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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.

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.

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.

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.

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

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.

This paper aims to examine the unique Chinese context by analyzing the city labels (e.g. smart city and eco city) used by Chinese local governments at or above the provincial capital level to represent themselves (adopted city labels) and the developmental pathways they actually pursued (adopted developmental pathways).

The authors compared the city brand choices to those anticipated based on their geographic and economic contexts (predicted city labels and developmental pathways) as well as the directives outlined in national planning documents (imposed city labels and developmental pathways). The authors identified ten main categories of city labels used to designate themselves and establish the frequency of their use based on municipal plan documents, economic and geographic data and national plan documents and policy reports, respectively.

The authors discovered that both local economic development and geographic factors, as well as top-down administrative influences, significantly impact city branding strategies in the 38 Chinese cities studied. When these models fall short in predicting adopted city labels and pathways, it is often because cities favor a service-oriented reputation over a manufacturing-focused one, and they prefer diverse, multifaceted industrial images to uniform ones.

The originality and value of this paper lie in its contribution to the academic literature on city branding by developing a predictive model for brand development at the municipal level, with explicit attention to the national-local nexus. The paper’s approach differs from existing research in the first cluster of city branding by not addressing issues of stakeholder involvement or adoption and implementation processes. Additionally, the paper’s focus on the political power dynamics at the national level and urban governance details at the municipal level provides a unique perspective on the topic. Overall, this paper provides a valuable contribution to the field of city branding by expanding the understanding of brand development and its impact on the socioeconomic environment.

Stepgrandparent-stepgrandchild relationships are increasingly common as a result of relatively high rates of divorce and remarriage and increased longevity. When relationships are close, stepgrandparents may be valuable resources for stepgrandchildren, but the relational processes salient to the development of these ties remain largely unknown. The purposes of our research were: (1) to explore the complexity of stepgrandparent-stepgrandchild relationships, and (2) to examine processes that affected stepgrandparent-stepgrandchild relationship development.

We present results from four grounded theory projects, which were based on semistructured interviews with 58 stepgrandchildren who provided data about 165 relationships with stepgrandparents. Collectively, these studies highlighted key processes of stepgrandparent-stepgrandchild relationship development operating within four distinct pathways to stepgrandparenthood – long-term, later life, skip-generation, and inherited pathways.

Stepgrandchildren’s closeness to stepgrandparents was influenced by factors such as timing (the child’s age and when in their life courses intergenerational relationships began), stepgrandparents’ roles in the life of the middle-generation parent and the quality of those relationships, whether or not the stepfamily defined the stepgrandparent as kin (e.g., through the use of claiming language), intergenerational contact frequency, and stepgrandparents’ affinity-building.

Our study furthers understanding of stepgrandparent-stepgrandchild by attending to the importance of context in examining the processes that affect intergenerational steprelationship development. Exploring processes related to intergenerational steprelationships strengthens our understanding of the benefits and challenges associated with steprelationship development. Our study also sheds light on the “new look at kinship” and the processes that inform the social construction of family in a changing familial landscape.

President Obama positions community colleges as a linchpin of federal policy on education and training for citizens adversely affected by the recession. Chief among recommended reforms is the notion of career pathways that enable students, especially non-traditional age adults, to participate in postsecondary education directed at employment.

This paper reviews the literature on career pathway reforms to describe these programs and the students who enroll in them. It also presents evidence from two third-party evaluations of federal grants supporting career pathway implementation.

Results suggest career pathway programs are spreading throughout the United States through unprecedented levels of federal funding. Adult learners are a primary target group, but more data are needed to determine on a deeper level who these students are and whether they are being well served.

This paper offers new information to help readers consider whether President Obama’s agenda will achieve its goals and positively impact college completion and economic recovery.

HealthPathways is an online decision support portal, primarily aimed at General Practitioners (GPs), that provides easy to access and up to date clinical, referral and resource pathways. It is free to access, with the intent of providing the right care, at the right place, at the right time. This case study focuses on the experience and learnings of a HealthPathways program in metropolitan Sydney during the COVID-19 pandemic. It reviews the team's program management responses and looks at key factors that have facilitated the spread and scale of HealthPathways.

Available data and experiences of two HealthPathways program managers were used to recount events and aspects influencing spread and scale.

The key factors for successful spread and scale are a coordinated response, the maturity of the HealthPathways program, having a single source of truth, high level governance, leadership, collaboration, flexible funding and ability to make local changes where required.

There are limited published articles on HealthPathways. The focus of spread and scale of HealthPathways during COVID-19 is unique.

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.

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

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.

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.

The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway.

A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted.

Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness.

The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway.

While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation.

There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.

The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients.

Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts.

Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy.

The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality.

The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.

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.

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.

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.

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.

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.