Clinicians are trained to use a standard approach to similar clinical problems. When a
 group of clinicians agrees upon and documents a similar approach, it is called a “clinical
 pathway”. As the field of evidence-based medicine matures and data collection about
 quality increases, those who are charged with overseeing quality initiatives and
 controlling costs naturally push for their development and implementation given the fact 
that in certain instances, clinical pathways have been proven to control costs and ensure
 quality.

 

Although diseases behave in predictable ways, there is often more than one way to
 approach diagnosis and treatment. Evidence-based medicine is maturing as a field, but
 good evidence is often lacking to support one single approach to most clinical problems. So, many clinical pathways are based on “guidelines” created from the “consensus
 opinion” of “expert panels”. This leaves room for individual clinicians to customize their
 approach to given problems. Ideally, this should then become a “personal clinical
 pathway” that is consistently followed. Following this standard approach ensures that all
 critical elements of care are delivered at the right time to all patients. It should be noted
 that although the primary focus of a clinical path is to improve a clinical outcome, some
elements fulfill regulatory requirements, collect data for quality control, improve patient
 satisfaction/service or are necessary for reimbursement. Standard practice is a 
requirement of quality assurance (consistent quality) and quality improvement (always
 get better). You cannot make improvements if the baseline approach is not standardized.

 

Even when good evidence exists for a best practice, we know that patients don’t always 
fit those molds and respond differently. Some frontline providers are so consumed with 
managing these exceptions that they fail to recognize the standard path they typically
 follow and so reject the notion of “clinical pathways” as cookbook medicine (In
actuality all great chefs follow recipes. They use their creativity to develop the recipes.)
 Encouragement to follow these pathways is seen as an infringement on their autonomy as
 a physician. They are more likely to identify themselves with the “art” rather than the
 “science” of medicine. In point of fact, given that this variation in patient response is
 more often psychological, rather than biological, they fail to realize that there is plenty of 
room to use their creativity to individualize their care of each patient. The emotional,
 educational, cultural, and spiritual backgrounds that patients bring to their healthcare
 experience require individualization. If the standard part of the pathway can be
 implemented automatically, then that leaves more time for the busy clinician to 
customize his communication and delivery of care to the individual. This includes having
 a path or plan for what the patient does when they leave the formal clinical care setting 
and return to their full lives in the world.

 

Typical clinical pathways tell the clinician what critical steps they should follow but
 don’t always address the issue of getting patients to follow those steps. Keeping patients
 on track with their care, a process that often involves changes in lifestyle and behavior is
 often neglected, in part because there is even less evidence to support any one
approach. This last mile of care may have the greatest effect on the desired outcomes of
 care. Communication with the patient is where the “art” of medicine lies and done
 properly is the key to a good outcome and a satisfying patient experience. Patients need 
just the right amount of information at the right time in order to trust and understand their
 diagnosis, follow their treatment plan at home, know how to contact their providers
 should problems occur, and finally to feel that they have been heard and had all their 
questions answered. They want to understand what they should expect from the outcome
 of their care, how much it will cost, the availability of other options and an expected time 
course of recovery. If they need to change their lifestyle, they want focused, practical
 advice and coaching.

 

How does a provider go about creating a personalized clinical pathway?

 

How can Twistle help the development and implementation of the pathway?