Exploring the patient journey: a collaborative approach to patient-centred improvement in healthcare.

Abstract

Despite widespread endeavours over many years, patient-centred care continues to evade some areas of healthcare. This can be clearly evidenced by regular reporting of sub-standard care and the findings of national patient experience surveys which repeatedly highlight a number of common contributory factors. Amongst these include a predominant culture of secrecy and blame rather than openness and support; failure to listen and respond to staff or patient issues; workloads and time constraints; fragmented teamwork; an overriding focus on targets rather than people; in addition to varying perceptions and interpretations of, and expectations and priorities for patient-centred care (PCC). These occur between patients, staff, educationalists, policy-makers, healthcare managers and the public. These factors, which are further reinforced by this study’s review of empirical studies of patient-centred care, strongly indicate that new approaches to improvement, that involve service providers as well as service users, are called for. Addressing this call was an interest of this study. Action research was selected because this promotes a collaborative and democratic approach to research-based organisational, social and cultural change and improvement. In this study, which was also underpinned by the philosophy of patient-centred care, action research was combined with the Patient Journey. This is a patient-centred improvement, and, or, practice development process developed and tested by Campbell et al (2004) at the City Hospitals Sunderland NHS Trust. By combining the action research and Patient Journey (PJ) processes, this enabled the generic potential and effectiveness of the approach to be concurrently investigated and established as will be explained. Through the collaborative efforts of a participating 25 member Vascular Patient Journey project team, data was gathered during the process through team discussions, mapping and interviews with 17 service users. 75 issues were identified using inductive thematic analysis; 34 of which emerged from the data of service users, 35 from service provider data, and a further six jointly emerged from both datasets. These provided powerful catalysts for change and points of learning which the team, empowered by their involvement in the process, used as the evidence-base from which to action change, as discussions in this thesis will demonstrate. They will also illustrate why more should be done to involve multidisciplinary teams as well as service users in improvement.