Process mapping: enhancing the implementation of the Liverpool Care Pathway

Abstract

Arohanui Hospice is a 12-bed specialist palliative care service based in Palmerston North, New Zealand. It serves a population of 180 000 people spread over a wide geographical area, both urban and rural. The Liverpool Care Pathway (LCP) was initially implemented at the hospice inpatient unit in January 2005. Following this, the 'LCP Pilot Project' was developed. This project involved the implementation of the LCP within three aged residential care facilities and two wards within the regional hospital. Included in the project was a research component to enable evaluation of the effectiveness of the LCP in each setting. This article will consider and demonstrate the use of process mapping (Buckman, 2003) as a quality improvement tool to enhance the effective implementation and sustained use of the LCP for the dying patient within aged residential care. Measures are considered that support the implementation of the LCP at an organisational level rather than at a purely clinical level. While this work has been completed within the New Zealand context, it is believed that the principles are transferable to similar settings internationally.

Systematic Realist Review of Key Factors Affecting the Successful Implementation and Sustainability of the Liverpool Care Pathway for the Dying Patient

“…; Dawson et al. ; Taylor & Randall ; DHWA ; Kennedy et al. ; Midson & Carter ); a desired outcome of the LCP (MCPCI ).…”

“…For example, education created more confidence and openness in staff to discuss death and dying. This in turn improved communication and collaboration amongst the multidisciplinary team, and with patients and their relatives (Pooler et al 2003;Hockley et al 2004;Jack et al 2003;Jones & Johnstone 2004;Rycroft-Malone et al 2004;Hockley et al 2005;Dawson et al 2007;Taylor & Randall 2007;DHWA 2009;Kennedy et al 2009;Midson & Carter 2010); a desired outcome of the LCP (MCPCI 2009d).…”

“…According to Greenhalgh et al's (2004) model, support and advocacy from top management for the implementation process is vital for success. This was borne out in the literature, which showed that necessary resources were made available only with the approval or support of top management (Kitchiner & Bundred 1999;Jones & Johnstone 2004;Mellor et al 2004;Carr et al 2005;Ellershaw & Murphy 2005;Hockley et al 2005;Mirando et al 2005;Main et al 2006;Dawson et al 2007;Preston 2007;Taylor & Randall 2007;DHWA 2009;Edmonds et al 2009;Masso & McCarthy 2009).…”

Process mapping the patient journey: an introduction

“…[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.…”

A way forward: Process mapping and the delivery of mental health services

“…Although process mapping is generally a tool used by NHS trusts or commissioners, backing up research findings with a process map in which all staff have been involved ensures staff are aware their opinions are fundamental to any change process (Taylor and Randall, 2007).…”