Facing the challenges of the change

1. Convincing people that there is a problem;
2. Convincing people that the solution chosen is the right one;
3. Getting data collection and monitoring systems right;
4. Excess ambitions and ‘projectness’;
5. The organizational context, culture, and capacities;
6. Tribalism and lack of staff engagement;
7. Leadership;
8. Balancing carrots and sticks – harnessing commitment through incentives and potential sanctions;
9. Securing sustainability;
10. Considering the side effects of change;

Back to basics: using clinical pathways to standardize healthcare and improve quality

• Be patient-centered;
• Be multi-disciplined;
• Represent best practice for most patients most of the time;
• Be an indicator of the care a patient is likely to receive;
• Include prompts to see if tests/interventions have been carried out and whether results have been as expected.

The 5 key attributes of successful clinical pathways

1. Be interdisciplinary and multidisciplinary;
2. Be applicable across the entire continuum of care;
3. Channel guidelines and evidence;
4. Include measurements beyond outcomes;
5. Align with the strategic objectives of the institutions.

A practical framework to design a clinical pathway

1. Evaluate current practices
   
   Before starting to design any program, we suggest you review your current care delivery practices. You should consider all aspects of patient flow through the continuum.
   
   This step, alongside your goals and resources, will give you meaningful insights about which processes need be standardized.
   
2. Choose a clinical condition
   
   In this phase, you identify the patient population that will benefit from a given clinical pathway. This can be achieved through consideration of high-volume admissions, variations in clinical practices, the average length of stay, etc.
   
3. Define the guidelines that must be incorporated into the pathway
   
   Conduct a literature search on diagnosis and treatment approach that you wish to develop a pathway for. Involve your team in this discussion and review evidence-based consensus.
   
4.  Map the care pathway
   
   At this stage you are able to design your pathway, detailing how should a patient in particular conditions be treated.
   
   Besides clinical aspects, we suggest you add an operational approach, detailing the actions to be taken according to the available resources, the local structure, the systems involved, and the necessary schedules to carry out these actions in your hospital unit.
5. Define the target outcomes
   
   Establish outcomes indicators that will be important in measuring progress and success for the pathway population. Define also how outcomes and variances from pathways will be collected.
   
6. Engage your team
   
   Several studies deliver negative results and report implementation problems because of resistance to cooperate.
   
   Staff who contribute to care delivery for a patient population must be provided with information sessions as to pathway content and utilization as well as providing them with data related to the outcome measurement. 
   
   Here, we go deeper on how important it is to involve your team in the clinical pathways' development process. Long story short: successful implementation of care pathways, to a large extent, depends on the involvement and investment of both clinical service providers and managers.
   
7. Implement and evaluate the efficiency and effectiveness of the care pathway
   
   When your clinical pathway is mapped, the outcomes defined and your team aware of all processes, everything is ready to go live. Establish a timeframe for implementation and promote regular discussions to review outcomes.