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