Clinical pathways: the cornerstone of a sustainable healthcare future

Clinical Pathways

As the complex relationship between climate change and human health has become increasingly pronounced, many initiatives are emerging, encouraging and supporting hospital leaders in their transition to sustainable and resilient care. In this blog post, we provide some insights on how clinical pathways are the cornerstone of a sustainable healthcare future.

Matilde Ferreira

October 25, 2023 · 7 min read

Health and environment affect mutually: on one hand, the healthcare sector is a huge responsible for greenhouse gas emissions, which contribute to the deterioration of human health and the planet; on the other hand, health professionals and experts recognized climate change as the greatest threat to human health in the 21st century, with more than 250,000 additional annual deaths to be expected between 2030 and 2050¹ – a number that has since been reported as an underestimation.

The impact of care settings, such as hospitals, clinics, and long-term care facilities, on the environment is multifaceted and significant, ranging from energy consumption, to waste generation or transportation emissions:

Energy consumption: care settings are energy-intensive environments, where constant lighting, heating, cooling, and medical equipment usage are essential. High energy consumption contributes to greenhouse gas emissions and can strain local energy grids, leading to increased reliance on fossil fuels if not managed sustainably. Yet, in 2022, it was announced that greenhouse gas emissions from the healthcare sector have steadily increased to reach 5.2% of total global carbon emissions.² This represents more than twice the emissions from the aviation sector.
Waste generation: healthcare facilities generate a substantial amount of waste, including hazardous materials like medical waste and chemicals and consume significant amounts of water for sanitation, medical procedures, and patient care. Taking USA by example, hospital generate about 33.8 pounds of waste each day, which leads to about 6 million tons of waste annually.³
Transportation emissions: the transportation of patients, healthcare workers, and medical supplies to and from care settings contributes to air pollution and carbon emissions. In England, approximately 3.5% (9.5 billion miles) of all road travel relates to patients, visitors, staff, and suppliers to the NHS, accounting for 14% of the health system’s total emissions (including 5% for patient travel, 4% for staff commutes, 4% for business travel and fleet transport, and 1% for visitor travel).⁴

Such figures are poised to increase further if unnecessary processes persist or redundant tasks continue, exacerbating the environmental impact and strain on energy resources. Implementing streamlined clinical pathways can significantly enhance efficiency in healthcare settings, reducing unnecessary resource consumption and energy use while maintaining high standards of patient care.

Are eco behaviors enough?

It is common to emphasize the need to tackle the unwarranted waste of resources, such as paper, or to reduce travel for the sake of sustainability and efficiency. However, one often underestimated dimension is the impact of process variations on the predictability of those very processes. And when operations lack consistent standards and suffer unpredictable variations, waste proliferates.

The lack of predictability in healthcare processes can lead to excessive inventory, work duplication, and ultimately, inefficient resource utilization. Therefore, in addition to adopting environmentally conscious practices, it is crucial for organizations to optimize their processes, seeking stability and predictability, in order to minimize resource waste, striking a balance between sustainability and operational efficiency.

There is no sustainability without consistency and predictability.

The process of standardization is a common practice in several industries, ranging from aviation to food handling. Throughout the ages, we’ve seen these industries responding to major safety crises by standardizing processes to reduce variation and ensure consistency among the workforce. This has resulted in a uniformity level that has allowed them to perform their job functions with fewer incidents and more predictable overall results.

Well, the opposite means unpredictability and waste:

Around a third of medicine is waste, with no measurable effects or justification for the considerable expenditure.⁵
Between 20-25% of all healthcare costs are attributable to unwarranted variations.⁶

The Institute for Healthcare Improvement defines waste as resources expended in services, money, time, and/or personnel that do not add value for the patient, family, or community.

It can take several dimensions:⁷

Failures of care delivery: includes the waste that comes with poor execution or lack of widespread adoption of known best care processes that are effective.
Failures of care coordination: in this case, that’s all about the waste that comes when patients fall through the slats in fragmented care, resulting in complications, hospital readmissions, declines in functional status, etc.
Overtreatment: waste that comes from subjecting patients to care that cannot possibly help them—care rooted in outmoded habits, supply-driven behaviors, and ignoring science.

How do clinical pathways help?

