Patient Journey Action Research: A collaborative and evidence-based approach to quality improvement in healthcare.

Abstract

Project aim and objectives To implement, test and evaluate a structured, evidence-based, collaborative approach to continuous quality improvement in healthcare and explore its wider potential as a model for improvement. Actions taken (including methods used) Patient Journey Action Research (PJAR) improvement project implemented and evaluated in an acute NHS Hospital Trust. The action researcher/project facilitator was external to the Trust but worked in close collaboration with NHS management; a core PJAR project team of 25 interdisciplinary NHS staff; 11 patients with peripheral vascular disease and 6 care partners. Supplementary methods included qualitative interviews with patients and care partners; mapping of Vascular Patient Journey; matrix sampling; PJAR project team meetings. Evaluation through qualitative interviews and/or questionnaire. Measures and Outcomes Measures included • Monitoring via a PJAR Steering Group comprising NHS Trust Management; NHS Executive Committee/Trust Board, Ethical and Research & Development Governance Committees and Bournemouth University. • PJAR meeting notes and ‘Issues and Solutions’ change document - audit trail of improvement. Outcomes: • Poignant catalysts for evidence-based change were quickly identified and effectively implemented where resources supported this. • By also inviting feedback from participants about what worked well, a more balanced approach to service review was achieved. This was reported to enhance team morale and motivation for initiating change and sustaining continuous quality improvement. Learning outcomes and conclusions Strengths; • The ARPJ achieves results as a collaborative, evidence-based and balanced approach to improvement that involves people with first-hand knowledge and experience. • Real involvement - patient and care partner participants valued the opportunity to be actively involved and able to ‘make a difference’ through their contributions. Limitations: • Requires significant buy-in from NHS Trust management and ARPJ team participants. • Time • Dependent on the qualities, attributes, knowledge and people skills of the ARPJ facilitator. Conclusions: • The ARPJ offers as a generic model for healthcare and services review and evidence-based improvement. • The outcomes may have wider reaching impact. For example the potential to “shift thinking” about how clinical care pathways are reviewed and what services are “like from the patient perspective”; and to trigger “cultural shift across the whole hospital”.