Report of the International Master Class on Care Pathways

From September 8 – 10 E-P-A organised a three day Master Class on Care Pathways and the Organisation of Care Processes. 35 delegates from 14 countries met with the 4 E-P-A teachers from Belgium, Italy and the Netherlands. It was a truly international event! As in previous master classes and summer schools, there was room for teaching sessions, small group work and a simulation / business game. Our motto: All teach, All learn!

On day 1 we discussed the history of care pathways and our view on care pathways as a complex intervention. Care pathways are a methodology consisting of multiple ‘active ingredients’ or building blocks. These are: 1) feedback on your actual / as-is care process, the current state; 2) evidence based key interventions and indicators; 3) teamwork; and 4) a development and implementation strategy.


I valued the Master Class very much. It offered me a platform to learn the methodology of building and implementing care pathways. Also it enabled me to view care pathways from various perspective such as definition, evaluation of evidence, change management and the broader organizational picture. Ultimately I was able to spar with colleagues and build my network. Considering the stage we are in I believe it is important to keep in touch with colleagues in different countries and learn from their experience.

Pieter Bocken, Sr. Consultant, Medtronic Hospital Solutions, the Netherlands

The first day’s activity included looking at the effect of care pathways as described in literature. Although there are a number of good studies, showing positive effects of care pathways, we are cautious in interpreting the results. Because a Care Pathway is a complex intervention, it is very hard to study! There is still a lot of work to do. Finally we discussed the 7 phase model for the development and implementation of Care Pathways, E-P-A’s preferred method to developing Care Pathways. Care pathways are flexible, but the method is a systematic approach.

KebapciThe International master class has improved the knowledge about clinical pathway developing process.  The team explained whole implementation process step by step. So every details about each step we got. Now everything is more explicit  for me, so that I can work for my pathway project systematically. EPA team was excellent, highly competent and all instructor were specialist in the pathway field.

Ayda Kebapçı, Instructor, Koç University School of Nursing

On day 2 we discussed the four building blocks of care pathways. As part of the European Quality of Care Pathway study, E-P-A developed a stepwise approach to identifying and selecting the clinical content of a Care Pathway: key interventions and indicators. Although suitable for scientific research, it may be too complex for a local project. Rather than using the Delphi method, a local expert group can play an important role in defining the evidence based content.

An important part of the Care Pathway methodology is to measure the ‘as is’ performance and give feedback based on these measurements. The goal of this step is ‘awakening’. Where are we doing well and what should we improve?

We discussed teamwork and leadership; both big concepts and we could have organised separate three days Master Class on both topics! We tied both concepts to Care Pathways, meaning that teamwork is the silo crossing, or the horizontal team, and the leader does not always have hierarchical power.

The second day concluded with a short theoretical introduction to Lean management in health care, followed by a very interactive business game. The delegates simulated a care process with the outcome of showing a change to improvement using Lean thinking.

Thank you so much for some very interesting days! I bring home a lot of useful information which I am looking forward to share with my colleagues.lundstroem

Stine Lundstroem Kamionka, Research assistant in the Centre for Global Health / the Migrant Health Clinic, University of Southern Denmark

The final day saw the group being divided into groups focussing on a) practical examples and cases, and b) focussing on evaluation of Care Pathways.
For evaluation of Care Pathways the formative or summative evaluation paradigm can be used. Formative evaluation is used to provide feedback to people who are trying to improve something. providing analyses of the process of implementation. It is used continuously, using quantitative and qualitative methods. Summative evaluation is used to determine the effectiveness of an intervention. It is used in a limited time frame, using predominantly quantitative methods.

coekelberghsFor me it was the first introduction to clinical/care pathways and I am very grateful that I got this opportunity. In three days, I learned so much and it motivates me to work with CP’s in the future. I have a general overview of what it is and want to learn more about it.

Ellen Coeckelberghs, Researcher, Health Services Research Group, KULeuven, Belgium


 We thank all delegates for their active involvement and are looking forward to organising a next Master Class!

Interview Sandra Buttigieg and Kris Vanhaecht

International Master Class on Care Pathways and the organisation of care processes – double interview with Sandra Buttigieg and Kris Vanhaecht

 This September, the European Pathway Association (E-P-A), organised a three-day master class on pathways. E-P-A invited EHMA to delegate a member to the master class. Sandra Buttigieg, Associate Professor in Health Services Management, University of Malta was asked to join the master class. After three days of interactive ‘all teach, all learn’ course we asked her and Kris Vanhaecht, E-P-A’s Secretary General, about their experiences.