A clinical pathway is a structured multidisciplinary complex clinical intervention that consists in a care plan describing a sequence of actions or steps, systematically organised around timeframes and criteria-based progression, translated from guidelines or evidence into local structures with the aim of standardizing care and optimizing patient outcomes. It is structured as a normative process diagram or decision tree, detailing interventions - and the actors who perform those interventions, as well as the expected results of these interventions.^8,9

Such tools translate clinical recommendations into clinical processes of care within the unique culture and environment of the healthcare institution aiming to maximize patient safety and care effectiveness, thus:

Improving clinical processes consistency and standardization;
Reducing waste and costs related to variation or bad care;
Increasing compliance with best practices and optimizing outcomes;
Enhance organizational predictability.

And how can UpHill support the transition towards greener hospitals?

UpHill is a clinical pathway software that integrates with existing hospital information systems to automate tasks and bridging gaps in care. With our software orchestrating care, hospitals have a comprehensive view of their patient's status throughout their journeys as individuals and as a population, including past history and expected next steps.

Additionally, UpHill supports health teams by automating tasks such as, scheduling exams and appointments, monitoring patients' signs and symptoms after discharge, intelligently interpretating patients’ answers, presenting the next best actions to be done, and getting records automatically proposed to the Electronic Health Records System.

That is to say, hospitals have optimized and predictable processes, as well as real time visibility on such processes, while healthcare professionals are able to strengthen their focus on high value and impact tasks.

Costs of hospitalizations: remote patient monitoring allows to identify early signs of worsening of the condition and adjusting treatments remotely and avoiding readmissions. By reducing hospitalizations, we are also reducing the consumption of resources related to in-hospitalizations (medical supplies, invasive procedures, etc).
Number of hospitals visits: patient-initiated follow-ups reduce the number of hospital visits letting go of rigid timeframes and considering the unpredictable nature of chronic crises. By reducing the number of hospital visits, we are also reducing transportation emissions and costs.
Costs of defensive medicine: evidence-based decision making reduces the adoption of defensive medicine methods, decreasing the related costs. That is to say, by increasing compliance with best practices, we support cost-effective intervention, reducing unnecessary diagnostic tests, exams, prescriptions, etc.
Paper waste: digital clinical pathways contribute to a paperless workflow that minimizes paper documentation waste.

In conclusion, as we stand at the intersection of healthcare and environmental sustainability, it becomes evident that clinical pathways are the cornerstone of a more sustainable future. The intricate relationship between human health and climate change underscores the urgency of adopting practices that not only reduce environmental impact but also enhance patient care. Clinical pathways provide a structured framework to achieve this balance. By standardizing care processes and minimizing unwarranted variations, they can drive consistency, predictability, and ultimately reduce waste in the healthcare sector.

Sustainability is not merely a buzzword; it is a requirement for a resilient healthcare system. Clinical pathways, in conjunction with innovative technologies like UpHill, offer a path towards greener hospitals, where resource consumption is minimized, processes are streamlined, and patient outcomes are optimized. In this pivotal moment, embracing clinical pathways is not just a choice but a necessity for building a healthcare system that prioritizes both the well-being of patients and the planet.

References

World Health Organization. (2023, October 12). Climate change. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
The Lancet Countdown. (2022, November 05) The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. 2022. https://www.thelancet.com/article/S0140-6736(22)01540-9/fulltext
Jain, N., & LaBeaud, D. (2022, October). How should US health care lead global change in plastic waste disposal?. AMA Journal of Ethics . https://journalofethics.ama-assn.org/article/how-should-us-health-care-lead-global-change-plastic-waste-disposal/2022-10
Vinoth, P., & Obeidat, A. (2022, December 1). Toward a Net-Zero Health Care System: Actions to Reduce Greenhouse Gas Emissions. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0307
Braithwaite Jeffrey. Changing how we think about healthcare improvement BMJ 2018; 361 :k2014
Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978
Macfie H, Leo J. IHI Leadership Alliance. Call to Action: Reduce Waste in the US Health Care System and Return the Cost Savings to Patients and the Economy. Boston: Institute for Healthcare Improvement; 2019.
Lawal, A.K., Rotter, T., Kinsman, L. et al. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC Med 14, 35 (2016). https://doi.org/10.1186/s12916-016-0580-z
E-P-A Definition of care pathway. European Pathway Association. Available at https://e-p-a.org/care-pathways/

Matilde Ferreira

Content Strategy & Communication Manager

Graduated in Communication Sciences, early on fell in love with storytelling. Started off as a journalist and then pivoted to the public relations world, she was always driven to craft relevant stories and bring them to the stage.