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The purpose of this paper is to provide novel theoretical insight into service delivery system (SDS) design. To do so, this paper adopts a customer journey perspective, using it as a frame to explore dimensions of experience quality that inform design requirements.

This study utilises UK Patient Opinion data to analyse the stories of 200 cancer patients. Using a critical incident technique, 1,207 attributes of experience quality are generated and classified into 17 quality dimensions across five stages of the customer (patient) journey.

Analysis reveals both similarity and difference in dimensions of experience quality across the patient journey: seven dimensions are common to all five journey stages, from receiving diagnosis to end of life care; ten dimensions were found to vary, present in one or several of the stages but not in all.

Limitations include a lack of representativity of the story sample and the impossibility to verify the factual occurrence of the stories.

Adopting a patient journey perspective can improve the practitioner understanding of the design requirements of SDS in healthcare. The results of the study can be applied by managers to configure SDS that achieve a higher quality of patient care throughout the patient journey.

This paper extends existing literature on SDS design by adopting a customer journey perspective, revealing heterogeneity in experience quality across the customer journey currently unaccounted for in SDS design frameworks. Specifically, the findings challenge homogeneity in extant SDS design frameworks, evidencing the need for multiple, stage-specific SDS design requirements.

A broader challenge of co-creating digital solutions with patients addresses the question how to apply an open-access digital platform with trusted digital health information as a measure to transform the way patients access and understand health information. It further addresses use this for adherence to treatment, risk minimization and quality of life throughout the integrated patient journey. The aim of this paper is to demonstrate the early steps in towards progress to co-creating the digital solution.

To coordinate the co-creation process, the authors established a multiphased plan to deep-dive into user needs and behaviors across patient journeys, to identify nuances and highlight important patterns in stakeholder and end-user segment at various stages in the patient's journey.

A set of tools was designed to serve as a human-centered compass throughout the lifecycle of the project. Those tools include shared objects; personas, user journeys, a set of performance indicators with related requirements – all those tools being consistently refined in ongoing co-creation workshops with members of the cross-functional stakeholder groups.

In this study, a multidisciplinary, public-private partnership looked at integrated digital tool to improve access, understanding and adherence to treatment for diverse groups of patients across all stages of their health journeys in a number of countries including European Union (EU) and United States of America (USA). As a result of this work, the authors attempt to increase the possibility that the improved availability and understanding of health information from trusted sources translates to higher levels of adherence to treatment, safer use of medication (pharmacovigilance), better health outcomes and quality of life integrated in the patient's journey.

The purpose of this paper is to present a business process reengineering (BPR) framework of process and data integration with patient journey as the basis for process evaluation and the improvement of patient-flow.

A BPR framework is developed using a mixed-method research design, which incorporated a case study to demonstrate a healthcare scenario with associated processes and data elements, using process models based on event-driven process chain methodology as well as patient and data models, based on unitary structuring technique. The framework includes key processes including patient booking and rebooking, and associated inputs, outputs, and control parameters. In this case, the framework is demonstrated through application to computed tomography (CT) services in a hospital to improve patient-flow, with numerical simulation of CT data collected over time.

The framework supports flexible patient scheduling and the associated planning of healthcare operations and logistics – this in turn helps to improve patient-flow. Furthermore, mathematical modelling and simulation precisely reveal the impact of booking and rebooking on the performance of the CT department.

This innovative framework has potential value for other services, within and beyond the hospital setting.

The proposed framework of process modelling, data, and patient journey addresses the lack of a holistic approach to monitoring and evaluating service performance in hospital settings. Patient journey modelling is an integral part of process and data models that can be implemented in an integrated system environment such as an enterprise resource planning system for real-time monitoring of patient-flow under dynamic conditions.

Capture, consumption and use of person-centred information presents challenges for hospitals when operating within the scope of limited resources and the push for organisational routines and efficiencies. This paper explores these challenges for patients with Acute Coronary Syndrome (ACS) and the examination of information that supports successful hospital discharge. It aims to determine how the likelihood of readmission may be prevented through the capturing of rich, person-specific information during in-patient care to improve the process for discharge to home.

The authors combine four research data collection and analysis techniques: one, an analysis of the patient record; two, semi-structured longitudinal interviews; three, an analysis of the patient's journey using process mining to provide analytics about the discharge process, and four, a focus group with nurses to validate and confirm our findings.

The authors’ contribution is to show that information systems which support discharge need to consider models focused on individual patient stressors. The authors find that current discharge information capture does not provide the required person-centred information to support a successful discharge. Data indicate that rich, detailed information about the person acquired through additional nursing assessments are required to complement data provided about the patient's journey in order to support the patients’ post-discharge recovery at home.

Prior research has focused on information collection constrained by pre-determined limitations and barriers of system design. This work has not considered the information provided by multiple sources during the whole patient journey as a mechanism to reshape the discharge process to become more person-centred. Using a novel combination of research techniques and theory, the authors have shown that patient information collected through multiple channels across the patient care journey may significantly extend the quality of patient care beyond hospital discharge. Although not assessed in this study, rich, person-centred discharge information may also decrease the likelihood of patient readmission.

