Patient pathways - basic building blocks methodology: guidance

2. Developing the Basic Footprint of Hospital Flow

The first step of the Basic Building Blocks is to understand the current capacity and pathway of patient flow in the hospital site and any support services that ensure patients are cared for in their own home. This may also include additional pathways which reduce admission such as ambulatory care, short stay and clinical decision units.

The footprint diagram (Fig 2.) summarises the emergency patient pathway within an acute hospital, requiring input and care from numerous clinical staff groups and departments/wards. Understanding demand profiles and aligning appropriate capacity at each stage of the patient's pathway is vital to ensure we understand the complexity of patient flow and how it is managed.

Before launching into data analysis it is valuable to invest time in the preparation of your footprint diagram (Fig 2.), and process mapping your patient's pathways (Fig 3).

Engaging with clinical teams, managers and data analysts is vital at this point to ensure that the complexity of your system is clearly described and broken down into relevant pathways and staging posts. The initial footprint diagram (Fig 2.), and the pathways process maps (Fig 3.) act as an important visual guide for the system and will support the operational team in recognising the key staging posts along the route and the relationship these have within the whole system Basic Building Block information that is produced. The format of the analysis will mirror the process maps reinforcing the link between information and operational management decision-making.

Process Mapping is used to develop a 'map' of a process within a system. It will help you to map the whole patient journey or diagnostic pathway with a range of people who represent the different roles involved. Process mapping can be used to help a team understand where the problems are and identify areas for improvement.

http://www.qihub.scot.nhs.uk/knowledge-centre/quality-improvement-tools/process-mapping.aspx

Fig 2 and Fig 3

The Basic Building Blocks is a bottom-up systematic approach to the generation of a demand and capacity analysis report for each staging post within each defined pathway, together creating a demand and capacity summary for the entire pathway. Once each pathway is complete, the resulting suite of reports, together create an over view of demand and capacity within the entire emergency pathway.

The hospital management team can use these reports to create a greater understanding of the hospital system by combining operational knowledge of the existing patient pathways with the 'meaningful data' within the reports. This data will numerically describe demand and capacity at each stage of the pathways, assist in identification of bottlenecks and improve understanding of the cause-and-effect relationships in the system, which can help managers identify the numbers associated with a 'functioning system'.