Pub Date : 2010-09-01DOI: 10.1258/jicp.2010.010024
M. Panella, K. Vanhaecht
In the previous issues of this journal, we have discussed the need for knowledge sharing and research on pathways as complex interventions. Other papers have also recently been discussing that if we want to use pathways as one of the tools to change the future of health care, the need for continuous learning and understanding of how, when and where pathways were developed, is crucial to understand the effect on the main outcome. The organization of care processes has been receiving increasing attention from clinicians and managers and many care processes are undergoing change; but although every improvement involves change, not all changes are improvements. To know that change is producing improvement, we need information about what is happening. Different authors have discussed the direct relationship between interventions or organizational changes and outcomes. Based on Donabedians’ paradigm of Structure–Process–Outcome, the Realistic Evaluation Configuration contends that causal outcomes follow from mechanisms acting in a context (Context þ Mechanism 1⁄4 Outcome [CMO]). The Realistic Evaluation approach offers researchers the opportunity to look at evaluation from a realistic perspective, one in which action is not happening in a laboratory environment. The questions posed are ‘What works, for whom, in what circumstances?’ instead of ‘Does this work?’ or ‘What works?’. The basic CMO concern is still, of course, the outcome. However, the explanation first focuses on the mechanism (e.g. the program that was introduced, known as the process in Donabedians’ paradigm) and second focuses on the context (e.g. the characteristics of the organization where the programme was introduced, known as the structure in Donabedians’ paradigm). The Realistic Evaluation Configuration has previously been used in a wide range of health-care projects. The care process organization triangle is a conceptual framework to better understand how pathways work, and was developed based on different models of care organization (see Figure 1). The care process organization triangle suggests that if we want to understand how pathways work, we need to understand the structure (defined by other authors as the context, the system, the design, the company and the firm) and the process (defined by other authors as the mechanism, the interventions, the professional development, the frontline employee and the delivery of care) in order to understand the effect on the outcome (defined by other authors as the results, the patient, the customer and the client). In evaluating pathways, we need to make sure we fully understand the type of information we are searching for. When we want to understand what is happening in our own organization with regards to the care process, and what the impact is of our care pathway in our care organization, the aim is a formative evaluation. When we are searching for the proof that pathways work, the aim is a summative evaluation. For summative evaluation
{"title":"Are project presentations important?","authors":"M. Panella, K. Vanhaecht","doi":"10.1258/jicp.2010.010024","DOIUrl":"https://doi.org/10.1258/jicp.2010.010024","url":null,"abstract":"In the previous issues of this journal, we have discussed the need for knowledge sharing and research on pathways as complex interventions. Other papers have also recently been discussing that if we want to use pathways as one of the tools to change the future of health care, the need for continuous learning and understanding of how, when and where pathways were developed, is crucial to understand the effect on the main outcome. The organization of care processes has been receiving increasing attention from clinicians and managers and many care processes are undergoing change; but although every improvement involves change, not all changes are improvements. To know that change is producing improvement, we need information about what is happening. Different authors have discussed the direct relationship between interventions or organizational changes and outcomes. Based on Donabedians’ paradigm of Structure–Process–Outcome, the Realistic Evaluation Configuration contends that causal outcomes follow from mechanisms acting in a context (Context þ Mechanism 1⁄4 Outcome [CMO]). The Realistic Evaluation approach offers researchers the opportunity to look at evaluation from a realistic perspective, one in which action is not happening in a laboratory environment. The questions posed are ‘What works, for whom, in what circumstances?’ instead of ‘Does this work?’ or ‘What works?’. The basic CMO concern is still, of course, the outcome. However, the explanation first focuses on the mechanism (e.g. the program that was introduced, known as the process in Donabedians’ paradigm) and second focuses on the context (e.g. the characteristics of the organization where the programme was introduced, known as the structure in Donabedians’ paradigm). The Realistic Evaluation Configuration has previously been used in a wide range of health-care projects. The care process organization triangle is a conceptual framework to better understand how pathways work, and was developed based on different models of care organization (see Figure 1). The care process organization triangle suggests that if we want to understand how pathways work, we need to understand the structure (defined by other authors as the context, the system, the design, the company and the firm) and the process (defined by other authors as the mechanism, the interventions, the professional development, the frontline employee and the delivery of care) in order to understand the effect on the outcome (defined by other authors as the results, the patient, the customer and the client). In evaluating pathways, we need to make sure we fully understand the type of information we are searching for. When we want to understand what is happening in our own organization with regards to the care process, and what the impact is of our care pathway in our care organization, the aim is a formative evaluation. When we are searching for the proof that pathways work, the aim is a summative evaluation. For summative evaluation","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126737353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01DOI: 10.1258/jicp.2010.010019
K. Vanhaecht, M. Panella, R. van Zelm, W. Sermeus
Care pathways, also known as clinical pathways, critical pathways or integrated care pathways, are used all over the world. Although they are used internationally, there are still a large number of misunderstandings. The goal of this paper is to provide an overview on the history of pathways and how pathways are actually perceived and defined. Pathways are more than just a document in the patient record. They are a concept for making patient-focused care operational and supporting the modelling of patient groups with different levels of predictability. Pathways are a method within the field of continuous quality improvement and are used in daily practice as a product in the patient record. This paper explains these different issues and provides an extensive list of references that should support pathway facilitators, clinicians, managers and policy-makers in their search for excellence.
