Many oncology practices have adopted clinical pathways over the last 5 years with varying degrees of success. These mixed results may stem from a lack of understanding or full commitment from practices in terms of infrastructure, supportive technology, and communication. The articles in this issue touch on multiple facets of pathways implementation including: a theoretical discussion of a pathways management framework; real-world results of a successful pathways program; and, from a psychosocial perspective, the importance of an organizational culture change within practices.
Clinical pathways can be important tools for translating medical evidence into practice and delivering high-quality, value-based care. However, despite existing conceptual frameworks, there may still be a significant “downstream” gap with respect to pathway management in practice. Christopher P Chen, MD, MBA, and colleagues describe an applied framework that can support the management of clinical pathway programs aimed at improving value. This framework is a result of authors’ collective involvement in pathway programs and insights from peer organizations. They then apply principles from current management theory to present 4 core areas of emphases practices can concentrate on to facilitate greater harmony within their pathway programs.
In November 2016, the Helen F. Graham Cancer Center & Research Institute began enrolling patients in the Supportive Care of Oncology Patients (SCOOP) pathway program. SCOOP is a clinical pathway designed to enhance navigation and increase the availability of supportive and palliative care to patients with curable cancers who are at high risk of clinical deterioration necessitating emergency department evaluation and/or admission. Major interventions included: (1) a nurse navigation electronic checklist; (2) a mandatory screening by the supportive and palliative care team during the multidisciplinary clinic visit; (3) flags in the inpatient information system that alerted in real time both the supportive care service and oncology services when patients were seen in the emergency room, admitted, and discharged; and (4) development of a better educational journal. Christopher Koprowski, MD, MBA, and coauthors provide an overview and update on the program evolution and outcomes 29 months after implementation.
Effectively implementing a pathways program can be more challenging than one might initially believe. Implementing a pathways system and making it an effective part of daily efforts for success require two very different approaches. In his column, Gordon Kuntz, explains why a shift in a practices’ organizational culture is essential to achieve other operational pathways goals. To encourage the correct shift in organizational culture, practices should demonstrate their full commitment to the ideologies underlying clinical pathways across the organization.
