SYSTEMATIC REVIEW PROTOCOL

Reporting of patient journey mapping in current

literature: a scoping review protocol
Ellen L. Davies 1  Danielle Pollock 2  Amy Graham 1  Robert E. Laing 1  Vikki Langton 3  Lemma Bulto 1 
Janet Kelly 1
1
Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia, 2JBI, The University of Adelaide, Adelaide, SA, Australia, and
3
The University of Adelaide Library, The University of Adelaide, Adelaide, SA, Australia

ABSTRACT

Objective: This scoping review will assess the literature that documents or utilizes patient journey mapping
methodologies in health care settings. It will also examine the reporting processes of studies that use this
methodology.
Introduction: Health care systems are complex and can be challenging for patients to navigate. Using patient
journey mapping as a research method promotes a deeper understanding of patient experiences when navigating
these systems. Patient journey mapping provides valuable insights into where systems are working well, where gaps
in care exist, and how the system could respond to these gaps.
Inclusion criteria: This review will consider peer-reviewed articles and publicly available academic literature
documenting patient journey mapping methodologies. The review will also consider studies providing guidance
and recommendations on how to report patient journey mapping studies in health care services and systems.
Methods: The proposed review will follow JBI guidance for scoping reviews. The following databases will be
searched: MEDLINE, Embase, Emcare, PsycINFO, Scopus, Web of Science Core Collection, the Directory of Open
Access Journals, Informit, and ProQuest Dissertations and Theses Global. The search will not be limited to year of
publication but will be limited to studies reported in English. The PRISMA-ScR extension will be used to document
the literature search. Two reviewers will screen titles, abstracts, and full-text articles. An extraction table will be used
to extract relevant data from all included articles and to facilitate data analysis.
Keywords: patient experiences; patient journey mapping; quality and safety; scoping review; service delivery
JBI Evid Synth 2022; 20(5):1361–1368.

Introduction with health services.1-3 These challenges have signif-

elivering appropriate and timely health care
D to large populations involves providing and
coordinating a complex array of health and social
services.1-3 Complexity seems unavoidable in mod-
ern health care systems, which are required to pro-
vide increasingly specialized, evidence-based care to
patients with diverse medical, social, and cultural
needs.1 This complexity can overwhelm people
needing to enter, become oriented in, and navigate
health care systems, particularly if they do not have a
high level of health literacy or previous experiences
Correspondence: Ellen L. Davies, ellen.davies@adelaide.edu.au
DP is a salaried academic at JBI and is a member of the author team
that led the recent update of the JBI Scoping Review Methodology. The
other authors declare no conflicts of interest.
DOI: 10.11124/JBIES-21-00226
icant implications for the people requiring this ser-
vice as well as the service providers themselves.
For individuals, challenges accessing or navigating
health care systems can lead to delays in assessment,
diagnosis, and treatment.1,2,4,5 The consequences of
such delays include poor clinical outcomes, emotional
distress’ increased financial burden’ disenfranchise-
ment’ and reduced trust in the health care system.1,2,4
Navigation challenges experienced by patients and
consumers may result in sections of the system
becoming overloaded (such as emergency services)
while other sections (such as preventive and primary
health care services) become underutilized.2
While a level of complexity innately exists within
health care systems’ dysfunction’ poor communica-
tion’ outdated modes of care delivery’ and hierar-
chical structures add layers of complexity. These are

