Introduction: Patients with acute myocardial infarction (AMI) experience differences in mortality and length of stay between and within Canadian provinces, and between individual hospitals. These variances are well documented but there is little evidence as to why they exist. There may be many explanations for these disparities: 1) lack of knowledge of evidence-based guidelines, 2) inability to translate knowledge from guidelines into practice, and 3) systems and personnel factors affecting the ability to diffuse knowledge institutionally.

Purpose: We wanted to use novel methodology to further elucidate individual, environmental, and institutional level factors that may contribute to these variances. We developed a service blueprint illustrating health care delivery to AMI patients admitted from ER to the ICU/CCU. This will facilitate our understanding of the factors in the decision-making process that is undertaken with these patients.

Methods: Service blueprinting originates from the areas of logistic and industrial engineering and helps one focus on the depiction and design of efficient workflows and tasks. Conceptualizing information in this way, allows one to develop a critical pathway with decision points and to identify system or person factors that mediate the anticipated outcome. The benefit of this technique is that it allows measurement of system components and identification of potential fail points viewed by both the patient who accesses the service and the employees who deliver the service.

Building a service blueprint: 1. Identify the process to be blueprinted 2. Map the process from the patient's perspective 3. Map the process from the provider's perspective, distinguishing front room from back room elements 4. Draw the lines of interaction (illuminates the patient's role and demonstrates where the customer experiences quality), visibility (promotes a conscious decision on what patient's should see and which providers will be in contact with patients), and internal interaction (clarifies interfaces across departmental lines) 5. Link the patient and provider activities to needed support functions 6. Refinement of the blueprint through quantitative data collection and qualitative information obtained through interviews

Results: The illustration conceptualizes the framework we used to develop a detailed blueprint using both quantitative and qualitative methodology.

Conclusions: We developed a robust model that is applicable to different diseases.