Putting the consumer in the driver's seat: A visual journey through the Australian health-care system as experienced by people living with dementia and their carers.

OBJECTIVE: To better understand the individual journeys of people living with dementia and their carers through the Australian health-care system. METHODS: Stories were collected from 25 participants, through five face-to-face workshops, across Australia. This produced 18 visual storyboards and a range of opportunities for improvement, which were then synthesised into an aggregated "ideal-journey" model. RESULTS: Several issues were identified: long lead times to diagnosis; diverse experiences of treatment and support; and little coordination of care or thought for its impact on the consumer. Information about services, their purpose and eligibility criteria was difficult to obtain, and potential care pathways were largely unexplained. Much of the carer support received was reactive rather than proactive. CONCLUSIONS: A better understanding of the current health-care pathway of dementia is essential for the design and delivery of future health-care services. It is vital to include the consumer voice in future research and allocation of health-care resources.

Finding brilliance using positive organizational scholarship in healthcare.

PURPOSE: Positive organizational scholarship in healthcare (POSH) suggests that, to promote widespread improvement within health services, focusing on the good, the excellent, and the brilliant is as important as conventional approaches that focus on the negative, the problems, and the failures. POSH offers different opportunities to learn from and build resilient cultures of safety, innovation, and change. It is not separate from tried and tested approaches to health service improvement--but rather, it approaches this improvement differently. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: POSH, appreciative inquiry (AI) and reflective practice were used to inform an exploratory investigation of what is good, excellent, or brilliant health service management. FINDINGS: The researchers identified new characteristics of good healthcare and what it might take to have brilliant health service management, elucidated and refined POSH, and identified research opportunities that hold potential value for consumers, practitioners, and policymakers. RESEARCH LIMITATIONS/IMPLICATIONS: The secondary data used in this study offered limited contextual information. PRACTICAL IMPLICATIONS: This approach is a platform from which to: identify, investigate, and learn about brilliant health service management; and inform theory and practice. SOCIAL IMPLICATIONS: POSH can help to reveal what consumers and practitioners value about health services and how they prefer to engage with these services. ORIGINALITY/VALUE: Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.

Using Patient Journey Modelling to Visualise the Impact of Policy Change on Patient Flow in Community Care.

Health policy plays a crucial role in community care, particularly within care programs such as ComPacks. ComPacks is a short-term care program administered by New South Wales (NSW) department of health which runs for up to 6-weeks and its goal is to prevent or minimise hospital readmission. Compliance to the ComPacks health policies is required in order to gain financial support from overnment bodies, however when the Government makes changes to service policies, this may potentially cause ripple effects to the workflow of the service and increase pressures on care providers, which in turn may affect the patient. Utilising a multi-layer visualisation tool can help identify whether changes made to policy are impacting patient flow in a positive or negative way. This research study investigates the use of an emerging patient journey modelling technique to better understand service design in a community care setting, whilst also determining the impact of State-level policy interventions.

Gerontechnology: the importance of user participation in ICT development for older adults.

With the ageing of our society and the increasing pressure on health and aged care services, the need for technological solutions to help older people stay in their own home for as long as possible is becoming increasingly important. To create information and communications technology (ICT) that will fit with the way older people live their lives and wish to use technology, necessitates their involvement in the design and development process. This paper will highlight some of the issues when designing for and with older people, and highlights the need for more research on how to involve older persons as stakeholders when designing technology for their use, as well as the need for easily accessible guidelines for how to do this.

Combining patient journey modelling and visual multi-agent computer simulation: a framework to improving knowledge translation in a healthcare environment.

This article focuses on a framework that will investigate the integration of two disparate methodologies: patient journey modelling and visual multi-agent simulation, and its impact on the speed and quality of knowledge translation to healthcare stakeholders. Literature describes patient journey modelling and visual simulation as discrete activities. This paper suggests that their combination and their impact on translating knowledge to practitioners are greater than the sum of the two technologies. The test-bed is ambulatory care and the goal is to determine if this approach can improve health services delivery, workflow, and patient outcomes and satisfaction. The multidisciplinary research team is comprised of expertise in patient journey modelling, simulation, and knowledge translation.

A case study on parsing chemotherapy related free-text data.