1. What was your most important lessons during the master class?
Sandra: I have gained a great deal of knowledge and skills in patient care pathways.  The hospital where I work has been developing Clinical guidelines, protocols and standard operating procedures without going through all the steps identified so clearly in the Master Class.   Therefore one crucial lesson is that if one wants to use care pathway methodology, all the steps need to be undertaken.  Additionally, as part of the seven steps identified, we need to close the loop in proper evaluation of the care pathways. The second lesson is that using steps similar to what clinicians use when managing patients, namely history, differential diagnosis, investigations, diagnosis and treatment into similar steps for care pathways, will stand a better chance to get physician buy-in. The third lesson is the importance of effective leadership and well-structured interdisciplinary teams for being successful in implementing care pathways.

Kris adds: Off course it was a privilege to teach care pathways to a group of experts from 14 different countries. The fact that all these clinicians, managers and researchers were willing to share their knowledge was also this time for me the most important fact. We found out that even in 2014 we all have the same challenges and find the same bottlenecks on the organization of care. Knowledge sharing is the number one priority of our European Pathway Association and I think it will stay our n°1 for the next years.

Group Picture

The group of teachers and delegates, E-P-A master class 2014

2. How can care pathways help in improving healthcare services?
Sandra: Care pathways help to scrutinize in detail all the processes involved in patient care and relate these to patient outcomes.   Care pathways help to identify roles of clinicians involved as well as empower patients to be part of care pathways. Clarity in leadership, roles and responsibilities of team members is important. Care pathways also help to identify critical points during which measurement (identification of clear KPIs) can take place. The use of care pathways will help to improve quality of care delivery, reduce errors, improve staff and patient satisfaction and reduce costs through lean management concepts.

Kris: If I look at the recent research studies I am involved in, I see that pathways can improve the organization of care and more specifically the compliance to the evidence. Not all pathways will lead to improved patient outcomes but if we can improve knowledge sharing among team members and enhance the standardization, I think we can improve the outcomes for our customer. Pathways are for me the method that can bring all the separate pieces of the complex puzzle together. It takes time, resources, willingness and creativity of everyone involved, but finally we all get better from these initiatives.

3. Both EHMA and E-P-A focus on improving (quality of) health care. How can we help each other?
Sandra: I believe that the two bodies have one major aim, namely that of improving the quality of health systems in Europe, through the improvement of healthcare services and management. The use of care pathways and more importantly using simple and effective means to implement care pathways should be encouraged by EHMA.  Using the expertise provided by EPA will put care pathways on a much more solid platform.

Kris: Care pathways is about care “management” so a link with EHMA seems logical. That is why E-P-A offered a scholarship to EHMA and that they could appoint a free delegate to our master class. I think E-P-A has a proven methodology and EHMA has a great network, so let’s share knowledge and inform each other about innovative things, conferences and opportunities. I hereby would like to thank the EHMA staff, and especially Mr. Paul Giepmans, for the excellent collaboration ! I look forward to a bright future!

Contact details:

Prof. Sandra C. BUTTIGIEG Buttigiegl

Associate Professor in Health Services Management
Room 7, Department of Health Services Management
Faculty of Health Sciences
University of Malta
Mater Dei Hospital
Msida, MSD 2090

Prof. Kris VANHAECHT Vanhaecht

KU Leuven Department of Public Health & Primary Care
Department of Quality Management, University Hospitals Leuven
Kapucijnenvoer 35 blok D bus 7001
3000 Leuven



The European Pathway Association (E-P-A) is an international not for profit association of Clinical/Care Pathway networks, user groups, academic institutions, supporting organisations and individuals who want to support the development, implementation and evaluation of Care Pathways. The association has an international network of more than 1100 pathway facilitators, researchers and managers from more than 50 countries. More information can be found at

The European Health Management Association (EHMA) is a membership organisation that aims to build the capacity and raise the quality of health management in Europe. Our 170 members bring together the research, policy and management communities. EHMA membership is open to all organisations or individuals committed to improving health and healthcare in Europe by raising standards of health management. More information can be found at


Master Class on care pathways – first impressions

From Monday 8 – Wednesday 10 September we organised the international Master Class on care pathways and the organisation of care processes. 34 delegates from 14 countries met in Leuven to learn and teach about care pathways. Topics of the Master Class followed the logic of care pathways as a complex intervention:

  • introduction to care pathways – care pathways as a complex intervention
  • the 7 phase appraoch to care pathways
  • teamwork
  • feedback on current care process and performance
  • Evaluation of care pathways

Here are some inputs from delegates and teachers that we’re posted on Twitter:

daan aeyels @daanaeyels  ·  Sep 8

introduces the team work aspects of care pathways


daan aeyels @daanaeyels  ·  Sep 8

introduces the team work aspects of care pathways

Kris Vanhaecht @krisvanhaecht  ·  Sep 8

Prof Panella discussing the (possible) effect of … What about publication bias?


ilse weeghmans ‏@IlseWeeghmans Sep 9

How about an information pathway: which member of the team informs patients about what and when?

daan aeyels @daanaeyels  ·  Sep 9

The game in masterclass