Five ways patient journey design can ensure an effective virtual ward

At the recent Convensis Virtual Wards event in London, we heard from many speakers how essential it is to map the journey and pathway for your virtual ward.

Here are five reasons why:

1. Deliver on the promise of a better patient experience
2. Build and stress test the business case - and deliver on it
3. Specify how you will assure clinical standards
4. Align the team to a common vision and model for the service
5. Avoid the ‘IT tail wagging the healthcare dog’

Let’s unpack each of these a little.

1. Deliver on the promise of a better patient experience

A virtual ward means patients receive care at home, not in hospital. At this most basic level that should mean a better experience, and better experiences typically yield better health outcomes. That being said, the benefit of care being provided at home can swiftly become a negative if managing this causes confusion, fear or anxiety for a patient and their household.

Patients and their homes can vary hugely, and we need to be able to design for this range. A patient journey that is built around an understanding of the broad spectrum in patient needs will enable the service to accommodate them into its practices, processes and systems.

For example, we see that virtual wards often require some form of training for patients or caregivers. Ensuring that we build this into the journey will be critical for success. If we know what the patient and caregiver challenges at home may be then this training will be better suited to setting people up for success.

2. Build and stress test the business case - and deliver on it

A patient journey design can make a hypothetical virtual ward tangible. It tells a story of the future service, first through the patient's eyes, but also for all the roles involved in delivery. This ‘map’ can be used to gather feedback on a design and make improvements to it from a full range of stakeholder perspectives. This may call into question claims being made in the business case. We can take these insights and devise ways to provide greater assurance that the case - both financial and clinical - can achieve the desired results. For example, we heard at the event that sometimes medicines management can be forgotten in the service design if it is not made explicit. By engaging pharmacy colleagues early this can be identified and built into requirements.

Once approved, the ‘patient journey map’ provides a way to guide implementation and ensure that the design worked on in theory also works in practice. If there are changes in the process of development and implementation, then the assumptions in the business case can be reviewed. Deliberate consideration of these changes provides the opportunity to find alternative solutions before launch.

3. Specify how you will assure clinical standards

A common challenge raised to our team was the need to convince consultants that a virtual ward could deliver on clinical safety standards. Among others, the main concern was that at-home care may have assurance gaps that clinicians need to support the service. Journey maps enable you to identify clinical decision points and assurances at specific steps in the pathway and define how clinical standards will be achieved.

We have seen that defining referral criteria, patient vital sign reporting and feedback mechanisms are all important ways to build clinical assurance into your virtual ward designs. A journey map can help to diagram and review the governance of your virtual ward, while providing a way to engage clinicians in solutions (not just problems).

4. Align the team to a common vision and model for the service 

A patient journey map provides a coherent story – the target patient experience – that all ‘actors and factors’ involved in development and delivery of the service can align around. At each step we can examine the role of the consultant, the Community team and the digital tools/systems being employed. This coordinates the effort of all relevant parties towards a common vision and delivery model for the virtual ward.

5. Avoid the ‘IT tail wagging the healthcare dog’

We heard more than one example of how IT made the work on virtual wards more complicated. Digital ecosystems in healthcare are typically a complex environment with legacy systems and new technologies, not a greenfield. Because it is difficult and expensive to change IT tools/providers, the risk is that the service follows the system, not the patient.

A journey map that describes the desired experience and outcomes can set the requirements for IT. Ideally, it could guide the procurement of new systems. With existing or legacy systems, it could enable you to better specify your needs and ask for reconfigurations, integrations or workarounds that put the service back in your control.

Patient journey maps define ‘what good looks like’

We heard the comment at the event that describing the target patient experience is easy. This is true – it is easy to define ‘what good looks like’ for a patient. The hard part is delivering on this promise. If we do not start with what good looks like, we are at risk of delivering suboptimal outcomes and another exciting new promise falls short. Without a way to then manage this vision for patients, that guides the delivery effort to bring the service into existence, it may never reach its true potential. At best, patient satisfaction goes up in isolated pockets of the pathway. At worst, another large sum of money is simply sunk into the IT hole.