Joanne Curry

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 patients 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 patients 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

The e-Baby data warehouse: a case study

Neonatal intensive care units (NICUs) require equipment and facilities to assist and monitor premature (and some full-term) babies. This equipment outputs physiological and clinical data, but current research does not provide doctors with techniques for capturing this data in a format that is suitable for analysis and research. Additionally, regional hospitals provide limited NICU support, but, without access to a neonatologist, the baby must be moved to another hospital. This paper details a framework for clinical and physiological data capture, the storage structures within the e-Baby data warehouse, and information access through a secure intranet/Internet browser. The key contribution of this work is the infrastructure that provides a platform for patient information data capture, storage, display and analysis. A key benefit of this work is to provide a mechanism for neonatologists to receive information directly from a regional hospital, thereby preventing, in some cases, the immediate need to move the baby.

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.

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 XML to facilitate information management across multiple local government agencies

The main barriers to the level of electronic data interchange required to seamlessly integrate services offered by legacy systems in an Internet environment are the need for applications to share a common data definition and the non-heterogeneity in database platforms. This paper details a collaborative research initiative between the Penrith City Council, Penrith Australia and the Centre for Advanced Systems Engineering (CASE) at the University of Western Sydney. It details the development of a fully functioning XML-based prototype system that provides effective integration of services offered by a collaborating group of legacy systems. The key contribution of this work is to provide an open systems based infrastructure that allows collaborating legacy systems, based on heterogeneous database and server platforms, to offer an integrated query service over the Internet.

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.

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.

Improving the cancer patient journey.

The research discussed focuses on improving the delivery of cancer services, specifically lymphoma, at a regional Australian hospital. The work examines whether an emerging patient journey modeling technique known as Essomenic, which has been successfully applied in the domains of; midwifery, chronic kidney disease, mental health, ambulatory care, bariatric and osteoarthritis can deliver similar results to the highly time critical domain of cancer diagnosis and treatment commencement. The work also analysed if enhancements were required to the modelling syntax to accommodate domain specific requirements.

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.

Patient journey modelling: using students as a vehicle for the diffusion of innovation.

This paper describes a case study involving third-year undergraduate computing students and their conduct of a patient journey modeling project for the Ambulatory Care department of a Regional Hospital in New South Wales, Australia. The goal of the research was to determine if students, given minimal training in an emerging patient journey modeling tool known as Essomenic, could be an effective vehicle for the diffusion of innovation to operational staff involved in a healthcare improvement project. Under academic supervision, students interacted directly with staff to develop models of the current system of care from GP referral to the completion of the patient consultation. The methodology also included model validation, identification of opportunities for improvement, investigation of alternative solutions and solution recommendations. Outcomes of the project, conducted over a 14 week semester, demonstrate that the students found the technique quick and easy to learn and that they could transfer their new found knowledge of this innovation to healthcare staff for the purposes of developing true and accurate representations of the current state patient journey. Staff were then able to interact directly with the student team, using the models as a communication medium, to identify opportunities for improvement and understand more deeply, how changes would impact their daily tasks and increase patient satisfaction in service delivery.