Mary Sawan M.Ed, Quality Improvement Lead, NI

Patient Journey Mapping

The Northern Way

the northern way of caring

the northern way of caring

Types of Mapping

There are many ways to map

In the North we took the best of what was

available in the literature and put a

“Northern” spin on the work.

the northern way of caring

Where We Have Been

Frail Elderly Patient and Family – Home

and Community Care

Blood Bourne Pathogens – [HIV/AIDS]

Adult Mental Health and Addictions

Aboriginal Adult Mental Health and

Addictions

Peri-natal [Pending]

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Improvement On Mapping

We began to work with marginalized

populations whose experiences were not

effectively being captured by the

traditional mapping

We wanted to improve upon the mapping

process by capturing the raw emotions of

patients

the northern way of caring

Traditional Mapping

Creates a visual representation of every

step taken by a patient as they move

through the system

Can be seen as linear and process

focussed

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Emotion Focused Mapping

Creates a visual representation of every

step taken by a patient

and

their emotional reaction as they move

through the system

the northern way of caring

Emotional Reaction

How did you feel?

This question is asked at each intersection

point and in addition the patient is asked

about their emotional reaction to the

wait times throughout their journey

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Why is the emotional

journey important to map

and capture?

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Traditional Mapping

The map does not represent one patient’s

experience but a typical experience of a

hypothetical patient

The goal is to map what happens 80% of

the time

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Emotion Focused Mapping

The map is specific to an individual

patient and their unique journey through

the system

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Emotion Focused Mapping cont’d

We use multiple patients and their stories

to verify the system and process

examine themes in the system

Examine themes amongst the patient

experience

Identify gaps in care that are not process

related [ how we greet patients, eye contact,

tone. ]

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Emotional Focussed cont’d

Some of the gaps described by the patient

can be quick fixes that the system did not

always recognize as a problem.

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Briefing the Patients

In order for patients to feel comfortable sharing

their story we brief them before the event

– We let them know who will be in the room

– We assure them that even if they have something negative

to say about their experience or care that they will still

receive services

– We let patients know that this is not a debate and that their

story and journey is their own and will not be debated by

the providers in the room

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Briefing the Providers

We prepare providers to hear positive and

negative reactions to some of the care

that they have been part of

We indicate to providers that this is not

the proper forum to debate a patients

journey or experience

Providers are there to hear the story

being told to them and see the system

from the patient’s experience

the northern way of caring

This is How We Do It

Brief the patients

We separate the room: providers are at the back

of the room, patients sit front and center

We facilitate in pairs – one mapping, the other

facilitating and facing the patient listening to

patients story and asking the questions

We write the emotions expressed on post its and

apply them appropriately to the journey

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This is How We Do It - Continued

We debrief the patients in another room

after the mapping sessions to ensure

safety

In addition the providers are debriefed in

another room

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This is How We Do It - Continued

We reunite with patients after the maps have

been entered into Visio to validate their stories

before sharing with the larger group

We hold a follow up meeting with patients and

providers to discuss and celebrate the changes

that have occurred due to the lessons learned

from their journey

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Debrief and Validation

After the mapping session patients and/or

caregivers are debriefed

All maps are validated by the patients

before brought to system providers

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Follow Up

After we have brought the system maps to

the providers and changes have occurred

(or PDSA cycles are ramping) we bring

patients and/or caregivers back for follow

up

Here we inform patients how their story

and their suggestions have lead to change

to help support the patient journey

the northern way of caring

What We Have Discovered

Briefing patients puts them at ease and

allows them to tell all parts of their

journey – good and bad

Debriefing patients ensures that we do no

harm

Providers report learning from hearing

patients stories and many providers are

emotionally impacted by what they hear –

this encourages change and engagement

with the changes

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What We Have Discovered

Patients LOVE to be heard

Patients enjoy the celebration day as a

way to tie up what they have contributed

to

Hearing the exceptions provides deeper

understanding to marginalized patients

and the changes necessary to create a

level playing field for ALL Northerners

the northern way of caring

the northern way of caring