How to design a clinical pathway?

Despite the increased utilization of CPWs, ongoing challenges remain from their conceptualization to evaluation.

How to design a clinical pathway?

Ensuring the best medical care represents a huge challenge. Several studies point out the gaps between the care patients receive and the evidence about what they should have received, preventable adverse events in hospitals are considered as a serious issue, and medical acts with no measurable effects have also represented a third of all care in the last decade.

It’s easy to agree that improving quality in healthcare is intrinsically a good thing to do and, consequently, that efforts to make improvements should be commended. However, as it happens with everything that involves a behavioral change, it poses several challenges to the healthcare institutions. The Health Foundation names some of them:

  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

In this article, we won’t go deeper on this topic (find the report if interested to know more about how to face each challenge). However, it brings us to a critical point: clinical pathways are an efficient way to overcome some of the aforementioned barriers. These are the tools all healthcare providers need to translate standardized best practices to the operational reality, making sure that all patients receive the best care, concerning the available resources and infrastructures, and the population served by a given health unit.

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

Clinical pathways are expected to be patient-centered, to be multi-disciplined, to represent best practice for most patients most of the time, to be an indicator of the care a patient is likely to receive, to include prompts to see if tests/interventions have been carried out and whether results have been as expected.

Thereby, they work as evidence-based roadmaps for clinicians, having a positive impact on the quality of care delivered to individual patients, on patients with particular diseases or conditions, on the workflow of frontline providers (reducing errors), and on processes within the health care organization (improving efficiency). Additionally, clinical pathways can drive positive economic results and can have an impact on advancing the strategic mission of the health care organization.

Despite the increased utilization of clinical pathways as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. In an article published in Pediatric Clinics of North America, the authors outline 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

We have already shared some thoughts on how to create hospital-specific customized clinical pathways, namely by taking into account your unit-specific goals (which areas would you like to improve), and the available resources (the medical specialties that exist in your hospital, how many professionals you have, and technical resources available). We’ve also defined practice tips to guide a design session for clinical pathways. The question now is, after reflecting on these issues, how to design a clinical pathway.

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, considering 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.

Guess what? We can do all of this for you!
UpHill works with leading companies and has impact values to prove its worth in healthcare. We have a large medical crowd allowing us to guaranty excellent quality standards in several medical specialties. So, if you are looking to improve your hospital outcomes and foster your competitive advantage, reach out to us.