For a while I’ve been trying to figure out how to map the health & care system based on how people manage their health in their everyday lives.
The challenge is that user journey maps are often created based on the product, platform or programme siloes of an organisation and the resulting journey maps can fit all too conveniently into the world where they were created. This means we may not be able to see where gaps exist in our services.
By mapping journeys from the point of view of people’s lives, we can understand what kind of service they might need.
With NHS Digital’s Lead User Researcher, Rochelle Gold, I am collating everything we currently know about our users, their needs, pain points and challenges in managing their lives. So much of this research exists within NHS Digital and the wider research community. The challenge is how to combine all the data into a meaningful model that can be used to make decisions.
We discovered that health journeys can happen over a long period of time and are very different to a more traditional transaction. In this model there are both circular and linear journeys. The circular journeys represent regular patterns of activity that happen over a longer period:
Manage my wellbeing: This is about living our lives the best we can. We may or may not be aware of the risk of becoming unwell, and thus we may be taking actions to prevent that, or not. This is the prevention and self-management cycle.
Manage my long-term condition: This can be as much about managing a mental health condition, as it is about diabetes, or cancer. There are certain steps patients take in a regular pattern, which forms the cycle.
Manage my end-of-life care: We know people want to have dignity and the best possible quality of life even at the end. This could be managed much more by charities and the third sector, than the NHS.
I’m assuming that each circular journey also has multiple layers. At the moment, the inner most layer is “self”, next circle is “communities”, real or virtual. We know communities are important for people, especially in managing different health conditions. The outmost circle is called “the system”. In this context, this is the wider system of the NHS, central and local government, the 3rdsector, etc.
The linear journeys have a more defined beginning and end, and probably won’t last as long as a circular one. An accident may well trigger a trip to an A&E and may be a stay in a hospital, but if the stay in the hospital is taking longer, it probably is more like one of the other circular journeys; managing a long-term condition, or end-of-life care.
The trigger points
The key in these circular journeys are the red “trigger points”, which are caused by a change, something happening to the person, like an accident, or a life event, like getting pregnant, or the death of a family member. These are important, because they can knock someone off their regular cycle.
We need to understand what the trigger points are and how to manage the consequences of them; Where do people drop off to? What do we need to provide to be able to catch them and get them back onto their regular cycle? And, lastly, how can we prevent the trigger points causing such a disruptive effect in the first place?
This health & care map is a model, which I hope will raise discussions about how we could map health & care journeys and how they are different to other, more transactional journeys which are shorter in length.
As the next steps, I’d like to find out answers to some big questions:
- How would different health & care related journeys fit into this model?
- What other circular and linear journeys are there?
- What are the trigger points? Are they specific to an action, or can they happen at any time? Are they life-events, or more specific to a condition or the person?
I would like to hear from you whether this makes sense and how could this model be evolved further.