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!