Going further on cancer waits

Mapping the last ten patients

What is it?

Patient journeys can be mapped in several ways. One useful technique is to take the last ten consecutive patients and use clinical case notes to identify variation in journey times working back from the time treatment delivered. This really helps you understand what is going on in the patient's pathway, so you can manage it. You can also use this tool to check compliance with your locally agreed pathways of care with regard to timescales or key stages in the pathway.

When does it work best?

By mapping patient journeys in this way, you can get to grips with what is really happening to patients along their journey. It may expose differences in practice or workload that can cause variation and unnecessary delay. Tackling these can reduce the referral to treatment time. Discussions with the clinical teams can often lead to finding and resolving issues along the pathway.

How to use it

1. Start by reviewing clinical records for the last 10 patients treated along a pathway

Your aim is to have a simple picture of whathappens to ten patients treated by a named or identifiable consultant.

In the example cited in this tool, the team had already agreed timescales along key stages in a patient's pathway, but you can do this exercise with or without agreed timescales. Try to keep it simple; no more than ten key stages altogether.

2. Next, develop a data collection form

This should include:

• The consultant's name
• A way to link back to the patient record
• Dates when key stages took place (starting with GP referral and ending in treatment date)
• Any additional information (things that stand out)

3. Select a day to start

As patients are treated, use the case files and talk to clinical staff, recording the dates that key stages took place - if a step was bypassed that's OK. Collect information on the last ten patients' journey times and record their progress from a defined start and end point along the agreed key stages.

Don't try and collect the detail: your purpose is to identify the size of any differences and the key stages where patients wait for a long time. Keep the information simple, as there are other tools and techniques designed to pick up the details.

4. Map out the stage

You could use the template in the example. GP referral is day 0, then add up the days as you go through the pathway.

Don't just assume that a consultant is at fault: there are a number of potential reasons:

• Differences in workload and capacity to do work (some teams have their caseload allocated by size of waiting list rather than anticipated waiting time)
• Different types of patient
• Different working practices

You may find that consultants are interested in the difference and the total journey time and are eager to discuss different practices and solutions to reducing the delay. Think about clinical engagement alongside this activity.

Download a template for recording the patient journey