Development of a method for modelling and analysing patient pathways: application and integration of value stream analysis in healthcare

Hospitals face increasing efficiency and quality pressures under constrained resources, prompting growing interest in Lean Management approaches such as Value Stream Mapping (VSM). However, applying VSM in complex clinical environments remains challenging. This study develops and evaluates a clinically adapted, pathway-centred VSM-based methodology – Patient Pathway Analysis (PPA) – to model and improve inpatient care. Using a single-centre case study design in neurosurgery, multidisciplinary teams conducted participatory pathway mapping, iterative consolidation, and digital modelling supported by PDCA-based improvement cycles. Outcomes were assessed using routine quality and risk-management data and structured pre-/post-intervention process metrics. Following implementation, routine operational data showed reductions in pre-operative and total length of stay and improved operating-room productivity. Exploratory workforce indicators suggested fewer short-notice surgery cancellations and lover nursing turnover, but these observations require further validation. Patient-centred effects were assessed indirectly through process indicators; future work should integrate patient-reported experience and outcome measures.