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient” ( 9 , 15 ). This statement is as valid today as it was when it was first spoken. Our interest in the humanity of our patients naturally leads us to care for the person who is suffering from an illness and seeking help from the health-care system, rather than merely managing a case or disease. The human experience is, therefore, central to the overall conceptual understanding of the patient experience.

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” ( 16 ). This definition indicates that the human experience in health and disease is multidimensional and includes physical, mental, and social dimensions. Puchalski identified a fourth, spiritual dimension; she calls compassionate care “serving the whole person—the physical, emotional, social, and spiritual” ( 17 ); research has shown this to be important to many patients ( 18 ). The social dimension emphasizes the importance of engaging not only the patient but also their families and communities ( 19 - 21 ). Needham recognizes the multinational nature of the patient experience in stating that both emotional and physical experiences must be managed, highlighting 2 out of the 4 dimensions noted above ( 22 ).

The Patient: The Experience of Illness

As noted above, this article uses the word patient to refer to a person suffering from a disease before and after they begin receiving or are registered to receive medical treatment. It has a central role in the conceptual framework of Figure 1 , as it preserves what is “distinctive about medical practice” ( 10 ) and what separates health care from many other service industries: a human being suffering from a disease seeks care from another human being who not only provides a service but also is moved with compassion and empathy for the one seeking help ( 8 ). Despite its limitations within the evolving landscape of health care, Dr. Raymond Tallis’ comment regarding replacing the word patient, to “leave it well alone” ( 10 ), seems to be echoed by most patients and providers ( 23 ).

The onset of a disease marks the critical landmark of the transition from a person who is healthy to a person suffering from a disease before or after they are registered or begin receiving medical treatment. The individual, who we assume was previously healthy, begins to experience a disease in the psychological, physical, social, and spiritual dimensions. For example, a patient with a broken bone may experience not only physical pain and sight of a possible deformity but also the fear and anxiety of lifelong loss of movement or being admitted to a hospital for the first time.

Shale describes 3 aspects of the patient experience, including physiologic experiences of illness, customer service, and lived experiences of the illness ( 24 ). The patient’s experience of an illness is a distinct aspect of their overall experience. The ultimate hope of medical care is to eliminate, reduce the impact of, or manage the varied psychological, physical, social, and spiritual experiences of illness, for both the patient and their families and communities. These distinct spheres of experiences, which simultaneously occur during every interaction between the health-care organization and the person, form the continuum of the patient’s holistic experience of care.

The Experience of Health-Care Services

Health care is, “after all, a service” ( 2 ). Patients become users or consumers of health-care services when they begin using those services, starting with their first interaction across the continuum of care. Health-care service, as a continuum of all interactions with the patient, is experienced in the same 4-dimensional sphere of human experience, that is, physically, psychologically, socially, and spiritually. The patient experience, in essence, is the human experience of health-care services. The central reason for the existence of the health-care industry is to care for the patient: to manage their physical, psychological (emotional/mental), social, and spiritual health needs as presented.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized, well-established, and extensively-validated instrument that measures the degree to which health-care services have managed to meet the aforementioned complex needs ( 13 ). The HCAHPS addresses specific aspects of interactions between the patient and the health-care organization, such as communication with doctors and nurses. The patient’s experience begins with the onset of disease, which, however, the HCAHPS cannot capture. This is because the health-care system is not responsible for the prior, varied experiences that individual patients may have experienced in their illness before seeking care for this disease state. However, when these patients are under the care of a health-care organization, the degree to which the care services meet their needs, in the context of the family and community, is the health-care service provider’s direct responsibility. The HCAHPS scores give health-care service providers a quantitative measure to assess how well they are meeting the needs of their patients, families, and communities. They can then determine areas of strengths and weaknesses and clearly plan quality improvement changes across the continuum of care so that “patients would experience care” that is safe, effective, patient-centered, timely, efficient, and more equitable” ( 8 ).

A proper, clear, and precise understanding of the patient experience will benefit the health-care industry and society in multiple aspects, including but not limited to establishing a tailored and personalized clinical bedside care, providing clear guidance for further research, stimulating consistent and sustainable improvements in medical care quality, and guiding health-care policy. The conceptual framework presented in this article, which seeks to clarify the centrality of the patient’s human experience across the continuum of care, is only the beginning point for a better overall understanding of this multidimensional, multifaceted concept. The health-care industry has not received the full benefit of the data provided by patient experience measurement tools. Given the potential impact on quality, safety, and cost of health care in general, research efforts should be made to not only create a standardized definition of the patient experience but also clarify its various components. The current methods of measurement and reporting should be improved in order to establish the best ways to incorporate the patient experience data into general health-care improvement efforts.

Author Biography

Patrick Oben is a hospitalist at MercyOne Des Moines Medical Center. He serves as the Physician Lead of the MercyOne Patient Experience unit.

Authors’ Note: No research was performed on human or animal subjects and as such approval by an Ethics Committee or Institutional Review Board was not required. Similarly, no informed patient consents were obtained as these were not required.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

The Patient Journey

• Open Access
• First Online: 15 December 2020

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• Elena Beleffi 5 ,
• Paola Mosconi 6 &
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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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Top 10 interventions in paediatric patient safety.

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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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