The future for care pathways

Abstract

The following is an invited commentary on the paper by Vanhaecht et al., which raised the question, ‘Is there a future for care pathways’, and is intended to contribute to further debate on the subjects raised. The paper answered, ‘yes’ there is a future, and it can be a future which benefits patients more if five issues are addressed. My commentary raises questions about some of the Vanhaecht et al. conclusions and adds other subjects for researcher and practitioner attention. The comments are presented in the spirit of improvement, by a disinterested critical outsider to the growing ‘pathway movement’. I present my comments in the belief that a scientific scepticism can strengthen interventions, and that this can benefit rather than weaken a movement if it seeks continually to improve. My comments are based on research into pathway development in multidisciplinary teams, mostly in the UK in the early 1990s, on research and practical development in quality improvement in Europe, the USA and Australasia, and on reviewing evidence of the effectiveness of interventions for improving quality, which involved comparing effectiveness of pathway interventions to other interventions. My current research focus on coordination to reduce adverse events, including how pathways can do this, also brings a particular perspective to my comments. This commentary first discusses the five challenges, and then raises other issues that I think are important for making more use of pathways to benefit patients. The excellent overview by Vanhaecht et al. is based on a much needed international survey in 23 countries by the European Pathway Association, and on a recent literature review, as well as on experience within the Belgian Dutch Clinical Pathway Network and the European Pathway Association. The paper headings are five recommendations that arise out of the evidence and experience: (1) make pathways more evidence-based; (2) focus on diseasespecific-oriented care; (3) invest in real teamwork; (4) develop technical support for pathways; and (5) see patients as partners. The authors propose these as areas for future work ‘to enhance or even just sustain the quality and efficiency of pathways and to keep the already implemented pathways alive’. Their choice of these five subjects and discussion of the issues are thus related to this aim.