Human Factors Quarterly / Winter 2018 / Issue 21

Building Journey Maps for Stronger Health Information Technology

Kyle Maddox, MS, and Ashley Cook, HFE, OHI

What is a Journey Map?

A journey map is a visualization of a series of interactions a person has with an organization while attempting to accomplish a goal over time. Journey maps are a type of alignment diagram that allow for visual representation of different aspects of an experience in a grid-like display for easy comparison and analysis. Aspects of the experience, e.g. tasks/activities, emotional state, Health Information Technology (HIT) tools used, etc., are aligned vertically along a chronological timeline so that relationships between the different aspects, that positively or negatively, affect the user experience and can be easily identified and compared throughout the entire experience. VHA Human Factors Engineering (HFE) develops journey maps to visualize provider and Veteran experiences.

A high-level image of a user journey map.
Figure 1. (Click for full sized image) Example of the Visualization of a Journey Map. HFE developed this journey map to explore provider and Veteran needs for Primary Care and Women’s Health services delivery. Detailed call outs are included in subsequent sections of this article.

How can they be used?

The purpose of the journey map is to understand, communicate, and address needs and pain points. Journey maps can be used to create a shared understanding of user goals and collaboratively identify innovative solutions to pain points that would produce the best experience for all individuals involved. Providing this information to development teams and executive decision makers can help them understand how opportunities or compromises in HIT investment could affect current experience and the vision of the “to-be” experience. Journey maps encourage consideration and balance of users’ questions and needs throughout decision making at all levels.

  • HIT managers can use them to gain a more holistic view of the user experience, helping them to identify areas to improve and drive organizational impact.
  • Software designers and developers can use them to gain perspective on the motivations and constraints of the users of their products, resulting in a stronger empathetic bond that can translate into better software design decisions.
  • VHA program office and clinical teams can use the maps to help inform the patient and provider experience. These teams can also use the maps to prioritize fixes or enhancements based on user needs.

How is HFE producing Journey Maps?

Journey maps produced by HFE can be used by VHA program offices to improve provider and Veteran experiences in the subject areas that they cover and/or to act as examples for development of journey maps by other VHA offices. Human Factors Engineering (HFE) is developing the VHA User Experience Guide (UX Guide), an online guide serving as a collection of resources which inform better design practices for Veterans. Part of that effort is providing a process and practical, validated examples of journey mapping. Human Factors Engineering utilizes the following process for producing journey maps:

  1. Identify Stakeholder Goals – Working with stakeholders to create a clear statement of the project’s goals and scope. This can be as simple as a need to understand where the patient and provider experience can be improved. Then choose a user role to develop into the journey map.
  2. Conduct Internal Investigation – Collecting and evaluating existing user information and interview appropriate stakeholder roles to understand the problem space.
    • Examples: Patient satisfaction reports, questionnaire data, existing and new stakeholder interviews.
  3. Journey Mapping Workshop – Gathering together subject matter experts and utilizing collected data to uncover user actions, mindsets and emotions in a logical sequence from the scenario start to finish.
  4. Validate Hypothesis Map with Research – Conducting qualitative research methods and utilizing quantitative data to fill gaps in knowledge and to validate/invalidate assumptions.
    • Examples: Interviews, usability test results, contextual inquiry reports.
  5. Visualize the Scenario by Mapping – Documenting the user experience by creating a visually compelling journey map. This map should identify and prioritize opportunities for user experience optimization.

Once completed, HFE’s UX Guide will provide visualization templates and method descriptions to facilitate the Internal Investigation, Workshop, Validation and Mapping activities in the process.

Journey Mapping Tips and Tricks

HFE learned quite a bit in the development of journey maps for understanding and communicating the experiences of providers and Veterans. The following important pieces of information outline a handful of these lessons and may help your team produce a better journey map for your needs.

1. Center the Journey on the User Experience

Journey maps should be focused on one persona and one scenario per map. A persona is a specific individual (but not a real person) who represents the needs and expectations of a larger group. Personas form an “empathetic bridge” between stakeholder teams and end users. They enable everyone to make decisions that produce the best user experience possible.

High level journey map with persona called out.
Figure 2. (Click for full sized image.) A persona is used as the focus of the journey depicted in the map. Typically, a summary of the persona is displayed on the map, including a photo and a description of the individual. In this example, HFE used a validated persona as the focus of the journey and included her photograph, demographics and summary on the map.

2. Visualize the Narrative

Each persona experiences both individual and shared events. These events are conveyed in the form of a specific rich narrative scenario, which provides context for the persona’s experience. In the journey map, this narrative needs to be told visually and be easy to comprehend. The map should document key user behaviors at each phase of their interaction with the enterprise.

High level journey map with timeline call-out.
Figure 3. (Click for full sized image.) In this example, HFE visualized the narrative using a timeline with photos and text describing each event in the journey.

3. Visualize Service Flow of the Touchpoints

The journey map should outline the actions that occur throughout the experience and should indicate importance of these interactions relative to each other. A subset of these actions can be identified as ‘touchpoints’ with the organization. Visualizing these on the map provides a clear sense of the flow of an experience and ownership for each phase of the journey. Being able to review each part of the journey will help identify insights and requirements for the most optimal user experience.

Figure 4. (Click for full sized image.) In this example, HFE visualized touchpoints in a "transit style" diagram, which shows the touchpoint in each event and demonstrates how they are shared with other personas and which technologies are used.

4. Visualize the Persona’s Mindset and Emotions

While visualizations may vary in terms of what elements they focus, an important and common piece of most journey maps is the persona’s mindset and emotions across the phases of engagement with the organization. This allows decision makers to provide better Veteran and provider experiences by communicating end user expectations versus their actual experience.

High level journey map with a graphic of visualized emotions called out.
Figure 5. (Click for full sized image.) In this example, HFE visualized the emotions of the primary persona prominently alongside the emotions of the secondary personas in this journey, allowing for comparison across the entire experience.

Conclusions & Next Steps

Journey maps are powerful tools to help put and keep the user at the center of organizational thinking. Journey maps of clinical scenarios can support the prioritization of business process re-engineering needs, process improvement projects, and HIT development. HFE currently is refining our approach to developing journey maps to optimize the value they provide in supporting VHA to design optimal user experiences. If your team is building journey maps or interested in working with HFE to build maps, please reach out to us. We would welcome the opportunity to collaborate with your team.

Human Factors Quarterly / Winter 2018 / Issue 21

Human Factors Quarterly / Winter 2018 / Issue 21