{"title":"An overview on the history and concept of care pathways as complex interventions","authors":"K. Vanhaecht, M. Panella, R. van Zelm, W. Sermeus","doi":"10.1258/jicp.2010.010019","DOIUrl":"https://doi.org/10.1258/jicp.2010.010019","url":null,"abstract":"Care pathways, also known as clinical pathways, critical pathways or integrated care pathways, are used all over the world. Although they are used internationally, there are still a large number of misunderstandings. The goal of this paper is to provide an overview on the history of pathways and how pathways are actually perceived and defined. Pathways are more than just a document in the patient record. They are a concept for making patient-focused care operational and supporting the modelling of patient groups with different levels of predictability. Pathways are a method within the field of continuous quality improvement and are used in daily practice as a product in the patient record. This paper explains these different issues and provides an extensive list of references that should support pathway facilitators, clinicians, managers and policy-makers in their search for excellence.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114912361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01DOI: 10.1258/jicp.2010.010022
J. Verkerk-Geelhoed, R. van Zelm
This study was conducted to prioritize the competencies for the operational manager regarding the management of care pathways. In the Schouten & Nelissen Competence Model (SNCM), the operational manager works according to the management style ‘task-centred leader/producer’. A measurement instrument was developed to conduct a Delphi study. The competencies on which complete consensus has been reached were presented to a focus group in the second phase of the study. The Delphi was carried out with five experts in three rounds. Complete consensus on 30 competencies was reached. The focus group consisted of three participants and produced 10 core competencies. These belong to the level of operational management and the management style ‘task-centred leader/producer’ in the SNCM. The number of experts in both the Delphi study and focus group was limited, which may have influenced the outcome. There is hardly any literature on competencies operational managers' need for managing care pathways. This study has produced 10 competencies that the operational manager needs for coordinating care pathways. These core competencies can be used to specify or complete the competence profile of operational managers working with care pathways.
{"title":"Competencies for managers of care pathways: an exploratory study","authors":"J. Verkerk-Geelhoed, R. van Zelm","doi":"10.1258/jicp.2010.010022","DOIUrl":"https://doi.org/10.1258/jicp.2010.010022","url":null,"abstract":"This study was conducted to prioritize the competencies for the operational manager regarding the management of care pathways. In the Schouten & Nelissen Competence Model (SNCM), the operational manager works according to the management style ‘task-centred leader/producer’. A measurement instrument was developed to conduct a Delphi study. The competencies on which complete consensus has been reached were presented to a focus group in the second phase of the study. The Delphi was carried out with five experts in three rounds. Complete consensus on 30 competencies was reached. The focus group consisted of three participants and produced 10 core competencies. These belong to the level of operational management and the management style ‘task-centred leader/producer’ in the SNCM. The number of experts in both the Delphi study and focus group was limited, which may have influenced the outcome. There is hardly any literature on competencies operational managers' need for managing care pathways. This study has produced 10 competencies that the operational manager needs for coordinating care pathways. These core competencies can be used to specify or complete the competence profile of operational managers working with care pathways.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"05 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129406364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01DOI: 10.1258/jicp.2010.010021
S. Dy, A. Gurses
Although care pathways often target efficiency of care through mapping and standardizing care processes, care can also be improved by reducing patient safety events, such as complications. In this paper, the authors review key concepts and literature relevant to parallels between patient safety and pathway interventions, as well as patient safety issues that should be considered in pathway development and implementation. Both care pathways and patient safety interventions are more likely to be effective when based on a theoretical framework related to human or systems factors or behaviour. Care pathways can target patient safety outcomes, but can also produce new hazards, through applying standards too broadly, reducing adaptability to complex situations or changing care processes in unforeseen ways. Both pathways and safety interventions must also be efficient and consider the opportunity costs of the time needed for providers to implement the intervention. Further research should explore how best to standardize care when needed, while evaluating how best to prevent and monitor hazards, allow for innovation and adaptability to customize care when appropriate, and continue to develop new methods for improving quality.
