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Article
Publication date: 1 April 2000

Kathryn de Luc

Care pathways are becoming increasingly popular within UK healthcare organisations yet very little is known about the tool. Using the results from a survey of healthcare…

1914

Abstract

Care pathways are becoming increasingly popular within UK healthcare organisations yet very little is known about the tool. Using the results from a survey of healthcare organisations, which are members of the National Pathways Association (NPA), the author suggests that different models of care pathways are being implemented. Four models or different types of care pathways are identified, with different features in each model. The models can be used prospectively by organisations to decide which particular features they may want to include. Alternatively, the models can be used as an assessment tool to identify the type of pathway being developed. This assessment can form the basis for any future evaluations of the effectiveness of the pathways which are developed.

Details

International Journal of Health Care Quality Assurance, vol. 13 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 June 2010

Anu Kajamaa

This study seeks to challenge the notions of the standardized care pathway and patient‐centred care, both of which provide only a partial view of care as a complex system…

Abstract

Purpose

This study seeks to challenge the notions of the standardized care pathway and patient‐centred care, both of which provide only a partial view of care as a complex system. In exploring and contrasting the care pathway protocol and an actual care pathway, the study aims to analyze the conceptualizations of care that actors involved in the actual care pathway have. The study makes suggestions on how to expand care pathways and thereby improve patient care.

Design/methodology/approach

A care pathway protocol is contrasted with the actual care pathway of a patient at a university hospital in Finland. Observational ethnography is combined with a narrative approach and activity‐theoretical ideas.

Findings

The study depicts the gap between the care pathway protocol and an actual care pathway. The actual care pathway, rather than being a clear‐cut process, is ruptured and unpredictable. The conceptualizations of care (i.e. care‐objects) held by the doctors, nurses and the patient were fragmented and clashed in their practical work activity. The main message to hospital management is that in order to expand care pathways, the multiple care‐objects need to be placed in constructive interplay.

Research limitations/implications

A single actual care pathway is presented and the results are interpreted accordingly.

Originality/value

The study explores the idea of a care pathway and patient‐centred care in the analysis of care‐objects. A new discursive model is introduced that places different care‐objects into interplay and opens up the possibilities for the expansion of care pathways.

Details

International Journal of Public Sector Management, vol. 23 no. 4
Type: Research Article
ISSN: 0951-3558

Keywords

Article
Publication date: 2 December 2014

Joanna Blackburn and Virginia Minogue

The purpose of this paper is to describe the development of an eating disorder care pathway for adults with eating disorders, in a northern borough town. It arose out of a…

Abstract

Purpose

The purpose of this paper is to describe the development of an eating disorder care pathway for adults with eating disorders, in a northern borough town. It arose out of a need to reduce and address inconsistent access to services and treatment pathways.

Design/methodology/approach

The development involved a mapping exercise of current service delivery, a review of the literature on eating disorder care pathways, consultation workshops, the engagement of service users and carers, and the development of draft pathways for patients and carers.

Findings

Significant emphasis was on raising awareness, prevention, identification and assessment, treatment and recovery. Two pathways were proposed, one for service users focusing on awareness raising/prevention, identification and assessment, treatment, stabilisation and relapse prevention and one for carers/families focusing on carers being identifiable in their own right to receive support for caring for someone with an eating disorder.

Research limitations/implications

A limitation of the care pathway under development was the difficulty obtaining an accurate figure of the true number of cases of eating disorders in the local area. This, together with the lack of any form of systematic review or meta-analysis of care pathways made identifying the number of people suffering from eating disorders and developing an effective model difficult.

Originality/value

The proposed pathway places significant emphasis on increasing knowledge, incorporating the patient perspective, and enhancing the recognition and understanding of eating disorders in the community. A model was created that could be implemented successfully and identify patients suffering from eating disorders, when the true incidence of eating disorders remains hidden.

Details

The Journal of Mental Health Training, Education and Practice, vol. 9 no. 4
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 1 June 2003

Laura Bragato and Kerry Jacobs

This paper describes the development and implementation of care pathways in two orthopaedic units in Scotland. Although originally developed as a tool of project…

2818

Abstract

This paper describes the development and implementation of care pathways in two orthopaedic units in Scotland. Although originally developed as a tool of project management, care pathways have been promoted internationally as a response to concerns for patient safety, variability in care and increasing costs. Generally, care pathways can be seen as an example of clinician led rather than management led reform. However, it does reflect a wider shift towards process and away from hierarchical approaches to management. Within the UK care pathways have been promoted as a response to the modernisation initiative of the Labour Government. While the initiative was a success in both units it was more difficult to implement care pathways in a trauma rather than an elective unit. In conclusion, it is questionable whether care pathways are a universal response to the requirement for modernisation and service redesign in the NHS.

