Article type
Abstract
Background:Clinical pathways (CPs) are multidisciplinary care plans with essential care steps for patients with specific clinical problems. While high-quality, expert-developed clinical pathways have many potential benefit (such as assuring quality and controlling costs), their impact has been limited by variable implementation barriers and suboptimal research designs. To our knowledge, there is no published system review literature on the barriers and facilitators in clinical pathways implementation to now.
Objectives:To describe and categorise the most important barriers and facilitators to clinical pathway implementation.
Methods:Identified articles related CPs implementation in PubMed, screening and including articles involving influencing factors about CPs implementation. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and facilitators.
Results:The search algorithm led to the identification of 4079 articles in PubMed. Overall, 27 articles were included in the data synthesis. after analysis, factors affected the process can be organised in three main categories as clinical pathway-related factors, Staff-related factors and external factors, while barriers and facilitators to clinical pathway implementation can be identified respectively in 56 and 37 main points. The often-cited barriers are lack of stuff agreement, decreased professional autonomy, lack of resources (time, finances, equipment, staff), lack of support and the rigid nature of CPs. When it comes to facilitators, allow for flexibility, dedicated clinician champion, support, education and training, audit and feedback, sufficient resources and supports are considered crucial to successfully implement CPs. Table 1 presents an overview of the main barriers and facilitators.
Conclusions:The implementation of CPs involves many problems at the moment. Only by solving the barriers identified and making full use of the facilitation, will clinical pathway be implemented effectively. Meanwhile, more challenges will be solved in future.
Objectives:To describe and categorise the most important barriers and facilitators to clinical pathway implementation.
Methods:Identified articles related CPs implementation in PubMed, screening and including articles involving influencing factors about CPs implementation. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and facilitators.
Results:The search algorithm led to the identification of 4079 articles in PubMed. Overall, 27 articles were included in the data synthesis. after analysis, factors affected the process can be organised in three main categories as clinical pathway-related factors, Staff-related factors and external factors, while barriers and facilitators to clinical pathway implementation can be identified respectively in 56 and 37 main points. The often-cited barriers are lack of stuff agreement, decreased professional autonomy, lack of resources (time, finances, equipment, staff), lack of support and the rigid nature of CPs. When it comes to facilitators, allow for flexibility, dedicated clinician champion, support, education and training, audit and feedback, sufficient resources and supports are considered crucial to successfully implement CPs. Table 1 presents an overview of the main barriers and facilitators.
Conclusions:The implementation of CPs involves many problems at the moment. Only by solving the barriers identified and making full use of the facilitation, will clinical pathway be implemented effectively. Meanwhile, more challenges will be solved in future.