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P-230 Service and pathways design in a hospice setting
  1. Konstantina Chatziargyriou,
  2. Natalie Carroll-Woods,
  3. Sarah Fidler,
  4. Megha Jain,
  5. Sophia Monastirioti and
  6. Andrew Wigley
  1. Princess Alice Hospice, Esher, UK


Background Continuous quality improvement requires commitment to constantly improve operations, processes, and activities (Varkey, Reller, Resar. Mayo Clin Proc. 2007;82(6):735–9). Clinical pathways allow us to reduce variation, improve quality of care, and maximise patient outcomes (Lawal, Rotter, Kinsman, et al. BMC Med. 2016;14, 35). We believe in continuous improvement, and recognise that one of the biggest barriers to delivering even better care and support is the overall design of our frontline services and the processes that deliver those services.

Aims To review the design of our service user touch points from the point of referral to the hospice until completion of bereavement support. To deliver service design and pathways that create an optimum, inclusive service user experience fully involving the user to choose their services and support. To optimise the use of resources across the organisation, improving the efficiency of pathways, removing duplication and silo working.

Methods With support from an external specialist organisation, we upskilled an in-house team who led on and delivered the project. Jun. – Jul. 2022: Project scoping, planning and development of project plan. Aug. – Sept. 2022: Upskilling of in-house resources including training workshops focusing on customer-centric design, process mapping, Lean Principles. Sept. – Oct. 2022: Customer journey mapping and service design, including production of a service design covering high level pathways, data flows, measures, structures, capabilities, systems and locations. Oct. – Dec. 2022: redesign of detailed pathways to remove waste and improve effectiveness, including detailed pathway maps, with tasks, rules and implementation plan.

Results Development of an Organisational Service Design identified pathways to be reviewed whilst customer engagement work provided context. Three clinical pathways were redesigned: Referral to the Hospice; Bereavement; Pre-bereavement/Carer Support. In-house team was skilled in Lean Principles and tools, service and pathway design.

Conclusions Pathways are crucial to our ongoing pursuit for optimal care, seamless navigation and person-centred experience. By linking evidence to practice (Rotter, Kinsman, James, et al. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006632), our approach allowed us to develop the skills and a structured way to continuously review and improve our services.

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