Details

Journal of Health Organization and Management, vol. 17 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 June 1999

Brian W. Ellis and Sue Johnson

A care pathway defines in detail the individual components of treatment for a group of patients. A well‐written pathway can lead to consistent care of the highest…

1666

Abstract

A care pathway defines in detail the individual components of treatment for a group of patients. A well‐written pathway can lead to consistent care of the highest quality. There are both educational and audit advantages to the approach. The authors detail the means by which groups are selected and the care pathways written. An example of the benefits that can accrue comes from their experience at Ashford Hospital of running a pathway for patients having prostate surgery. The pathways are appreciated by patients, nurses, doctors and managers. Care is improved, costs contained and clinical governance enhanced.

Details

British Journal of Clinical Governance, vol. 4 no. 2
Type: Research Article
ISSN: 1466-4100

Keywords

Article
Publication date: 21 March 2016

Thim Prætorius

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address…

Abstract

Purpose

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals.

Design/methodology/approach

Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions.

Findings

Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals.

Research limitations/implications

The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research.

Practical implications

The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals.

Originality/value

Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

Details

Journal of Health Organization and Management, vol. 30 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 11 November 2021

Juliana Thompson, Glenda Cook, Claire Masterman, Mark Parkinson and Lesley Bainbridge

Different pathways of frailty care to prevent or delay progression of frailty and enable people to live well with frailty are emerging in primary and community care in the…

Abstract

Purpose

Different pathways of frailty care to prevent or delay progression of frailty and enable people to live well with frailty are emerging in primary and community care in the UK. The purpose of the study is to understand effective frailty care pathways and their components to inform future service development and pathway evaluation in primary- and community-care services.

Design/methodology/approach

A rapid evidence review was conducted: 11 research publications met the inclusion criteria and were analysed using narrative thematic synthesis.

Findings

There is strong evidence that resistance-based exercise, self-management support, community geriatric services and hospital at home (HAH) improve patient health and function. In general, evaluation and comparison of frailty care pathways, components and pathway operations is challenging due to weaknesses, inconsistencies and differences in evaluation, but it is essential to include consideration of process, determinant and implementation of pathways in evaluations.

Originality/value

To achieve meaningful evaluations and facilitate comparisons of frailty pathways, a standardised evaluation toolkit that incorporates evaluation of how pathways are operated is required for evaluating the impact of frailty pathways of care.

Details

International Journal of Health Governance, vol. 27 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 24 March 2021

Syaribah Noor Brice, Paul Harper, Tom Crosby, Daniel Gartner, Edilson Arruda, Tracey England, Emma Aspland and Kieran Foley

The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of…

Abstract

Purpose

The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies.

Design/methodology/approach

The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature.

Findings

The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency.

Originality/value

As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 November 2003

Suzana Grubnic

This study seeks to extend knowledge of care pathways through describing the conception and development of them within a children’s hospital. The care pathway was…

1191

Abstract

This study seeks to extend knowledge of care pathways through describing the conception and development of them within a children’s hospital. The care pathway was conceived by the nurse manager as a tool to improve care to children with minor injuries, and to their families. More specifically, it was developed as a tool to multi‐skill experienced nurses in a children’s emergency department to assess and treat children with minor injuries. It is argued that the conception of care pathways aligned with the purposes of the manager, and integrated rather than reflected national NHS policies. Prospective managers are not confined to developing care pathways as prescribed; the care pathway tool may be used for varying management initiatives.

Details

International Journal of Health Care Quality Assurance, vol. 16 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 31 July 2009

Thomas Crocker, Owen Johnson and Stephen King

The purpose of this paper is to examine the suitability of current care pathway modelling techniques for supporting business improvement and the development of information…

608

Abstract

Purpose

The purpose of this paper is to examine the suitability of current care pathway modelling techniques for supporting business improvement and the development of information systems. This is in the light of current UK government policies advocating the use of care pathways as part of the £12.4 billion programme for Information Technology and as a key strategy to reducing waiting times.

Design/methodology/approach

A qualitative analysis of the variety in purpose, syntax and semantics in a selection of existing care pathways is conducted.

Findings

Care pathways are typically modelled in an ad hoc manner with little reference to formal syntax or semantics.

Research limitations/implications

The research reviews a small selection of existing pathways. The feature set used for evaluation could be further refined. Future research should examine the suitability of applying existing process modelling techniques to care pathways and explore the motivations for modelling care pathways in an ad hoc manner.

Practical implications

The development of care pathways can aid process improvement and the integration of information systems. However, while syntax and semantics are not standardised the impact of care pathways in the work of Department of Health agencies, in particular Connecting for Health, is likely to be limited.

Originality/value

The results provide insight into the limitations of the state of the art in care pathway models. This highlights a significant omission in the Department of Health's approach and identifies an important direction for further development that will aid Connecting for Health, healthcare organisations and healthcare professionals to deliver more effective services.

Details

Transforming Government: People, Process and Policy, vol. 3 no. 3
Type: Research Article
ISSN: 1750-6166

Keywords

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