Health Service Co-Design


Patient journey mapping

Patient journey mapping is a way of visualising and summarising the service experiences patients have over time.

Why use it

You can use patient journey mapping to identify, map and plan patient experiences of services. The tool can be applied to improving patient experiences of health services, specialist units, or encounters with individual staff.

When to use it

Use this tool during the early stages of your co-design work to understand the patient journey and their parallel experiences of services. With stakeholder input, it then becomes a template for identifying key service touchpoints and improvements.

1. Start your interview or workshop by exploring the patient journey

Do this from the perspective of patients, their families and their other supporters (noting families and supporters have significant journeys of their own).

Elicit patient stories about their journey from the beginning (such as when they first noted symptoms) to the present day.

Ask participants to divide their stories into phases (these can be visualised as sections, chapters or scenes) to help others understand how the journey changes.

Between three and five phases is usually practical from a patient perspective but use as many as you need.

Write down the phases on a large sheet of butcher paper. This is known as a journey sheet.

2. Ask participants to describe their overall experience of each phase in more detail

You may start this by using a scale from one to ten to rate how high or low participants felt during this phase. Note this against each phase on the sheet.

Then prompt for the feelings and emotions experienced during their highs and lows, noting these on the sheet. You can prepare a set of 12-24 words covering a range of positive and negative feelings and emotions to help them with this or use Plutchik's Wheel of Emotions below. Work through the whole journey this way.

You can use the mapping template and improvement opportunities template below to help you.

3. Ask participants to highlight any especially good and bad service experiences in each phase

Note the emphasis falls on both (avoid asking for negatives only). Summarise the experience on the journey sheet and record any details about specific service elements on a separate sheet.

Example of patient journey phases:

4. Ask participants to suggest the values and actions that led to these positive and negative experiences

Emphasise the need to learn from both good and bad experiences. Summarise these on the journey sheet under appropriate phases with any details on a separate sheet. Then summarise 'do's and don'ts' to guide any improvements, detailing these on a separate sheet as well.

5. Ask for improvement ideas and suggestions

Note this includes applying values and actions from the good experiences as well as developing new ways of providing services and meeting desired experiences. Again, these can be summarised on the journey sheet and detailed on separate sheets.

6. Reflection

Congratulate the patient(s) on the map of their journey through the service and on the insights and opportunities it affords. Ask them to reflect on anything they see in the map or that occurs to them as a result of creating it. Add any observations of your own, asking for their comments on these as well.

7. Develop the patient journey map

Take photos of the maps and develop a master version integrating all the different versions you have. If patients want to keep their maps, make sure you have an accurate record (for example, take additional photos).

Start your master with an inclusive draft (this will be messy and complex) and then simplify it until key improvements are clearly contextualised in the journey phases and related experiences of patients. If you can, carry out this step with patients.

Finally, identify your organisation's service parameters (the phases in the journey it has a responsibility for) within the patient journey, perhaps highlighting any critical improvements here in particular. Make sure you understand these phases clearly. For example, if your service covers only some of the phases described by patients, you may create a separate and more specific diagram to detail patient experiences within your service.

Note: this final diagram commonly becomes a central reference for improvement teams and future work. It is important to make sure it is accurate, emotionally rich and visually simple.

8. Summarise your specific improvement opportunities

This is useful when working with other tools, such as service touchpoints and hotspots and SWIFT ideas.

Plutchik's Wheel of Emotions

Deciding your approach

There are two main ways of developing patient journey maps: individual interviews and group sessions.

  1. Interviewing individual patients with their families/whanau and other supporters: 
    These will give you the deepest understanding of the patient's journey and experiences. Interviews are suitable for more in-depth improvement work.
  2. Talking to patients with similar conditions or service experiences in groups: 
    This will give you the best overview of the journey, key experiences and key improvements. This suits full co-design projects where prior work has been done (such as interviews or surveys) or where time and budget are limited.

Note: You will need to organise recording methods appropriate to the approach you use. All approaches rely on note-taking by or on behalf of patients, so this needs to be managed carefully by facilitators. Audio or video recording may also be appropriate.

Mapping template

Improvement opportunities template

Example: Breast Service patient journey map

The Breast Service at Waitemata DHB explored patient journeys through a patient mapping workshop. The patient journey map is a summary of the results.