Raquel Felicio - Deputy Director of organization and processes at Luz Saúde

Clinical pathways define a set of activities that must be performed by all healthcare professionals, based on clinical protocols previously defined, and agreed upon by multidisciplinary teams striving for care standardization.

Furthermore, clinical pathways grant clinical results optimization, by structuring and maximizing efficiency within hospital settings. Thus, its implementation promotes resource optimization, both physical and human, to increase the quality and efficiency of all health services provided.

However, by its very nature, clinical pathways take into account the purely clinical aspects of a given pathology treatment (the clinician should or not perform surgery, which therapy should be applied, etc.), leading to several inefficiencies related to physical and logistical constraints.

An operational approach to clinical pathways implementation

Clinical pathways must have an operational approach that includes all variables, both clinical and procedurals, 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 a particular hospital unit where they are applied. This approach must also contain an observational component, in order to prove its feasibility.

However, anything that involves a behavioral change poses its challenges. By nature, humans tend to resist change, and it is necessary to adopt mechanisms that help the acceptance and, consequently, the adoption of the intended future behavior.

1. Healthcare professionals’ engagement in the training phase

In order to minimize the aforementioned resistance, it is important to involve all professionals in the training phase, giving each one a broader perspective about their intervention, their impact on other professionals, patients, and on the whole organization. Besides, this involvement brings relevant information to minimize difficulties and constraints that may exist in the implementation.

2. Implementation monitoring

Once a clinical pathway is implemented, a new cycle begins. During this phase, monitoring mechanisms must be created, as well as clinical and process-based indicators, in order to quantify compliance, identify positive and negative deviations, and take corrective actions regarding negative deviations, or introduce value, integrating positive deviations in a given clinical pathway.

Advantages and challenges

Although challenges are great, implementing clinical pathways by pathology has numerous benefits derived from clinical processes coordination and healthcare professionals’ specialization. In fact, several studies link clinical pathways with the reduction of hospital length of stay, costs reduction, clinical results improvements, benefits associated with interdisciplinary coordination, and the satisfaction of health teams and, consequently, patients.

In short, incorporating all the variables in the clinical organizational models may bring benefits in the following areas:

  • Improvements in communication between several actors/services involved.
  • Optimization of resource allocation (human and physical).
  • Creation of new knowledge through the analysis of deviations from the expected actions.
  • Exploration of processes’ improvements potential.
  • Integration of cost assessment and consequent enhancement of better management practices.

In conclusion, to successfully operationalize a clinical pathway, the following areas should be considered: incorporation of all the variables, involvement and training of all parties concerned, observation, and monitoring.

To finish my reflection, I leave you with an essential slogan - Listen and Observe - that must be multiplied by three when compared with any other variable.