Implementation of a Clinical Pathway: a Prospective Case Study

Abstract

Title Implementation of a clinical pathway: a prospective case study

Background Clinical pathways are increasingly being used to improve the effectiveness and efficiency of patient care. Numerous studies have been conducted on the effectiveness of clinical pathways in the last two decades. However there is limited evidence of innovation effectiveness. The Innovation Contingency model (IC-model) proposes that implementation effectiveness is necessary for innovation effectiveness.

Aim and research questions The knowledge and insights acquired can be used to provide evidence-based implementation decisions in the future. This study also contributes to the further development of the IC-model.

This study contains two main questions: ‘Is there, from the perspective of the theoretical framework of the IC-model, a relation between the fit of the innovation ‘clinical pathway’ and the context ‘organization’ and implementation effectiveness?’ and ‘How does the multidisciplinary team experience the implementation process?’

Method The research presented in this paper is a prospective case study with a mixed method design.

Results Baseline measurement: The configuration of the innovation is mainly perceived as rule focused and to some extent team and result focused. The configuration of the organization is perceived by nurses as mainly team and to some extent development focused. Physicians can be described as mainly team and to some extent rule focused. Follow up measurement: Higher configuration scores of both innovation and organization, goes together with higher implementation effectiveness. In the implementation process the multidisciplinary team experienced barriers and facilitators of implementation. An important barrier was the resistance within the team of physicians. An important facilitator was the introduction of the clinical pathway owner and coordinator.

Conclusions This study showed that higher configuration scores of the innovation and organization goes together with higher implementation effectiveness.

The multidisciplinary team experienced barriers and facilitators during the implementation process.

Recommendations Determination of characteristics of the context in relation to the innovation in the beginning of the implementation process will help to search for specific implementation interventions. Tailored interventions favour implementation effectiveness.