friendly doctor looking after a woman who just gets her bloodpressure checked

Journey mapping in healthcare: innovating patient experience

February 23, 2022

Healthcare services are among the most essential human needs. It does not matter what place on earth, culture, age, gender, predisposition – at some point we all need medical help. And in those sensitive moments, we are glad to have a health system where we can trust both the processes, and the human interaction.

However, the reality of patients’ experience with healthcare services is far from being flawless: disappointment about information sharing, a lack of understanding of the process ahead, and insecurities about one’s own possibilities and tasks are just a few things that make the use of healthcare services feel unpleasant and stressful. Obviously, practicing journey mapping in healthcare has an enormous potential to impact people’s lives.

For this article, we talked to an expert service designer with many years experience as a paramedic and flight rescuer. This article will elaborate on:

  • how healthcare contexts benefit from patient journey mapping, revealing a few real-life use cases
  • a suggestion on what a patient journey map might look like
  • share a few challenges and solutions that CX experts working in healthcare might encounter

Journey mapping in the healthcare context

The health system as we know it in countries of the Global North today has been built upon the analogy between a human and a machine: if something is broken, just use a tool and fix it. As it focused on curative medicine which is highly specialized and based on complaint-treatment, it tends to focus on biological aspects.

Illustration of a human upper body with all the body functions visualized as an industrial piece of machinery
Man as Industrial Palace. Kosmus publishers, Stuttgart, 1926. Chromolithograph. National Library of Medicine.

What’s been overlooked for a long time is that humans do not only consist of their physical health, but people’s mental health and social conditions are just as important, as underlined by the World Health Organization constitution.

95% of customers claim they had a bad experience in healthcare.
The doctor's answer

While we have many decent processes set up in many parts of the world, and the tools we’re using in healthcare are advancing further and further, the experience of people when receiving healthcare is still something we are not actively tackling, or not enough.

Humans can’t be handled like a car – putting them into a workshop, leaving them there waiting for a while, treating them without informing them what’s going to happen, and then letting them go again, hoping it will work for a while until it breaks down again. It can’t always be ‘treat and street’.

Together with the rise of scientific psychology and the decreasing stigma of fear and pain, the importance of human perception is increasingly gaining attention in the sector. For example, medical students learn soft skills at university, like patient-doctor-communication, and are entering healthcare institutions with the desire of not only fixing bodies, but also comforting minds by creating trust and supporting human wellbeing as much as they can.

Meanwhile, public and private health systems want to increase access to services and enhance workflows in different stages of the patient journey, besides promoting health and preventive care extensively, reducing future health care costs.

For all those who are interested in and willing to put effort into comforting patients, journey mapping of healthcare experiences can be a great tool.

What is patient experience?

Patient experience describes the entire set of experiences of a person using healthcare services. This can include the pre-service time, the service or treatment itself, but also post-treatment experiences like checks and ongoing training. Patient experience consists of touchpoints with the health service provider, but also includes moments of no interaction, such as waiting time for an outpatient appointment.

Questions to ask about healthcare experience

Knowing about the diversity of healthcare institutions, there are some questions that affect most of them. Keep in mind that it’s fine to start with assumptions, but then proper patient journey research can confirm or reject some of them so you’re building upon actual, real data.

Who are the patients?

In healthcare, the customer could not be more diverse: age, gender, personal characteristics and experiences with the healthcare system… Depending on the area of healthcare, one or the other characteristic might be dominant. Whereas in the emergency department patients will be mixed, dealing with children in pediatrics requires communication skills and taking multiple stakeholders like parents or school staff into account.

In general we can say: the more healthcare workers know about the people they’re dealing with, the easier it is to actively create and improve the service flow. A few questions that help to better understand the patients are:

  • How much expertise with healthcare do they (or their trusted people) have?
  • What’s their predisposition regarding support by their family or friends?
  • What’s their cultural predisposition, what are their beliefs, what are their fears?
Visualization of a patient persona created in Smaply.

What are the patients’ needs for information?