The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme – the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital.

The development of the evaluation framework involved three stages – namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme.

The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively.

The evaluation framework is limited by its retrospective application to a clinical process redesign programme.

This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

This article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project.

The project employs a service engineering and design science approach with the objective of addressing chronic and multimorbid patients in specialized multiprovider environments. It does this by applying information and communication technologies and organizational design. The project has been a cocreative effort with ongoing interviews and workshops with various stakeholders to inform the conceptualization of a solution, an intermediary step before the implementation phase.

Patient journey disruptions occur when caregivers do not know what to do in specific situations. A potential solution is a virtual care operator (VCO) with a personalized patient card that would enable service ecosystem actors to integrate and coordinate their tasks. This article presents the basic design principles of such a solution.

Conceptual ideas and preliminary results only indicative.

Systemic integration efforts like those ongoing in Finland can benefit from the VCO concept encouraging a more collaborative way of thinking about integrative solutions and opening up new avenues of research on business implications and ecosystem strategies.

The VCO concept answers to the continuity of care, the rising costs of health care and the growing numbers of patients with chronic disease and multimorbidity whose care remains fragmented and uncoordinated.

Taking an ecosystem approach to care integration and addressing interoperability issues are on the cutting edge of healthcare system transformation.

This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.

This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.

When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.

This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.

Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.

Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

The purpose of this paper is to examine the activity of a purpose‐built elective surgery unit in a busy district general hospital and the patient journey associated with same day admission to the elective surgery unit.

This paper describes the layout of the elective surgery unit in a busy district general hospital and the associated patient journey. Early challenges are identified and potential cost savings calculated.

The potential for cost savings in the NHS with purpose‐built units for elective surgery are immense.

An elective surgery unit has not been described in detail before. Apart from its value to the NHS, hospitals in developing countries can benefit from knowing about the early challenges, described in the paper, that were faced.

The increase in demand for health services requires companies in the segment to seek management tools and techniques that focus on reducing waste such as waiting, unnecessary displacement and low people productivity. The purpose of this paper is to present the value stream mapping (VSM) of patients at an occupational medicine clinic, proposing a new scenario with the aid of the simulation of discrete events to reduce the total waiting time during the patient's journey.

The methodology consisted of a case study developed in an occupational health clinic, involving the analysis of the patients' arrival times, time of attendance, number of employees and their functions. Data collection considered 100 random samples from the patients' arrival interval and 40 random samples for each of the operational processes performed by the clinic in a work shift. The collected data served as input for the simulation of scenarios and prioritization of the times for the proposal of the future VSM.

With the study it was possible to propose the reduction of time wasted in the patient's journey, mainly the waiting times (37.92%) and the lead time (29.86%), making it possible for the patient to go through the entire process without waiting for queues. In addition, the increase in employee productivity and efficiency in patient care during the work shift is considered.

Despite the considerable gains obtained with the realization of this study in relation to the processing times, total waiting time and lead time, the analysis was not considered, the mode of execution of the processes performed by the professionals and the influence of the layout to improve the flow of patients, being some of the challenges for future studies to consolidate lean culture in the health segment.

The simulation of discrete events indicated that it is possible to attend a larger number of patients with the same professional structure, in case the delay in the arrival time of doctors and speech therapists is resolved. There was a reduction in the average total waiting time of 37.92%, a reduction in lead time to 29.86% and identification of the steps that most contributed to the increase in queues for patients in a 05:30 min work shift.

The work proposed the constitution of a VSM based on a discrete simulation with data from the entire health unit system, considering everything from the reception for patient registration, collection of laboratory and image exams to medical assistance. The work differs from the others in that it considers the patient's entire journey in the occupational medicine clinic, instead of prioritizing only one service department. The analysis of the results considered the scenario that presented the maximum efficiency of the available resources, respecting the patient's individualized care times, which is one of the complaints of the therapeutic teams to the use of standardization by the VSM.

The “patient journey” technique is one that has been used by health care providers to investigate the strengths and weaknesses of their service delivery. The purpose of this paper is to discuss the experience of adapting this approach for use in an atypical context – the comparison of two systems for managing health care complaints and notifications. It highlights a number of relevant considerations and provides suggestions for similar studies.

The design and methods of the study are described, with commentary on the success of key aspects and challenges encountered. To enable comparison between the two systems, this study had a “paired” design, in which examples were selected from each system so that they matched on basic, prescribed, criteria. Data about each matter’s journey were then collected from administrative records.

While, overall, the technique provided rich data on the processes of the systems under investigation, the type of data collected (related to administrative/communicative events) and the study’s comparative purpose required consideration and management of a number of issues. These included the implications of using administrative records and the impact of differences between the systems on the paired design.

This paper describes an attempt to apply the “journey” approach in a context that is uncommon in two ways: first, in its focus on regulatory processes (complaint/notification handling), rather than care provision to an individual patient; and second, in its objective of comparing two different systems. It is hoped this account will assist in further development of this technique.