Patient journeys: the process of clinical redesign

Ben-Tovim, David I.; Dougherty, Melissa; O'Connell, T. J.; McGrath, Katherine

doi:10.5694/j.1326-5377.2008.tb01668.x

Cited by 96 publications

(103 citation statements)

References 6 publications

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“…[7][8][9] The NHS Institute for Innovation and Improvement proposes a range of practical benefits using this approach (box 1). 6 Several management systems are available to support process mapping and pathway redesign.…”

Section: What Information Does Process Mapping Provide and What Is Itmentioning

confidence: 99%

Process mapping the patient journey: an introduction

Trebble

Hansi

Hydes

et al. 2010

BMJ

316

297

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Section: What Information Does Process Mapping Provide and What Is Itmentioning

confidence: 99%

Process mapping the patient journey: an introduction

Trebble

Hansi

Hydes

et al. 2010

BMJ

316

297

View full text Add to dashboard Cite

show abstract

“…This is especially evident in emergency departments, which receive a steady stream of patients but often are slow to admit them to the hospital due to bed shortages in downstream units. Not coincidentally, emergency departments are often the first hospital units to “go lean” and demonstrate consistently positive results (Holden, 2011, Ben-Tovim et al, 2008, American Society for Quality, 2009). Consistent with our findings, a recent study of emergency departments in three Swedish hospitals found that the department whose triage was designed according to lean principles had the lowest length of stay, fewest patients leaving without treatment, fewer readmissions, and lower mortality (Burström et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals

et al. 2015

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As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N=236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.

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“…We emphasize that the purpose of the reported analyses is not to make definite conclusions regarding the relative cost-effectiveness of services provided at different hospitals, but to inform further investigation of the underlying causes of the estimated differences in cost-effectiveness. Further investigations might assess differences in clinical pathways using improvement tools such as process mapping [15,16], or process mining [17], to describe patient journeys and gain a better understanding of the content, sequence, and timing of the health care provided at different hospitals, including activities such as post-discharge monitoring and referrals to community-based health programs.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services

Pham

Caffrey

Ben-Tovim

et al. 2012

BMC Health Serv Res

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BackgroundMethods for the cost-effectiveness analysis of health technologies are now well established, but such methods may also have a useful role in the context of evaluating the effects of variation in applied clinical practice. This study illustrates a general methodology for the comparative analysis of applied clinical practice at alternative institutions – risk adjusted cost-effectiveness (RAC-E) analysis – with an application that compares acute hospital services for stroke patients admitted to the main public hospitals in South Australia.MethodsUsing linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework. Observed (plus extrapolated) and expected lifetime costs and survival were compared across patient populations, from which the relative cost-effectiveness of services provided at the different hospitals was estimated.ResultsUnadjusted results showed that at one hospital patients incurred fewer costs and gained more life years than at the other hospitals (i.e. it was the dominant hospital). After risk adjustment, the cost minimizing hospital incurred the lowest costs, but with fewer life-years gained than one other hospital. The mean incremental cost per life-year gained of services provided at the most effective hospital was under $20,000, with an associated 65% probability of being cost-effective at a $50,000 per life year monetary threshold.ConclusionsRAC-E analyses can be used to identify important variation in the costs and outcomes associated with clinical practice at alternative institutions. Such data provides an impetus for further investigation to identify specific areas of variation, which may then inform the dissemination of best practice service delivery and organisation.

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Patient journeys: the process of clinical redesign

Cited by 96 publications

References 6 publications

Process mapping the patient journey: an introduction

Process mapping the patient journey: an introduction

Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals

Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services

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