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SYSTEMATIC REVIEW PROTOCOL
at best, inconvenient, and, at worst, threaten patient
and staff safety.3 Understanding the barriers and
facilitators of patient access to appropriate and
timely care is an important step toward improving
quality and safety.3
A number of research approaches and methodol-
ogies have been used to examine these complex
factors. One such method is to map individual
patient journeys through the health care system to
identify and understand challenges and enablers
from various perspectives, including those of the
patients themselves, their relatives, carers, and clini-
cians.5-8 Patient journey mapping is a methodology
that originates in marketing research, where custom-
ers’ shopping experiences have been mapped in
relation to emotional experiences.9 The data gath-
ered have been used to inform changes in stores to
improve customer experiences, with the goal of
increasing sales.9
In health research, patient journey mapping is
used to explore patient experiences in a variety of
health settings and contexts. For example, a patient
journey mapping methodology has been used to
explore the experiences of Aboriginal people with
kidney disease. The findings indicate that Aborigi-
nal people are navigating disconnected health care
systems while having to leave home, family, and
community to receive lifesaving treatment. Health
care is often recorded as single episodes of care.
In this example, patient journey mapping allowed
the patients’ experiences to be documented and
explored as they traversed the health care system,
interacting with different services and health care
providers.5 In this type of research, patient journey
mapping can be used to identify barriers and ena-
blers from the unique perspective of patients, fam-
ilies, and the health professionals who care for
them.
In another example of patient journey mapping,
the experiences of single episodes of care for patients
undergoing hand and wrist surgery were mapped in
precise detail across different health care providers.6
In this instance, the journey mapping enabled the
pooling of experiences to draw comparisons between
different health care settings.6
Studies have recognized the value of patient journey
mapping to improve quality, understand changes in
health care needs over time, identify gaps in services,
examine patient experiences, and empower service
users and patients to voice their concerns and
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E.L. Davies et al.
considerations about how services should be provid-
ing care.3,5-9
While a number of tools and methodological
approaches have been proposed to conduct patient
journey mapping research,7,8 to date, there are no
formalized reporting guidelines on what to document
from publications and quality improvement reports.
As this methodological approach continues to evolve
and be adopted, health research reporting guidelines
are anticipated to improve the rigor and transparency
with which studies are conducted and reported. As
per the recommendations of Moher et al.,10 this scop-
ing review will act as the initial step in developing
guidelines by i) assessing the extent of the literature
that has documented patient journey mapping meth-
odologies; ii) examining the reporting of studies that
have used patient journey mapping methodologies in
peer-reviewed articles and other publications that are
publicly available; and iii) gathering and organizing
data to inform the development of formalized report-
ing guidelines for patient journey mapping studies.
Review question
How are studies that use a patient journey mapping
methodology in health services described and docu-
mented in the academic literature?
Inclusion criteria
Participants
There are no inclusion criteria relating to partici-
pants in this review.
Concept
The concept being explored in this scoping review
is the mapping of patient journeys through health
care systems and services as a method of collecting,
analyzing, and presenting data for research or qual-
ity improvement projects. Studies applying a patient
journey mapping methodology to document patient
experiences will be included in this review. Publica-
tions that provide guidance or describe a methodo-
logical approach for undertaking patient journey
mapping studies will also be considered if they contain
suggestions or requirements for documenting or
reporting research that adopts this data collection
and analysis strategy.
Context
This review will consider studies that include all
settings where patients are provided with health care
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services. A broad definition of health care will be
adopted throughout the review. Examples of the
context in which studies have been conducted may
include, but are not limited to, primary, secondary,
or tertiary health care services in the public or private
sector. There will be no exclusions based on field of
health care research.
Types of sources
This review will include all peer-reviewed primary
research articles that have used a patient journey
mapping methodology to examine, explore, des-
cribe, or document the experiences of individuals
as they enter, navigate, and/or leave any section of
the health care system. These articles may include
studies published in journals, theses, and disserta-
tions. The review will also include any peer-reviewed
methodology papers that directly describe reporting
requirements for patient journey mapping studies.
Methods
The proposed scoping review will be conducted in
accordance with the JBI methodology for scoping
reviews.11,12 The reporting of methodology and
results will be guided by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses
extension for Scoping Reviews (PRISMA-ScR).13,14
Search strategy
The search strategy will aim to locate published and
peer-reviewed studies. An initial limited search of
MEDLINE and Scopus was undertaken to identify
articles on the review topic. A selection of articles
known to the authors was used to identify keywords
and phrases related to this study as they are not well-
established MeSH terms. This was evident in the
limited results and lack of some papers expected to
appear in the initial searches. The text words con-
tained in the titles and abstracts of relevant articles
were used to develop a search strategy in consultation
with an academic librarian. An initial search strategy
for MEDLINE (Ovid) is presented in Appendix I, with
examples of keywords categorized by concept and
context. This search strategy, including all identified
keywords, will be adapted for each included database
and information source. The reference lists of all
articles will be screened for additional studies.
Due to time and resource limitations, only studies
published in English will be included. There will be
no limitations for year of publication.
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E.L. Davies et al.
The databases to be searched will include
MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid),
PsycINFO (Ovid), Scopus, Web of Science Core
Collection, the Directory of Open Access Journals,
Informit, and ProQuest Dissertations and Theses
Global. Selected relevant journals, such as Patient
Experience Journal, will be hand searched for
articles. These journals are not indexed in the
