Practical Use of Process Mapping to Guide Implementation of a Care Coordination Program for Rural Veterans

McCreight, Marina; Gilmartin, Heather; Leonard, Chelsea; Mayberry, Ashlea; Kelley, Lynette; Lippmann, Brandi; Coy, Andrew; Radcliff, Tiffany A.; Côté, Murray J.; Burke, Robert E.

doi:10.1007/s11606-019-04968-x

Cited by 20 publications

(28 citation statements)

References 21 publications

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“…If PM is conducted without appropriate stakeholder participation, some of the bene ts derived from the social interactions, such as empathy between professional groups and agreement for shared solutions, are inhibited. [12] Two of the studies identi ed in the systematic review reported that the limited involvement of clinical staff was related to the di cultly of relieving them from their daily job, [96,114] but reasons for poor patient involvement should be further investigated. [24] Only 14 of the reviewed studies report training in PM techniques as part of the project.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported that they had to balance the rigorous use of the PM method with resource and time constraints they had to face in practice. [64,87,97,110,114,126] Despite reviewed studies demonstrating overall poor adherence to the identi ed PM quality criteria, they describe a number of bene ts derived from its use in healthcare improvement projects, demonstrating the key role played by PM in addressing the challenge of designing and implementing change in complex systems. Using PM in improvement work helps to achieve the strategic principles identi ed by the Successful Healthcare Improvement from Translating Evidence in Complex Systems (SHIFT-evidence) framework (act scienti cally and pragmatically, embrace complexity, engage and empower).…”

Section: Discussionmentioning

confidence: 99%

“…In this respect PM has been found to be particularly useful for clarifying the scope of projects, targeting the intervention and planning improvement actions. [9,72,113,114] (iii) Co-production and knowledge exchange PM was reported to be particularly useful to engage and motivate project stakeholders in designing and implementing change. Some studies report that PM supported the effective design of HIT by enhancing the involvement of process stakeholders.…”

Section: Bene Ts Of Using Pm In Improvement Workmentioning

confidence: 99%

“…[79,81,95] Other studies highlight how participation in PM helped to establish sense of urgency in clinicians regarding patient safety issues, thus enhancing their engagement. [74,86,114] Reviewed studies also show that the capacity of PM to facilitate the dialogue between diverse stakeholders helps to smooth barriers and tensions occurring during improvement projects or reach consensus on solutions. [65,74,80,86,97,98,[117][118][119] For example, some studies reported how PM helped to promote the integration of health services across different settings by developing clinical evidence-based recommendations agreed among different healthcare professionals.…”

Section: Bene Ts Of Using Pm In Improvement Workmentioning

confidence: 99%

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Process Mapping in Healthcare: A Systematic Review

Antonacci

Lennox

Barlow

et al. 2020

Preprint

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Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare.Methods We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analyzed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach.Results The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward.PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N=105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterizing healthcare improvement interventions.Conclusion The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM.Prospero ID : CRD42017082140.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Bene Ts Of Using Pm In Improvement Workmentioning

confidence: 99%

Section: Bene Ts Of Using Pm In Improvement Workmentioning

confidence: 99%

See 2 more Smart Citations

Process Mapping in Healthcare: A Systematic Review

Antonacci

Lennox

Barlow

et al. 2020

Preprint

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“…IS can contribute to pandemic preparedness by improving both robustness and agility of systems, drawing from contributing and relevant disciplines such as industrial engineering, business, political science, and more ( 3 , 4 , 27 ). We suggest that robust systems employ expertise and tools that are fit for purpose, while agile systems are built to be adaptable and flexible in quickly changing conditions.…”

Section: Reflecting Backward: Role Of Is In Planning For Emergency Prmentioning

confidence: 99%

Implementation Science to Respond to the COVID-19 Pandemic

Means

Wagner

Kern

et al. 2020

Front. Public Health

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The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions—such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement. We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.

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Effects of a Multimodal Transitional Care Intervention in Patients at High Risk of Readmission

et al. 2023

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ImportanceHospital readmissions are frequent, costly, and sometimes preventable. Although these issues have been well publicized and incentives to reduce them introduced, the best interventions for reducing readmissions remain unclear.ObjectivesTo evaluate the effects of a multimodal transitional care intervention targeting patients at high risk of hospital readmission on the composite outcome of 30-day unplanned readmission or death.Design, Setting, and ParticipantsA single-blinded, multicenter randomized clinical trial was conducted from April 2018 to January 2020, with a 30-day follow-up in 4 medium-to-large–sized teaching hospitals in Switzerland. Participants were consecutive patients discharged from general internal medicine wards and at higher risk of unplanned readmission based on their simplified HOSPITAL score (≥4 points). Data were analyzed between April and September 2022.InterventionsThe intervention group underwent systematic medication reconciliation, a 15-minute patient education session with teach-back, a planned first follow-up visit with their primary care physician, and postdischarge follow-up telephone calls from the study team at 3 and 14 days. The control group received usual care from their hospitalist, plus a 1-page standard study information sheet.Main Outcomes and MeasuresThirty-day postdischarge unplanned readmission or death.ResultsA total of 1386 patients were included with a mean (SD) age of 72 (14) years; 712 (51%) were male. The composite outcome of 30-day unplanned readmission or death was 21% (95% CI, 18% to 24%) in the intervention group and 19% (95% CI, 17% to 22%) in the control group. The intention-to-treat analysis risk difference was 1.7% (95% CI, −2.5% to 5.9%; P = .44). There was no evidence of any intervention effects on time to unplanned readmission or death, postdischarge health care use, patient satisfaction with the quality of their care transition, or readmission costs.Conclusions and RelevanceIn this randomized clinical trial, use of a standardized multimodal care transition intervention targeting higher-risk patients did not significantly decrease the risks of 30-day postdischarge unplanned readmission or death; it demonstrated the difficulties in preventing hospital readmissions, even when multimodal interventions specifically target higher-risk patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03496896

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Practical Use of Process Mapping to Guide Implementation of a Care Coordination Program for Rural Veterans

Cited by 20 publications

References 21 publications

Process Mapping in Healthcare: A Systematic Review

Process Mapping in Healthcare: A Systematic Review

Implementation Science to Respond to the COVID-19 Pandemic

Effects of a Multimodal Transitional Care Intervention in Patients at High Risk of Readmission

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