{"title":"Care pathways and patient safety: key concepts, patient outcomes and related interventions","authors":"S. Dy, A. Gurses","doi":"10.1258/jicp.2010.010021","DOIUrl":"https://doi.org/10.1258/jicp.2010.010021","url":null,"abstract":"Although care pathways often target efficiency of care through mapping and standardizing care processes, care can also be improved by reducing patient safety events, such as complications. In this paper, the authors review key concepts and literature relevant to parallels between patient safety and pathway interventions, as well as patient safety issues that should be considered in pathway development and implementation. Both care pathways and patient safety interventions are more likely to be effective when based on a theoretical framework related to human or systems factors or behaviour. Care pathways can target patient safety outcomes, but can also produce new hazards, through applying standards too broadly, reducing adaptability to complex situations or changing care processes in unforeseen ways. Both pathways and safety interventions must also be efficient and consider the opportunity costs of the time needed for providers to implement the intervention. Further research should explore how best to standardize care when needed, while evaluating how best to prevent and monitor hazards, allow for innovation and adaptability to customize care when appropriate, and continue to develop new methods for improving quality.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127500598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01DOI: 10.1258/jicp.2010.010011
L. Brepoels, R. Verscuren, D. Dierickx, G. Verhoef
As nuclear physicians, we wanted to assess the opportunities and chances of success of clinical pathways in our daily clinical practice, and therefore, we initiated an integrated project concerning the use of positron emission tomography (PET) for the diagnosis of post-transplant lymphoma (post-transplant lymphoproliferative disorder [PTLD]). PTLD is a pathology that occurs typically after long-term immunosuppression in a transplant patient, and often behaves as an aggressive lymphoma. We evaluated the possible benefits of a clinical pathway through the evaluation of the accuracy and cost-effectiveness of PET in this setting. We looked at the difficulties during the development of such a clinical pathway and tried to predict its chances of success. We showed a high accuracy and a substantial financial benefit for the use of PET. Despite this clear benefit, the development of a clinical pathway including PET for diagnosis in PTLD is very difficult due to the very heterogeneous patient population, the urgent nature of the disease and the structure of the organization of the nuclear department. Consequently, the chances of success of such a pathway seem limited to us at this time point, and we propose a different management of the patients with suspicion of PTLD, namely through the development of a central disclosure point.
{"title":"Feasibility of pathways for the organizational and quality aspects of the use of positron emission tomography in patients with suspected post-transplant lymphoma","authors":"L. Brepoels, R. Verscuren, D. Dierickx, G. Verhoef","doi":"10.1258/jicp.2010.010011","DOIUrl":"https://doi.org/10.1258/jicp.2010.010011","url":null,"abstract":"As nuclear physicians, we wanted to assess the opportunities and chances of success of clinical pathways in our daily clinical practice, and therefore, we initiated an integrated project concerning the use of positron emission tomography (PET) for the diagnosis of post-transplant lymphoma (post-transplant lymphoproliferative disorder [PTLD]). PTLD is a pathology that occurs typically after long-term immunosuppression in a transplant patient, and often behaves as an aggressive lymphoma. We evaluated the possible benefits of a clinical pathway through the evaluation of the accuracy and cost-effectiveness of PET in this setting. We looked at the difficulties during the development of such a clinical pathway and tried to predict its chances of success. We showed a high accuracy and a substantial financial benefit for the use of PET. Despite this clear benefit, the development of a clinical pathway including PET for diagnosis in PTLD is very difficult due to the very heterogeneous patient population, the urgent nature of the disease and the structure of the organization of the nuclear department. Consequently, the chances of success of such a pathway seem limited to us at this time point, and we propose a different management of the patients with suspicion of PTLD, namely through the development of a central disclosure point.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121518335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1258/jicp.2010.010014
A. El-Ghorr, R. Cameron, M. Fleming, L. Mckechnie, D. Thomson, S. Doherty