Health data tends to be rich, complex, and easy to misinterpret if not communicated properly. Even if it requires years of education to understand and treat certain conditions, it is absolutely necessary to be able to communicate the matter in easy language to the patient so they can make an informed decision about the further process.

In order to have a decent flow of information between the patient and the different healthcare staff (doctors, nurses, psychologist, …), a patient journey map can help clarify the communication flow from the patient perspective:

  • What does a patient need to know about their health status to understand it, make decisions, and feel that they are in good hands, without being left behind with too many questions?
  • When does the patient need which information? When is a patient able to process and keep certain information in mind?
  • In what format would the information be most useful?
Four-step journey map of information sharing

How can we shape different stages of the patient journey?

We have to differentiate between the various stages of care. Mostly, we think of the actual treatment and consultation time. However, the pre-service and post-service experience are also essential parts of the overall patient journey. Let’s take an example from our interview partner:

The emergency journey is usually connotated very negatively as the main persona, the patient, is in pain and needs immediate help. At this moment, the main aim is to avoid chaos and panic and to listen to the patient's wishes and feelings, especially to find out pain points and provide comfort. Professional patient journey research can be quite tricky here, but it would be a good starting point for patient journey mapping to research further how this phase can be improved.
As soon as you enter the landscape of a hospital, there is a chance for vast improvements in many different areas – if you manage to raise awareness amongst staff and gather the right data for the patient.
Then the transition between the hospital stay and the after treatment is quite rough and yet provides us with a lot of chances from a service design perspective. There is a strong chance for improvement where awareness is lacking because of missing data.

A few questions that will help with journey mapping in healthcare are:

  • What is the right moment for delivering information to the patient?
  • What is the right time for the patient to process information and make decisions?
  • How can education help at each stage of the patient journey to make the patient feel self-efficient and at the same time rely on the system?
Four steps of a journey in a text lane visualizing the post service communication. Created in Smaply.

How do different staff types interact with patients?

Health is complex, and healthcare workers are experts in their very own field. However analysis and treatment usually needs the knowledge and skills of multiple people, collaborating, or handing over cases to one another. Each person will build their own interaction with the patient, have their own communication style and content.

Questions that will help with patient journey mapping are:

  • What other parties are involved and have an impact on the patient experience?
  • How can everybody in their own role support the patient and make them feel safe?
  • How is it possible to make it feel like a cohesive system, instead of a cluttered patchwork of single service providers that don’t properly communicate?
Four steps of a journey map visualizing the interaction with various staff members. Created in Smaply.

How to create a patient journey map

So now as we have laid the foundations, how can we employ a journey map to help us understand and improve patient experience? Of course there is no standard map type that is valid for each healthcare institution – we know they are both numerous and extremely diverse. However there are a few details that seem of great value for most patient journey maps in healthcare:

  1. Dramatic arc: the importance of an experience and how it develops along the patient journey
  2. Communication: channels and resources of information patients get
  3. Stakeholder impact: family, friends and other parties that are involved in the patient journey

Dramatic arc

Together with the emotional journey, the dramatic arc helps uncover the most important moments that should be tackled first: moments that are high on the dramatical arc (thus, highly important) and low on the satisfaction (patient does not feel treated appropriately).

The combination of dramatic arc and emotional journey visualized in Smaply.

Communication

Communication is key, and a very sensitive topic within healthcare discussions. How much does the patient know and how much is communicated to them in the early phases? A communication layer, basically a plain text lane, can help optimize the communication flow. How much does the patient know at what point, about their situation, about what’s to come? And how is it communicated to them, in what words and format?

These four steps of a journey map created in Smaply show how the persona Karl would have liked the communication to be like.

Stakeholder impact

First, patients might be involved in multiple institutions during the time of the treatment, so it’s beneficial for healthcare workers to know what other parties are involved, or what other experts and services are available to support the patients throughout their journey.