above-mentioned databases, but are known to con-
tain articles that would meet the inclusion criteria of
this review.
Source selection
Following the search, all identified citations will be
collated and uploaded into EndNote X9.3.3 (Clar-
ivate Analytics, PA, USA) and duplicates removed.
The studies will then be imported into Covidence
(Veritas Health Innovation, Melbourne, Australia)
for title and abstract screening. Each data screener
will participate in a pilot screening process to ensure
consistency. The pilot test will involve each reviewer
screening a random selection of 10 abstracts. They
will then meet to discuss their findings, determine the
need for further clarification of the eligibility crite-
ria, and identify any inconsistency in screening
approaches. During the title and abstract screening,
each article will be screened by two independent
reviewers for evaluation against the inclusion crite-
ria. Full-text articles that meet the inclusion criteria
will be retrieved and assessed. Initially, six full-text
articles will be assessed by all reviewers to pilot the
screening process. If significant issues are identified
at this stage, the eligibility criteria will be reviewed
and an additional six articles will be screened by the
reviewers. Full-text articles will be assessed by two
independent reviewers via Covidence. Reasons for
exclusion of full-text articles will be documented in a
separate table and reported as an appendix to the
scoping review.
Any disagreements arising at each stage of the
selection process will be resolved through discussion
between the data screeners. If a decision cannot be
made, advice from an additional reviewer will be
sought. The results of the search and the study inclu-
sion process will be reported in full in the final scoping
review and presented in a PRISMA flow diagram.15
Data extraction
Data will be extracted from papers included in the
scoping review using a data extraction table. The
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table will be piloted by three reviewers before being
populated with all included articles. All reviewers
will participate in data extraction from individual
studies’ with five double extracted in the first
instance to evaluate consistency and accuracy. Data
from fulltext articles will be extracted by one
reviewer each’ with the extracted information cor-
roborated by a second reviewer. Any disagreements
arising from the piloted papers will be resolved
through discussion, or with additional reviewers.
If necessary, additional extracted studies will be
reviewed.
Extracted data will include specific details about
the concept, context, study methods, and key find-
ings relevant to the review questions. For example,
sample demographics, the purpose of the journey
mapping research, the voice that is given privilege in
the study (eg, researcher, participant, both equally),
and the study context. A draft extraction form is
provided in Appendix II. This draft data extraction
tool will be modified and revised as necessary
during the process of extracting data from each
included evidence source. Modifications will be
detailed in the scoping review report.
Data analysis and presentation
Data analysis will include simple descriptive statis-
tics relating to sample size, sample demographics,
and methodological approach (eg, simple fre-
quency counts). Following the guidance of the
JBI scoping review framework,11,12 textual data
will be analyzed using a summative content analy-
sis approach.16
Data presentation will initially be in tabular for-
mat. Due to the iterative process of scoping reviews,
the decision on further presentation styles, such as
graphs and figures, will be decided once data extrac-
tion has been undertaken. A narrative summary will
be presented, together with visual data to create a
richer description of the findings.
Consultation with stakeholders
Consultation with key stakeholders is not often
undertaken in scoping reviews; however, it was
recommended in initial methodology papers describ-
ing this approach to evidence synthesis.17 In the
proposed review, key stakeholders are included as
authors. JK and AG are researchers who are actively
developing the patient journey mapping approach
to improve quality and safety in health care. These
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E.L. Davies et al.
researchers will participate in this review as content
and concept experts.
The results of this scoping review will be used
in consultation with key stakeholders to determine
the need for reporting guidelines for studies that
use patient journey mapping methodologies. If a
need is identified, stakeholders will be invited to
contribute to guideline development in a collabo-
rative study.
References
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Challenges in navigating the health care system: develop-
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2. Pope C, McKenna G, Turnbull J, Prichard J, Rogers A.
Navigating and making sense of urgent and emergency
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(3):435–43.
3. Ben-Tovim DI, Dougherty ML, O'Connell TJ, McGrath KM.
Patient journeys: the process of clinical redesign. Med J
Aust 2008;188(S6):S14–7.
4. Driscoll MA, Knobf MT, Higgins DM, Heapy A, Lee A, Haskell
S. Patient experiences navigating chronic pain manage-
ment in an integrated health care system: a qualitative
investigation of women and men. Pain Med 2018;19
(suppl_1):S19–29.
5. Kelly J, Wilden C, Herman K, Martin G, Russell C, Brown S.
Bottling knowledge and sharing it - using patient journey
mapping to build evidence and improve Aboriginal renal
patient care. Ren Soc Australas J 2016;12(2):48–55.
6. de Ridder EF, Dekkers T, Porsius JT, Kraan G, Melles M. The
perioperative patient experience of hand and wrist surgical
patients: an exploratory study using patient journey map-
ping. Patient Exp J 2018;5(3):97–107.
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ducing Aboriginal patient journey mapping tools for
improved quality and coordination of care. Aust J Prim
Health 2017;23(6):536–42.
8. McCarthy S, O'Raghallaigh P, Woodworth S, Lim YL, Kenny
LC, Adam F. An integrated patient journey mapping tool for
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advocacy tool for disabled people. Soc Mar Q 2012;18
(1):67–76.
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Med 2010;7(2):e1000217.
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Alexander L, et al. Updated methodological guidance for
the conduct of scoping reviews. JBI Evid Synth 2020;18
(10):2119–26.
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12. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC,
Khalil H. Chapter 11: Scoping reviews. In: Aromataris E,
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https://synthesismanual.jbi.global.
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M, et al. A scoping review on the conduct and reporting of
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D, et al. PRISMA extension for scoping reviews (PRISMAScR):
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15. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffman TC,
Mulrow CD, et al. The PRISMA 2020 statement: an updated
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Appendix I: Search strategy

