Quality Improvement Zone

The Last 10 Patients tool helps teams examine recent patient journeys through a pathway to better understand variation, delays and opportunities for improvement. By looking at individual patient experiences rather than averages, teams can identify where patients spend time, where delays occur and how journeys vary between individuals.

The tool is commonly used to explore patient flow through a service or pathway and compare actual patient journeys with locally agreed pathways, timescales or expected stages of care. It complements tools such as process mapping and value stream mapping by providing real data about how people move through a system.

Although the tool is called "Last 10 Patients", ten journeys is a guide rather than a rule. Teams may choose to review more or fewer patient journeys depending on the pathway, the information available and the questions they are trying to answer.

Looking at a small number of patient journeys in detail can reveal insights that are often hidden within summarised statistics. The tool helps teams understand how a pathway works in practice and identify where improvement efforts may be most beneficial.

The Last 10 Patients tool can help you:

• understand how patients move through a pathway
• identify bottlenecks, delays and longest waits
• highlight variation between patient journeys
• identify differences in practice across teams or services
• challenge assumptions about how a pathway operates
• generate ideas for improvement and further investigation

By reviewing a small number of journeys in detail, teams can often identify opportunities for improvement that apply to many more patients across the pathway.

The Last 10 Patients tool uses information from recent patient journeys to help teams understand variation within a pathway. The focus should be on learning about the system rather than evaluating individual patients or staff.

1. Define the pathway

Identify the pathway you want to explore and agree the start point, end point and key stages in between. These should reflect the journey you want to better understand.

2. Select patient journeys

Identify the most recent patient journeys you want to analyse. Many teams start by reviewing the last ten patients, although more or fewer journeys may be appropriate depending on the situation.

3. Collect and enter the data

For each patient journey, record the dates or times associated with each stage of the pathway and enter the information into the data collection template.

4. Review the patient pathway chart

The patient pathway chart displays all journeys together, allowing you to compare pathways at a glance.

Look for:

• stages where patients spend a large proportion of their overall journey
• differences between patient experiences
• unusually long waits
• stages that may represent potential bottlenecks

Long sections of the same colour may indicate parts of the pathway where patients spend a significant amount of time, and which may warrant further investigation.