Focus on external hospital care: identifying communication barriers with mapping methods

Functioning communication and smooth information flows play an important role in the complex setting of outpatient care. The CuraComm project is investigating where communication hurdles arise and how these could be overcome in the future. This article shows how the use of the visualisation technique “mapping” can be used to identify communication hurdles in a targeted manner.

External home care (Spitex) plays a decisive role in the care of chronically or post-acutely ill people at home. Their clients are primarily referred to them by healthcare providers such as GPs or from hospitals, psychiatric clinics or rehabilitation clinics. Unhindered communication between healthcare providers, but also within Spitex and between Spitex professionals and their clients and caring relatives, is crucial for high-quality and effective Spitex care. Only with up-to-date information can a clear picture of the existing problems, risks, concerns, resources, health goals and options for organising everyday life be created, allowing Spitex to create and implement careful, needs- and resource-oriented care planning

But what if communication and the flow of information do not run as smoothly as they should? The CuraComm project is looking for answers to this question. Spitex carers, parents of sick children and senior citizens are involved in the project. On the one hand, the aim is to understand where communication processes are difficult in everyday Spitex care and, on the other, how communication takes place when clients have health complaints. Nursing and design researchers are working together in the interdisciplinary research project: Nursing research contributes expertise in care processes, information flows, medical expertise and understanding the needs of people in need of care and healthcare professionals. Design research contributes expertise in communication processes, visualisation methods and the user-friendliness of communication tools. This enables a multi-perspective gain in knowledge. Methodologically, the researchers used, among other things, the visualisation technique of mapping (journey mapping, mind mapping and stakeholder mapping). This allows the difficulties of analogue and digital communication and the associated challenges in the digital information flow to be recorded in a concrete, detailed and clear manner

The use of visualisation techniques: Journey mapping

The journey mapping method was used to identify the communication hurdles[i] was used to identify communication hurdles. This originates from design thinking and is used not only to better understand complex processes and procedures, but also to visualise them in an understandable and appealing way. Journey mapping is often used in product development and service design to improve the user experience. In the CuraComm project, journey mapping was applied to communication and the flow of information in the care process and used as a care journey both in analogue form for data collection (interviews) and digitally for evaluation. In the columns of a matrix, the care journey maps the process from the client’s admission to the needs assessment through to their discharge from Spitex care. Different aspects of communication are recorded in the rows: who exchanges what kind of information during which actions via which communication channels and what communication problems occur in the process. Post-its in different colours were used to record problems and possible solutions on a DIN A1 poster during the discussions. Along the care journey, the topic was discussed in greater depth together with carers and parents of children with special needs. The visual aid thus served both as an orientation aid in the process and as a guide for the interviews and focus groups (see also Fig. 1)

Figure 1: Analogue map of the care journey. This served as a thought aid and discussion guide during the interviews.

These jointly developed analogue journey maps were digitised and critically compared, completed and analysed using the interview notes and audio recordings. This made it possible to inductively crystallise the important thematic dimensions, validate them based on data and specify the care journey. Important problem areas were, for example, the flow of information during transitions (e.g. transition from hospital care to home care), the transfer or retention of expertise on both the caregiver and parent side and the variety of communication channels used

The use of the “Mindmanager” software enabled efficient data processing during the analysis while at the same time presenting the conversations in an appealing way. It quickly provided an overview of where problems occur in the care process in terms of communication and information flow. By using the digital tool “Mindmanager”, it was also possible to quickly test and compare different variants of presentations and content organisation

The researchers consider the mapping method used in the CuraComm project to be particularly interesting, as it combines various advantages

  • Visual representation: Visual representation makes complex relationships easier to understand. This is particularly helpful when it comes to analysing complex procedures and processes in care communication.
  • Better orientation: Journey mapping provides a clear overview of topics relating to the various phases of the care process. This makes it easier to navigate and identify problem areas.
  • Interdisciplinary communication: The visual representation and joint discussion using the maps promotes and drives critical professional discourse and interdisciplinary communication, as it offers different specialist areas a common language.
  • Efficiency in analysis: Mapping methods enable complex topics to be analysed efficiently with limited resources without the need for time-consuming qualitative coding analysis methods based on a transcript. [ii] iii]

At the same time, however, visual representation and better orientation are also challenges, as these have to be developed from a large amount of information and topics


The results of the care journey mapping summarise the identified analogue and digital communication hurdles and problems in the flow of information. They will now be prepared as use cases in collaboration with Prof. Dr Mascha Kurpicz-Briki ( (BFH Engineering and Information Technology) and Spitex specialists, with the aim of testing the potential of innovative, user-centred and feasible digital solutions. Economic aspects are also included through dialogue with interesting providers. Artificial intelligence could play a role in improving the efficiency and quality of communication and information flows

In terms of the methodological approach, journey mapping has proven to be an efficient method of an interdisciplinary data collection and analysis process. The required depth of analysis could be achieved while at the same time taking into account the complexity of communication processes. It is conceivable that such methods could also be of added value for other constellations of inter- and intradisciplinary collaboration in the healthcare sector

About the CuraComm project

Researchers from the BFH Departments of Health, Engineering & Information Technology and Bern University of the Arts are analysing the needs of Spitex customers and their relatives as well as Spitex nursing staff with regard to the communication of health complaints. The researchers will make a valuable contribution to improving communication in Spitex care and interprofessional communication and demonstrate a perceptible benefit for digital solutions


[i] Joseph, A. L., Kushniruk, A. W., & Borycki, E. M. (2020). Patient journey mapping: current practices, challenges and future opportunities in healthcare. Knowledge management & e-learning, 12(4), 387

[ii] Fearnley, C. J. (2022). Mind mapping in qualitative data analysis: Managing interview data in interdisciplinary and multi-sited research projects. Geo: Geography and Environment, 9(1), e00109

[iii] Pelz, C., Schmitt, A., & Meis, M. (2004, May). Knowledge mapping as a method for analysing and presenting the results of focus groups in market and evaluation research. In Forum Qualitative Sozialforschung/Forum: Qualitative Social Research (Vol. 5, No. 2, p. 35). DEU.

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AUTHOR: Beatrice Kaufmann

Beatrice Kaufmann is an artistic-scientific assistant in the Institute of Design Research at the BFH University of the Arts. She leads the project "Talking Pictures" and is a collaborator in the interdisciplinary working group Health Care Communication Design HCCD.

AUTHOR: Tabea Schmid

Tabea Schmid is a research assistant at the Department of Nursing at BFH School of Health Professions.

AUTHOR: Loraine Olalia

Loraine Olalia is a member of the interdisciplinary working group Health Care Communication Design HCCD and a project collaborator in the Institute of Design Research at the BFH University of the Arts.

AUTHOR: Friederike J. S. Thilo

Prof. Dr Friederike Thilo is Head of Innovation Field "Digital Health", aF&E Nursing, BFH Health. Her research focuses are: Design collaboration human and machine; technology acceptance; need-driven development, testing and evaluation technologies in the context of health/disease; data-based care (artificial intelligence).

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