This document discusses mapping clinical pathways for patients across healthcare services. It describes standardizing pathways for common conditions that involve evidence-based, multidisciplinary care plans. The pathways would identify the appropriate sequence and timing of clinical interventions and outcomes. Mapping the existing patient journey can reveal inefficiencies and waste. Redesigning pathways based on analyzing the process maps could improve quality of care, convenience for patients, and reduce costs by removing unnecessary steps.

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Improving the information base and optimising service
solutions to support social welfare and healthcare reform.
Evidence-based clinical pathways: the application
of health economics, data systems and quality
improvement.
THL Helsinki, Finland 16th-19thApril, 2018
Professor James Dunbar
Deakin University
Victoria, Australia

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The Project

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Mapping Clinical Pathways for tracker
conditions
Shine a torch on the patient’s experience

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Mapping Clinical Pathways for tracker
conditions
Shine a torch on the patient’s experience
• Standardised pathway for each tracker
condition,
• evidence-based, multidisciplinary
management plans,

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Mapping Clinical Pathways for tracker
conditions
Shine a torch on the patient’s experience
• Standardised pathway for tracker
condition,
• evidence-based, multidisciplinary
management plans,
• identified appropriate sequence
of clinical interventions, timeframes, and
outcomes.

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Quality of Care
• Minimum Data Set derived from Duodecim
guidelines
• Registries and other databases
• (access and equity)
Evaluation of health care interventions

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Quality of Care
• Minimum Data Set derived from Duodecim
guidelines
Convenience for patients
• Only patients experience the whole pathway
• Their priorities are different from doctors
• Patients can contribute to redesign
Evaluation of health care interventions

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Quality of Care
• Minimum Data Set derived from Duodecim
guidelines
Convenience for patients
• Only patients experience the whole pathway
• Their priorities are different from doctors
• Patients can contribute to redesign
Cost
• Economic decision tree component costs
must match clinical algorithm
Evaluation of health care interventions

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HbA1c among type 2 diabetes patients
in North Karelia, 2013-2014

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Type 2 diabetes report, North Karelia

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Tracker conditions are:
Clinical pathways for a few key conditions
that cross primary, secondary and social
care.
• Map each process (step) on the
patient’s journey.
• Look for waste – slips, lapses and
errors especially at hand overs,
• Determine cost for each process.
• Basis for redesign of an improved
pathway

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The pilgrim and the patient’s
experience

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The outset of the
journey can look well
organised and paved for
an easy path

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A piece of very simple advice can be invaluable
The journey
can be long and
daunting but
starts with a
single step

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Others have been there
first and may not be
interested in your
journey

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Different paths can
look equally plausible

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It helps to have guidance

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We need to remember our fallibility.

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We need to
have belief in
our journey

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The journey
can get rocky
and slippery

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A piece of very simple advice can be invaluable

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A piece of very simple advice can be invaluable
Beware of false
prophets

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A piece of very simple advice can be invaluable
Advice can
sometimes be
confusing

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A piece of very simple advice can be invaluable
Sometimes
when you
reach an
apparent
impasse you
have to wade
through

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A piece of very simple advice can be invaluable
Others have right of
way and should be
given due courtesy

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A piece of very simple advice can be invaluable
The journey can
be tough and
you have to be
prepared to have
a few blisters
and bruises

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A piece of very simple advice can be invaluable
There is a
time for
work and
a time for
rest

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A piece of very simple advice can be invaluableAlong the journey
rewards are all
the sweeter for
having earned
them

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A piece of very simple advice can be invaluableI would really like
to emphasise that
last point!

30. Understanding the Patient Journey
Process Mapping

31. CONTEXT
‘80% of the problem is in the system not the people’
W. Edwards Deming

32. Process mapping….
• Views the system from the patient
perspective following their journey
across organisational boundaries
• Helps staff understand how complex
and confusing processes appear to the
patient
• Diagnostic and used as a basis for
redesign, actively involving frontline staff
in the process. (Shows how things actually are)

33. Process has inputs and outputs
Input OutputProcess
Definition - a process is a series of connected
steps or actions to achieve an outcome

34. A
Diagnostic process
B
Looking at Patient Processes
C D E
• 30 - 70% of work
doesn’t add
value for patient
• up to 50% of
process steps
involve a “hand-
off”, leading to
error, duplication
or delay
• no one is
accountable for
the patient’s
“end to end”
experience
• job roles tend to
be narrow and
fragmented
Organisational /departmental boundaries
Emergency care process
Treatment process

35. High level process map
6 – 12 steps
– Generate in set time e.g. 20 minutes
– Use to identify scope and identify problem
Low Level or Detailed process map
dozens of steps
– To establish loops and complexity
– Good to establish roles and relationships within
processes
– Use again in later phase to show effect of redesign

36. Appts
Hospital
GP
Another
Hospital
Appts.
Appts.
Hospital
Register
on
System
Consultant
Secretary
Consultant Screening
Referral
1 – 3 days
Consultant
Secretary
Appt.
made
Letter
sent
Patient
Attends
OPD
Appts
hospital
1 – 3 days
1 Day -12 weeks
GP Referral – Attend OPD Appointment
High Level Map

37. Analysing the process map
• How many steps in your process?
• How many duplications?
• How many handovers?
• What is the approximate time of or between
each step?
• Where are possible delays?
• Where are major bottlenecks?
• How many steps do not add value for
patients?
• Where are the problems for patients and staff?

38. Walk the Patient Journey for
yourself

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A piece of very simple advice can be invaluableCathedral of
Santiago de
Compostela

40. Outcome from redesigned Processes:
• Comparison with first process map
• Waste removed
• Cost savings calculated
• Health and social care better integrated
• Minimum data set for quality set up.

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Thank you and any questions?
Photos of the Camino de Santiago by courtesy of
Professor James D Best
Dean, LKC School of Medicine, NTU, Singapore
Professor James Dunbar
Deakin University
Victoria, Australia