What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Current pathway mapping is purely process based, highly medicalised and not adaptive to changes in clinical and patient needs. This endeavour aims to map whole-system, multi-layered surgical pathways from prevention to end of life, ensuring the patient voice is throughout.

It will aid in standardising care where appropriate and reducing unwarranted variation, waste and inefficiencies within the patient journey, improving equity. It will enhance sustainable and collaborative ways of working between boards and healthcare providers, with effective utilisation of resources and considering the population needs and carbon footprint of the service.

Utilising Value-Based Healthcare principles will ensure we engage all stakeholders, placing patients at the centre and consider societal and economic value to protect public money and interest. Value-Based principles ensures a data-driven, evidence-based and dynamic pathway is produced, also highlighting data-driven quality improvement opportunities that can be spread and scaled across Wales for maximal impact and equity of care.

What does your project aim to achieve?

Applying the VBHC principles and utilising this method of pathway mapping, we aim to achieve the below.

Personal Value

• Improving patient outcomes across the whole-system pathway- traditionally just one area e.g. surgical intervention.
• Introducing PROM and goal setting
• Including patient voice
• Improving patient experience
• Reduce health inequalities

Societal Value

• Reduce waste
• Improve carer/family experience and supportive burden of care
• Reduce carbon footprint by appointment/intervention rationalisation
• Population health improvement and reduction of inequality
• Reduce health service contacts across whole-system- each touch-point is value (with a purpose)

Allocative Value

• Improved healthcare professional allocation, releasing capacity for urgent/emergent
• Increase staff satisfaction & morale and ability to work at maximal skill level

Technical Value

• Facilitate demonstrating value across the system by highlighting process, outcome and system measures to ensure we are working effectively and efficiently.
• Layered approach captures what matters to all stakeholders not just the traditional process measures involved with pathway mapping.

How will the project be delivered?

Project team established

Objective 1:  Baseline the pathway using MS Visio.
Objective 2: Metromap against baseline.
Objective 3: Engage with stakeholders to understand variation and areas of opportunity to improve.
Objective 4: Using Metromapping technique to devise an action plan to improve patient journey moving towards zero deaths from colorectal cancer.

We have engaged with the C&V co-production team and patient experience team.

Mapping the pathway will highlight the true areas of quality improvement, involving data to demonstrate value for money and reduce variation. Value for money can only be determined when linking to patient outcomes and therefore this process will ensure that.

We will also incorporate improvement methodology going through PDSA cycles.  After mapping the pathway baseline, patients will be tracked to understand the true patient journey.

How is your project going to share learning?

https://youtu.be/wd_HmNhIh18

As it is a UK first, using metro mapping methodology will increase understanding of how the patient voice, experience and outcomes matter to quality improvement.  This technique was developed by patients, for patients so that healthcare establishments could understand the multifaceted experience of their patients.

Other Q members could utilise metro mapping tools to improve pathway re-design and benefit from our knowledge.  This could easily be scaled at pace throughout the UK and Ireland.  We would look to present and publish our project findings within future Q community workshops and events.

The project team has strong links with the Welsh Value in Health Centre, National Clinical Effectiveness Groups, Cancer networks and Clinical reference groups to share learning and scale across Wales and beyond. Whole-system enables full pathway improvement and the project team has strong links with National Palliative Care work and Public Health forums.