National Health Service (NHS) Scotland is taking a national approach to improving the quality and safety of mental health services. This programme relies on implementing integrated care pathways (ICPs) for people with mental health conditions across the whole journey of care. This long-term improvement programme has started with the publication of national standards by NHS Quality Improvement Scotland (NHS QIS), setting out the framework of what needs to be developed in each local area. The emphasis of development and implementation of the ICPs lies with local NHS Boards to ensure they are developed with local ownership and to meet the needs of the local population. However, to ensure accreditation by NHS QIS, the local ICPs must incorporate the national standards and evidence improvement to the quality of care provided. A concerted effort has been made to ensure good involvement of service users, social work colleagues and NHS staff in order to get buy-in from all stakeholders. NHS QIS is also supporting local boards and their partner agencies in their implementation of ICPs through a team of National ICP Coordinators and has developed a web-based toolkit to act as an electronic resource: www.icptoolkit.org. This supportive and facilitative approach helped to ensure that person-centred care was driving service redesign. This is the beginning of a long-term improvement programme that has been carefully staged and is being facilitated in order to give it the best chance for success. In Scotland, ICPs for mental health are being used as a tool for service redesign and continuous quality improvement and a way to focus on meeting service user needs.
{"title":"Scotland's national approach to improving mental health services: integrated care pathways as tools for redesign and continuous quality improvement","authors":"A. El-Ghorr, R. Cameron, M. Fleming, L. Mckechnie, D. Thomson, S. Doherty","doi":"10.1258/jicp.2010.010014","DOIUrl":"https://doi.org/10.1258/jicp.2010.010014","url":null,"abstract":"National Health Service (NHS) Scotland is taking a national approach to improving the quality and safety of mental health services. This programme relies on implementing integrated care pathways (ICPs) for people with mental health conditions across the whole journey of care. This long-term improvement programme has started with the publication of national standards by NHS Quality Improvement Scotland (NHS QIS), setting out the framework of what needs to be developed in each local area. The emphasis of development and implementation of the ICPs lies with local NHS Boards to ensure they are developed with local ownership and to meet the needs of the local population. However, to ensure accreditation by NHS QIS, the local ICPs must incorporate the national standards and evidence improvement to the quality of care provided. A concerted effort has been made to ensure good involvement of service users, social work colleagues and NHS staff in order to get buy-in from all stakeholders. NHS QIS is also supporting local boards and their partner agencies in their implementation of ICPs through a team of National ICP Coordinators and has developed a web-based toolkit to act as an electronic resource: www.icptoolkit.org. This supportive and facilitative approach helped to ensure that person-centred care was driving service redesign. This is the beginning of a long-term improvement programme that has been carefully staged and is being facilitated in order to give it the best chance for success. In Scotland, ICPs for mental health are being used as a tool for service redesign and continuous quality improvement and a way to focus on meeting service user needs.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123987129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1258/jicp.2010.010017
M. Panella, K. Vanhaecht
During the last 10 years in Europe, the rationale for the use of care pathways has progressively shifted from their use as an individual patient care management tool to a clinical governance methodology, to the point that today pathways are expected to raise the overall quality of the care process, and provide evidence of high-quality care for the whole organization. Why has this happened? Why is the relationship between pathways and organizational systems so strongly entwined? In our opinion the powerful link between care pathways and organizational systems has been created by the uniqueness of this complex intervention, as pathways work on different levels and in many different ways. First, care pathways are a flexible methodology and therefore it is possible to implement them in every health-care environment, ranging from hospitals to primary care. They are focused on improving the overall spectrum of clinical practice in a measurable way (with process and outcome indicators). As a consequence, pathways are effective in improving clinical outcomes (from disease identification to cure), as well as organization-related and patient-related outcomes (efficient and effective care). Second, pathways are also comprehensive, so that embedded within a care pathway are tools that can be used for analysis (such as process analysis and expected outcomes). Pathways support clinical and organizational decision-making methodologies (such as evidence-based medicine and lean management) and this is crucial when implementing a systemic approach to the process of care. Care pathways are a ‘democratic’ methodology: their development is based on multidisciplinary team work and local agreement and their success is based on effective implementation of networks of activities of different professionals, even including staff and people who are not directly linked to the direct process of care. Moreover, the use of pathways focuses the system of care centrally on the patient. As part of the development of pathways that place the patient at the centre, it is necessary to clearly identify all the relevant expected patient-related outcomes. This approach enhances the empowerment of the patients and helps the pathway team to identify the best outcomes. Pathway development enables the breaking down of potential barriers to the integration of care between professionals and organizations. Pathways can furthermore be a building block to the enhancement of accountability in health-care organizations, a central element of an effective system of clinical governance. It is also important to recognize that care pathways are intrinsically a systemic methodology. Pathways need to reflect the patients’ journey into the health-care system, taking account of the disease-subsystem and of the caresubsystem that occur independently of the wide ranging nature of the pathways. In fact, care pathways are developed taking into account the ‘natural trajectory’ of diseases. This is crucial to eli
