Inaugural pathways conference Canadian National Section

Hosted by DAVINCI co-leads Saima Awan and Dr. Andriy SamokhvalovcpclogoFINAL

November 28, 2015 |The Bram & Bluma Appel Salon at the Toronto Reference Library

The inaugural pathways conference was held this past November to an audience of doctors, nurses, clinicians, pharmacists, and various other medical professionals and mental health and addiction specialists.

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Graduations Care Pathway Course Belgian-Dutch CP Network

This week, a group of 12 professional graduated from the 10-day Care Pathway Course, in Utrecht, the Netherlands. This course is organised within the Belgian-Dutch Clinical Pathway Network. The 7-phase model forms the backbone of the course. The 10 days are spread over a period of just over  a year, in which the participants perform a care pathway project. The course ends with (poster) presentations on the projects, showing results and lessons learned.

groepsfoto afsluiting MOZ15We wish the participants success and good luck in following up their projects and new care pathways!



Project update: Care Pathways for Nutrition problems in surgical patients with Gastro Intestinal Cancer (CP4NutriGICan)

In E-P-A newsletter Issue 12, November 2013, we informed you of a project aimed at developing and implementing care pathways for nutrition problems. It is now time to give you a quick update. The project, supported by an unconditional educational grant by Baxter, is executed in 3 hospitals in Belgium, France, Germany and The Netherlands, and is a good example of working with a care pathway as a complex intervention. A complex intervention is always a combination of several ‘active ingredients’. In the case of care pathways these ingredients are: 1) the evidcence based key interventions and indicators for the target group; 2) feedback on the current care process on the basis of the key indicators; and 3) an improvement strategy to improve the care process.

So far, we have produced an overview of evidence based interventions and indicators by performing a systematic review. An international expert panel validated the output. A formal publication of the systematic review is under review with in the research team.

The 12 participating hospitals have performed a retrospective patient record analysis to provide data on the current care process. This has resulted in a 140 page feedback report, which can be used as a benchmark. We have organized feedback sessions per country for the participating teams, where we shared the results. Some of the results, such as time between decision for surgery and surgery, or number of patients that where screened for malnutrition, were real eye-openers for the teams, indicating room for improvement.

The next phase of the project is the quality improvement strategy (active ingredient #3) which is planned for the next few months. After this, the teams will perform a prospective analysis, to see if their performance has improved.

We will keep you posted!

The CP4NutriGICan research team,
Ruben van Zelm, MSc; Prof. Kris Vanhaecht (principal investigator); Ellen Coeckelberghs, PhD; Prof. Massimiliano Panella; Prof. Walter Sermeus

Lead contact person for Baxter: mrs. L. Nonneman

Research into STEMI care pathways: Online Survey

ST- Elevation Myocardial infarction (STEMI) is one of the most common  disease in our aging world that leads to mortality due to its time sensitivity characteristics. The promises by clinical pathway in  controlling the cost, time and quality of patient care has encouraged the use of clinical pathway in STEMI care. However, it is still not clear what are the the most optimal clinical pathway components that will suit the STEMI patients and will make the use of the clinical pathway more practical?. Hence, in this study a survey was designed to answer the aforementioned  question.

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New National Section: Italy

Following the successful International Care Pathway Conference 2015 in Reggio Emilia last October, E-P-A has a new National Section in Italy. Any country with more than 20 members can form a National Section. There are more than 20 individual E-P-A members in Italy, and there are two volunteers to lead the section. We introduce the Chair and Co-Chair of the Italian Section.

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ICPC2015 Patient experience

During the Round Table session on the final day of the ICPC2015, ms. G. Gelosini told the audience a very personal story from her perspective as a patient. She encountered negative and positive experiences during her illness. Among the negative experiences were not being taken serious by professionals and a fragmented care process. The positive experience were summarized in 7 positive aspects about care pathways:

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ICPC2015 Closing remarks

At the closing of the ICPC2015, prof. Sermeus gave an overview of developments and challenges, and E-P-A’s role in advancing care pathways. He used the model for managing complex change by T. Knoster as structure:

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Personalized Patient Care: Continuous improvement in Integrated Care Pathway for Stroke patients

In 2013, the Stroke care team from the region Roosendaal / Moerdijk, the Netherlands, was awarded for their achievements in improving patient care. They were awarded with the first prize of the Belgian-Dutch Clinical Pathway Network biannual competition for best care pathway project. One of the elements of this prize is presenting the project at the International E-P-A conference. Unfortunately, the team representatives are unable to attend ICPC2015. E-P-A still wants to share the project, a short overview of the project and lessons learned is published in this article.

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Care pathways and business process management (BPM)

Espen Salthaug

Espen Salthaug

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.

Ole Hermansen

Ole Hermansen

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
Ole Kristian Hermansen