When modelling and simulating healthcare related processes, free-text data is often the only possible source of information. This data may contain vocabulary variations such as mistyped, misspelled and/or abbreviated words. This paper describes a semi-automated approach to free-text normalisation based on a combination of commonly used techniques and local expertise of medical oncology nurses. The approach emphasises the effectiveness of the vocabulary creation process through an interactive software application. When local knowledge is successfully captured, normalisation of large data sets can be done very rapidly with a high accuracy rate achieved. Furthermore, the techniques for localised normalisation can have significant benefits to free-text parsing accuracy when data is aggregated from multiple sites (hospitals). This research may lead to increased understanding of issues associated with chemotherapy related free-text data which in turn may impact patient treatment safety.

Using visual tools to improve clinical engagement and group understanding of complex IT concepts.

This work describes how the use of a visual patient journey modeling tool significantly improved the engagement of clinical staff and their group understanding of the complex IT concepts associated with event-driven computer simulation. Such group understanding and engagement is acknowledged as critical to the successful implementation of a wide range of quality improvement initiatives [1, 2]. The specific example described in this paper relates to the improved utilisation of chemotherapy unit resources.

Multi-dimensional knowledge translation: enabling health informatics capacity audits using patient journey models.

This paper presents a multi-dimensional approach to knowledge translation, enabling results obtained from a survey evaluating the uptake of Information Technology within Neonatal Intensive Care Units to be translated into knowledge, in the form of health informatics capacity audits. Survey data, having multiple roles, patient care scenarios, levels, and hospitals, is translated using a structured data modeling approach, into patient journey models. The data model is defined such that users can develop queries to generate patient journey models based on a pre-defined Patient Journey Model architecture (PaJMa). PaJMa models are then analyzed to build capacity audits. Capacity audits offer a sophisticated view of health informatics usage, providing not only details of what IT solutions a hospital utilizes, but also answering the questions: when, how and why, by determining when the IT solutions are integrated into the patient journey, how they support the patient information flow, and why they improve the patient journey.

A structured approach to requirements gathering creation using PaJMa models.

The process of preparation for request for proposals for health information systems typically results in missed opportunities for improvements due to the technical focus of traditional requirements gathering processes. The increased integration of health care systems between wards and external supporting agencies, reliance on professional practice guidelines, and needs for cultural sensitivities requires a specialized method for requirements gathering. We explore the use of a patient journey modeling approach (PaJMa) to requirements gathering using a case study of Whitby Mental Health Center. The improvement of the PaJMa models in increasing the level of detail of requirements, inclusion of nonfunctional requirements, and the identification of required practices, policies, and metrics demonstrate a superior method for requirements gathering in health care.

A systems development life cycle approach to patient journey modeling projects.

Patient Journey Modeling, a relatively recent innovation in healthcare quality improvement, models the patient's movement through a Health Care Organisation (HCO) by viewing it from a patient centric perspective. A Systems Development Life Cycle (SDLC) provides a standard project management framework that can improve the quality of information systems. The concept of following a consistent project management framework to boost quality outcomes can be applied equally to healthcare improvement. This paper describes a SDLC designed specifically for the health care domain and in particular patient journey modeling projects. It goes on to suggest that such a framework can be used to compliment the dominant healthcare improvement method, the Model for Improvement. The key contribution of this paper is the introduction of a project management framework in the form of an SDLC that can be used by non-professional computer developers (ie: health care staff), to improve the consistency and quality of outcomes for patient journey redesign projects. Experiences of applying the SDLC in a midwife-led primary-care maternity services environment are discussed. The project team found the steps logical and easy to follow and produced demonstrable improvement results along with ongoing goal-focused action plans.

A communication tool to improve the patient journey modeling process.

Quality improvement is high on the agenda of Health Care Organisations (HCO) worldwide. Patient journey modeling is a relatively recent innovation in healthcare quality improvement that models the patient's movement through the HCO by viewing it from a patient centric perspective. Critical to the success of the redesigning care process is the involvement of all stakeholders and their commitment to actively participate in the process. Tools which promote this type of communication are a critical enabler that can significantly affect the overall process redesign outcomes. Such a tool must also be able to incorporate additional factors such as relevant policies and procedures, staff roles, system usage and measurements such as process time and cost. This paper presents a graphically based communication tool that can be used as part of the patient journey modeling process to promote stakeholder involvement, commitment and ownership as well highlighting the relationship of other relevant variables that contribute to the patient's journey. Examples of how the tool has been used and the framework employed are demonstrated via a midwife-led primary care case study. A key contribution of this research is the provision of a graphical communication framework that is simple to use, is easily understood by a diverse range of stakeholders and enables ready recognition of patient journey issues. Results include strong stakeholder buy-in and significant enhancement to the overall design of the future patient journey. Initial results indicate that the use of such a communication tool can improve the patient journey modeling process and the overall quality improvement outcomes.