{"title":"Care pathways and organizational systems: the basis for a successful connection","authors":"M. Panella, K. Vanhaecht","doi":"10.1258/jicp.2010.010017","DOIUrl":"https://doi.org/10.1258/jicp.2010.010017","url":null,"abstract":"During the last 10 years in Europe, the rationale for the use of care pathways has progressively shifted from their use as an individual patient care management tool to a clinical governance methodology, to the point that today pathways are expected to raise the overall quality of the care process, and provide evidence of high-quality care for the whole organization. Why has this happened? Why is the relationship between pathways and organizational systems so strongly entwined? In our opinion the powerful link between care pathways and organizational systems has been created by the uniqueness of this complex intervention, as pathways work on different levels and in many different ways. First, care pathways are a flexible methodology and therefore it is possible to implement them in every health-care environment, ranging from hospitals to primary care. They are focused on improving the overall spectrum of clinical practice in a measurable way (with process and outcome indicators). As a consequence, pathways are effective in improving clinical outcomes (from disease identification to cure), as well as organization-related and patient-related outcomes (efficient and effective care). Second, pathways are also comprehensive, so that embedded within a care pathway are tools that can be used for analysis (such as process analysis and expected outcomes). Pathways support clinical and organizational decision-making methodologies (such as evidence-based medicine and lean management) and this is crucial when implementing a systemic approach to the process of care. Care pathways are a ‘democratic’ methodology: their development is based on multidisciplinary team work and local agreement and their success is based on effective implementation of networks of activities of different professionals, even including staff and people who are not directly linked to the direct process of care. Moreover, the use of pathways focuses the system of care centrally on the patient. As part of the development of pathways that place the patient at the centre, it is necessary to clearly identify all the relevant expected patient-related outcomes. This approach enhances the empowerment of the patients and helps the pathway team to identify the best outcomes. Pathway development enables the breaking down of potential barriers to the integration of care between professionals and organizations. Pathways can furthermore be a building block to the enhancement of accountability in health-care organizations, a central element of an effective system of clinical governance. It is also important to recognize that care pathways are intrinsically a systemic methodology. Pathways need to reflect the patients’ journey into the health-care system, taking account of the disease-subsystem and of the caresubsystem that occur independently of the wide ranging nature of the pathways. In fact, care pathways are developed taking into account the ‘natural trajectory’ of diseases. This is crucial to eli","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"192 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132603016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1258/jicp.2010.010009
J. Ovretveit
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.
{"title":"The future for care pathways","authors":"J. Ovretveit","doi":"10.1258/jicp.2010.010009","DOIUrl":"https://doi.org/10.1258/jicp.2010.010009","url":null,"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.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123649580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1258/jicp.2010.010016
R. van Zelm
{"title":"Report on activities of the European Pathway Association in 2009","authors":"R. van Zelm","doi":"10.1258/jicp.2010.010016","DOIUrl":"https://doi.org/10.1258/jicp.2010.010016","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116433519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1258/jicp.2009.009016
D. Allen
In an earlier companion paper published in the journal, I drew on an ethnographic analysis of the care pathway field to argue that the growing popularity of pathway methodology can be explained, in part, by its effectiveness in aligning clinical and management interests in offering a single solution to shared health service problems. This breadth of appeal disguises tensions between clinical and management agenda which creates challenges in inscribing this multiplicity of interests into the pathway design and implementing the methodology in practice. This helps to explain the challenges of pathway development and implementation and the range of interventions to which the term ‘pathway’ is applied. In this paper I consider how pathway leaders have responded to these concerns and offer an alternative response, informed by social science.
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