Tracer Study

What is it and how can it help me?

A map of a patient journey is a visual representation - a picture or model - of the relevant procedures and administrative processes. The map shows how things are and what happens, rather than what should happen. This helps anyone involved see other people's views and roles. It can also help you to diagnose problems and identify areas for improvement.

There are different approaches to mapping patient journeys, procedures and administrative processes in healthcare services. Which one you select will depend upon:

What you need to know
Resources and timescales
Engagement and interest of staff.

Each one gives you a slightly different perspective and there is no definitive right or wrong. The key is to reflect how things are - and not how they should be.

Examples of process mapping techniques:

A guide to mapping patient journeys - process mapping; a conventional model

Process mapping - alternatives ways to conventional process mapping

Process templates

Walkthrough a patient journey

Spaghetti diagram

Value added steps

A picture of time and resources (process templates) required by a single patient

Reviewing the patient pathway; mapping your last ten patients - using patient files and records

Getting patient perspectives

Care pathway analysis

When does it work best?

Processes around paperwork are often a source of delay. A tracer study may identify hidden bottlenecks in parallel processes. It will reveal information to help you reduce unnecessary delays, time lost due to duplication and work that doesn't make sense or doesn't add value.

This is a way to truly understand a process, including timescales for each stage. So, in identifying sources of delay, you will be able to address the issues and reduce the delays for your patients.

How to use it

What resources you need

Planning time and good communication (staff who are involved need to know what they need to do and why)
A good form
Analysis time
Follow up time (meeting or possibly interviews).

When you sit and work through groups of tracer studies, you should look at this in terms of redesigning processes. Select the process and the paperwork (or electronic equivalent that you would like to track). The most revealing ones will cut across different departments.

Anticipate the start and end points for the paperwork - so you know how get them at the end of the trace. Make contact with the groups you anticipate will have contact with the paperwork and tell them what you are planning to do. It's worth spending a bit of time on this element to engage people with the work. This will be time well spent when you get to the stage of looking for and making suggested improvements.

Start off with a small number, say ten consecutive records.

Develop a tag e.g. a coloured sheet of paper or a ‘pop-up' for electronic records. Everyone coming into contact with the tagged document is asked to sign and date the marker. Keep additional information requested simple - the more complex an account the less likely people will complete it.

Map out the process for the ten consecutive tags.

If you want more qualitative information you can always follow up with a quick chat and ask them more detailed questions about the process. For example:

What is their role? What are they doing with the paperwork?
What do they think about the system? (e.g. blood tests)
Any thoughts on the quality of information?
Any thoughts about handovers?
Any thought about how things could be better?

The focus should be on what happens and what they actually do, not what should happen. Sometimes people find it difficult to say what actually happens and you may need to let them talk about both what they do and what they should do. Alternatively, you may wish to get a few people together to discuss what the map shows, where the delays are and any other problems. A difference between what should happen and what does happen may suggest a problem that is worth exploring.

Below is an example of a tag proforma.

* PLEASE READ THIS *

**********************************

We are asking for your input in helping us understand the process of information flow in e.g. Radiology. To do this we are following a report form.

Please sign a new row each time you use the report form. You may be asked to take part in a short interview about the information on the report form.

Please complete the next empty row on the table below, thank you.

From where did you receive the Report Form	Your Details	To whom will you send the Report Form
Name:	Name: Job Title:	Name:
Name:		Name:
Name:		Name:
Name:		Name:

Having completed the tracer study

Look at opportunities to redesign the process. Here are some ideas:

Reduce the number of steps and reduce the number of people who need to come in contact with the paperwork:steps that don't add value to the patient, steps that can be combined
Look out for times where paperwork is grouped together and dealt with in batches
Look for times where paperwork is processed or decisions are being made out of order.

The important thing is to get people on board with both the causes of delays and the potential solutions. You may need to test the changes out and use some more tracer studies to see the impact of these and spot more opportunities to make more improvements. It may be useful to do a spaghetti diagram to help improve the layout of your department. You will need to engage with your clinicians (see clinical engagement). It might also be useful to anticipate some resistance (see bullet proofing) and to carefully listen to staff and colleagues' views of any proposed changes (see art of listening).

It might also be helpful to consider using the information in overview of tools for identifying the cause of a problem (root cause analysis).

Other useful tools and techniques on this website

Additional resources

Books:

For further information on designing tracer studies see Hornby, P. and Symon, G (1994) 'Tracer Studies' in C. Cassell & G. Symon (eds). Qualitative Methods in Organisational Research (London: Sage)

For an example of the application of a tracer study in a hospital setting, see Symon, Long & Ellis (1996).

Journals:

Symon, G., Long, K. and Ellis, J. (1996) 'The Co-ordination of Work Activities: Co-operation and Conflict in a Hospital Context' Computer Supported Cooperative Work, 5, 1-31.

Also see: Symon, Long and Ellis (1996) The Coordination of Work Activities: Cooperation and Conflict in a Hospital Context. Computer-Supported Cooperative Work, 5, 1-31.

Background

The Tracer Study is a research technique based on process mapping methodology. Guidance on how to use it in the NHS was developed by Gillian Symon.

Acknowledgements / sources

We would like to thank Gillian Symon who was the source for this information and shared her learning.