Another thing that people usually neglect is the role of relatives, friends, and family in the patient’s journeys. Not only because they might be needed to support the patient pre, during, and post treatment, but also because they themselves might be affected emotionally.

Finally, healthcare workers themselves should be seen as important stakeholders: having to deal with sensitive cases might be stressful, touching, or raise other strong feelings and needs.

Having a layer to visualize stakeholder impact, stakeholder possibilities and pain points, maybe even by creating multi-persona-maps, can help to understand the bigger picture.

The stakeholders also visualized in the journey map as a backstage lane.

Common challenges of introducing journey mapping to a healthcare context

Yeah, sounds good. Sharpening communication, creating trust, engaging stakeholders, who wouldn’t agree with that. Well, there are reasons why journey mapping is not a standard tool in the healthcare context and they are manifold. However, knowing the issues and learning about potential solutions can help to overcome these hurdles.

The team is lacking awareness

Only few healthcare workers have ever heard about human-centered management tools/approaches, like journey mapping, personas, and the like. However the first time they hear about them, the reaction goes like: “Oh yes, that is really needed! Taking the patient's perspective into account, that makes so much sense!”

So what to do if the team is lacking awareness about patient-centric services?

  • Introduce them to the mindset. Talk about human centricity, about service design. Offer workshops for those who are interested and be sure they will spread the word.
  • Introduce them to the main tools like personas, journey maps and stakeholder maps. They don’t need to actively use them, purely having heard about them will impact their thinking
  • Give them time to process what they have learnt, and to reflect on it on an everyday basis
  • Together, reveal long-lasting habits that are contrary to what patients need
  • Together, reveal opportunities for change
  • Try to gather patient feedback in casual moments so the need for change is highlighted

There’s no time or budget for expensive projects

Change is expensive, especially when it affects the entire organization.
Well… not necessarily.

Looking at other patient-centered initiatives like the one conducted by the UK Government, it turns out that working on the patient experience can actually even help save money. It can make teams collaborate better, make use of synergies and result in more efficient processes.

To fight this prejudice, try the following:

  • Visualize examples of where bad service design results in wasted resources
  • Refer to successful projects from other initiatives
  • Conduct a small, below-the-radar project and showcase the results

The team does not know the big picture

Everyone knows the case of having tunnel vision after working quite a long time at the same place with the same people. The key here is to break up silos and not to be blinded in daily work.

  • Foster cross-silo interaction. Have different departments talk to each other: nurses with doctors, office workers with sanitary staff, patients with managers.
  • Employ managers. A special characteristic of the healthcare field is that most people come without an actual management background. Talking about T-shaped skill sets. Healthcare workers mostly are not generalists, but specialists. Make sure to have generalists aboard.
  • Show the impact. Start with a small and obvious project and use success to showcase how all parties – patient, healthcare workers, partners – can benefit from change.

The system is complex

Yes, the healthcare system is complex. In each patient’s case, there are multiple parties involved, often over long periods of time. Not only is handling interaction between humans not easy, but the same can be said of handing over sensitive healthcare data. Keeping track of artifacts, projects and data is obviously nothing an Excel-Spreadsheet can do for you.

To gain and keep an overview of the different construction sites will be helpful to:

  • Not take processes for granted. The only given thing is patient experience, and processes have to adapt to that – if not in the short term, then at least in the long run.
  • Gather the data you need – and only the data you need – and generate a patient experience insights hub.
  • Break complex maps / journeys down into high-level vs. detailed maps and make the different parts accessible to the people who need the specific knowledge
  • Break the silos. Create cross-silo, cross-functional teams that cooperate on the project and help to navigate the system

Find the journey map example here.

Summary

The experience patients have with their treatment does not only have a great impact on their recovery, but also on hard KPIs of healthcare. Managing patient experience is thus a must-do for healthcare institutions. Working in grown-up, complex systems might require starting small and waiting a long time for first success moments. However, even small changes can have a huge impact on a great number of people. Approaching the project with realistic expectations can increase both buy-in and the team’s motivation in the long run.

Start creating journey maps now!