Patient Ecosystem Mapping (PEM) : supporting system-shifting in healthcare

Many approaches to innovation are active in the health sector, the majority derived from the world of quality improvement. While these methods are potent and can yield significant results, when used in healthcare they frequently concentrate on individual patient pathways or specific components of a healthcare system - yet many of the challenges in healthcare are associated with patient and staff experiences and the poor interfaces between different parts of a service. In the conventional quality improvement (QI) toolbox there are relatively few methods that support exploration of these more holistic challenges. Design and systems thinking, however, have much to offer. Design thinking has methods and frameworks that put the user at the centre, encourage divergent and convergent thinking, promote early prototyping & iteration and support collaboration through visualisation. Systems thinking helps map the complex connections and relationships between different actors and elements within a system, it explores flows & feedback loops and encourages looking at the system in its entirety from the perspectives of events, trends, connections and mindsets. To translate design and systems thinking into action, healthcare professionals need design and systems methods that are framed around their very particular challenges, are described in the vocabulary of health and complement existing paradigms of quality improvement. This paper describes how a Patient Ecosystem Mapping methodology has been developed that enables a healthcare team to build a ‘London Underground’ style map of the patient pathways within which they work and then use this to reflect on potential improvements. The principles of the mapping process are described. Examples of how the Patient Ecosystem Mapping methodology has been used on various projects and Scotland and Northern Ireland are described. The maps have acted as Boundary Objects, breaking down silos and empowering teams to take ownership of their areas of healthcare. The way different frameworks from systems thinking, such as the iceberg model, have been used to help review the maps is also described. The work is a case study in how design and systems thinking principles can be integrated into a working method with real world value. The work is also a case study in how non-design professionals (from healthcare) can be upskilled in design approaches.