As a part of our master’s degree in economics and administration at the Norwegian School of Economics (NHH), we wrote our
master’s thesis in the spring of 2014 on the topic of care pathways. We conducted a qualitative study on the management and development of care pathways at two Norwegian hospitals, both having several Care Pathway projects at the time. The purpose was to investigate the differences in how Norwegian hospitals practice business process management (BPM) when developing and managing care pathways, and elucidate the benefits and drawbacks that the different approaches provide. BPM is a holistic discipline for managing the organization’s critical processes. Care pathways, being one of the hospital’s critical processes, perfectly fits the scope of BPM, and should be seen as a more than just a way of organizing a treatment within a department.
In Norway, where the healthcare system is 90 % public, several hospitals have started care pathway initiatives. Like in other Western countries, care pathways, quality improvement and collaboration across services have been on the political agenda of Norway for some years. However, the extent to which care pathways have been used as a means for quality improvement is still limited, and care pathways have not been sufficiently defined and described, or they have not been consistent with any theoretically and empirically supported care pathway approach.
“the concept of care pathways is inconsistently understood”
Our master thesis confirmed that the concept of care pathways is inconsistently understood among Norwegian health care professionals, and that the implementation process may be rudimentary or lack the necessary ingredients in terms of management and the resources allocated for the work developing care pathways. Hospital A approached the work with care pathways through process management. The hospital management had allocated resources to actively build process management capacity. They had a clear methodology for conducting care pathway- projects and the cross functional team conducting the work were supported by process supervisors to implement the care pathways. Thus, a system was in place to successfully create care pathways. Hospital B had access to a methodology for developing care pathways, however this was not actively used. The total responsibility for care pathways was delegated to departmental level, lacking foundation at management level and resources were hardly allocated to the wok. The result of this approach was that several initiatives stranded during development. Thus, successful creation of care pathways was mainly down to committed individuals. On the other hand, both hospitals experienced a descriptive decrease in length of stay and decreased mortality compared to pre-implementation in some successfully implemented care pathways.
“hospitals need to view care pathways as processes and control and manage them accordingly”
To increase successful development and implementation of care pathways, hospitals need to view care pathways as processes and control and manage them accordingly. This means involving management and allocating necessary resources, and using recognized methodology, i.e. the 7-phase approach described by Vanhaecht et al. (2012). Further, BPM can provide a systematic approach for developing and managing care pathways. We recommend that Norwegian authorities should make an effort to inform healthcare professionals about care pathways according to E-P-As definition (or similar approaches), and leaders, staff, and other stakeholders should try to learn more about care pathways before attempting to plan and implement them.
Espen Gilhuus Salthaug firstname.lastname@example.org
Ole Kristian Hermansen email@example.com