Pathway Improvement
What is an NHS pathway?
In the NHS, a healthcare pathway is the route a patient takes in receiving care or treatment. The pathway is a structured journey, typically involving several steps, designed to ensure that patients receive quality care and treatment.
Typically, NHS pathways will involve a number of stages from initial assessment and diagnosis through treatment planning, delivery of care, monitoring and follow up and transitions between different settings such as hospital, community and home.
The aim of NHS pathways in healthcare delivery is to improve the effectiveness of care delivery through a standardised, evidence-based approach, reducing variations in the quality of care delivery.
What is pathway improvement?
Pathways and patient pathways are commonly used terms in healthcare and the NHS. So what does healthcare pathway improvement mean?
In the FCA we use the term pathway to describe more than a set of processes or a prescribed way of doing something. Our definition of pathway is far reaching and at its core is how patients and staff experience care. The building blocks of healthcare are based in microsystems; the place where patients receive, and experience care relevant to a specific need. For example, this could be an outpatient clinic, a ward, the pharmacy, imaging department or community mental health outreach. Whilst these microsystems are incredibly important, they aren’t the whole picture.
Most people don’t experience healthcare in isolation and interact with more than one microsystem. Often this is centred or characterised around a condition. For example, someone requiring an inpatient stay on a mental health ward is unlikely to have all their needs met by this one area. Community mental health services, outpatient care, general practitioners, voluntary and community projects, family and friends, social care and other agencies are all likely to play a role.
In terms of teams, many people spend the majority of their professional work dedicated to one or a small number of microsystems, e.g. ward and outpatient work. This is essential to build expertise and mastery and professionally makes sense. However, for patients there is an inherent risk in the interface between microsystems where communication, relationships, processes, policy, IT systems and much more may differ or be poorly understood by everyone.
In the FCA a pathway is characterised by all the microsystems and points that a patient experiences. This experience extends to others close to the patient and it is also important to acknowledge the experience of staff within the pathway and the relationships that exist. This means that a care pathway will cross organisational and service delivery boundaries, differing professional viewpoints and varying organisational priorities and practices. This makes the job of delivering improvement in this context a huge, complex and crucial task.
In the FCA we believe that great patient experience, care and value is discovered by front line teams and those who experience the care. Leadership is essential to enable this to happen as well as an organisational recognition that complexity takes time to understand and redesign.
FCA Big Rooms are the place where this process begins. The roadmap provides the structure and a map of how to approach improvement work, key stakeholders and coaching supports strong and safe relationships to develop and help create the conditions for excellence in collaboration. Regular and purposeful meetings engage across the pathway, include patients and build ownership and shared understanding for the work.
For examples of NHS pathway improvements, visit our resource area.
To read more about improving care along flow pathways, read The Health Foundation report in our resource area.