Keywords

Concept Context
 
patient journey healthcare service
or or
journey map health care service
or or
patient experience adj4 map ward or wards
or or
patient experience map health service
or or
care journey hospital
or or
healthcare journe health care
or or
health care journey healthcare
or or
customer journey map tertiary health
or or
touchpoint primary health
or or
patient pathway secondary health
or
client journey
or
Consumer journey
or
service user journey
or
care mapping
or
healthcare mapping
or
health care mapping
or
(navigat adj4 patient)

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SYSTEMATIC REVIEW PROTOCOL E.L. Davies et al.

Ovid MEDLINE(R) ALL <1946 to June 18, 2021>

Date searched: June 20, 2021

# Search Records retrieved

       
1 (patient journey or journey map or (patient experience adj4 map ) or patient experience map or care journey or healthcare 5751
journe or health care journey or customer journey map or touchpoint or patient pathway or client journey or Consumer
journey or service user journey or care mapping or healthcare mapping or health care mapping or (navigat adj4 patient)).mp.
2 exp hospitals/ 286,577
   
3 (healthcare service or health care service or ward or wards or health service or hospital or health care or healthcare or 2,729,727
tertiary health or primary health or secondary health).mp.
4 2 or 3 2,741,780
5 1 and 4 3273

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SYSTEMATIC REVIEW PROTOCOL E.L. Davies et al.

Appendix II: Draft extraction tool

Voice that is privileged Context of study

Year of Sample Purpose (eg, patient, clinician, (eg, hospital, Reporting Gaps in reporting of
Authors publication Country Population demographics of research researcher) ward, service) approach project

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