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A Focus on the Whole Patient Journey

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A Focus on the Whole Patient Journey

What is it and how can it help me?

The efficiency of the whole patient journey is more important than the individual team's efficiencies. 

Taking steps to reduce waiting times in one part of a hospital service often highlights something else that prevents further improvement. For example, after extensive and detailed improvement work in ultrasound, a service improvement lead stated 'without improving transport we can go no further to improve ultrasound services'. As a result, the hospital decided to review porter services.

Diagnostics are often highlighted as a bottleneck in the patient pathways. This is because the speed of clinical investigation and clinical decision making depends upon diagnostic services. In turn, however, diagnostic services rely upon the transportation of patients and samples they need to test. This means that the turnaround time for test results will depend upon both diagnostics and porters (or other transportation) turnaround times. Transporting patients and / or samples for diagnostic tests isn't the only role porters have so their efficiency and way of working will have knock on effects for other parts of the hospital as well.

This is also called whole systems working.

When does it work best?

This tool will support your work to improve or design patient pathways and associated processes.

How to use it

1. Define the patient journey and associated processes you plan to improve

2. Map the whole pathway again in some more detail with a group of other people

3. Talk to the teams that you depend upon and who depend upon you
The needs and gets matrix can help you do this.

For example, talk to the team / people who transfer patients to your team, get to know them and when you feel ready say:

  • How can I make your job easier?
  • This is how you can make my job easier....

Then talk to the team you handover patients to, get to know them and when you feel ready say:

  • How can I make your job easier?
  • This is how you can make my job easier....

Other ways to think about the whole patient journey

  • Follow-up appointments which impact on the ability to see new patients
  • Transfer of care across different healthcare and social care organisations
  • Use of high dependency beds post-surgery for all surgical specialties
  • The impact of giving one patient group a higher priority over another means that the lower priority will end up waiting longer
  • The way a GP works and refers their patients affects the demand at the outpatient department in the local hospital


Imagine your team reduces its backlog of work and sees more patients, but the next team along the patient's pathway did not make any changes. Your backlog would only become their backlog. If this other team was the bottleneck, no more patients were seen along the pathway as a whole. Waiting times would not be reduced.

Not tackling the true cause of problems can often be an issue, as illustrated in the following statement, 'I have spent all week fire fighting, isn't it time I found the cause of the fires?
A large number of people waiting for my service may be a symptom of a problem elsewhere. I can check it out!'

Other useful tools and techniques on this website

process mapping - an overview

© Copyright NHS Institute for Innovation and Improvement 2008