Collaborative Clinical Pathways Background

 

One feature of the “Better, Sooner, More Convenient” (BSMC) Business Case, accepted by the Ministry of Health in 2010, was the development of 33 collaborative clinical care pathways.

 

Map of Medicine (MoM) is a UK based software system which houses a collection of approximately 300 clinical pathways based on existing evidence and international guidelines. These pathways are accessible to authorised users via the internet, and can be used as:

• A rapidly accessible check of best practice, most likely to be used by frontline clinicians;

• A tool to assist in planning and development of health services across the district, using evidence-based clinical pathways.

 

 

Click here for further information about Map of Medicine and what it offers.

Click here to view the Map of Medicine / Collaborative Pathways Workshop video (password: mom)

 

MidCentral District Health Board approved the purchase of MoM in October 2011. It has been agreed that MoM will be the vehicle used for achieving the BSMC pathway targets.

 

The purpose of implementing the CCP Programme in our DHB is to:

• Help meet the Better Sooner More Convenient Business Case aspirational targets, particularly the following:

  • Reduce presentations to the Emergency Department (ED) by 30%

  • Reduce avoidable hospital admissions to Medical Wards and Assessment Treatment and Rehabilitation for over-65-year-olds by 20%

  • Reduce poly-pharmacy in the over-65-year-olds by 10%

• Implement a tool to assist in planning and development of health services across the district, using evidence-based clinical pathways.

• Provide front line clinicians and other key stakeholders with a rapidly accessible check of best practice;

• Enhance partnership processes between primary and secondary health care services across the DHB.

 

The CCP Programme commenced in November 2011. It is expected that the workstreams under the CCP Programme will conclude work and be integrated into “business as usual” practices by June 2012.

 

The approach to be taken in this Programme will be for the CCP Executive Team to manage all components of the Programme.

 

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Update as at 25th April 2012

Excellent progress has been made to date in the rollout of the CCP within MidCentral and the implementation continues according to schedule.

 

The highlight for April has been the continued development phase for the first three Collaborative Clinical Pathways

1. Atrial Fibrillation

2. Chronic Kidney Disease; and

3. Cellulitis.

Phase One of the programme was completed on schedule, concluding on 28 February 2012.

 

Phase Two, Part One commenced on 1 March 2012 and is expected to be completed by 1 May 2012.

 

Click here to view the NZ Doctor article (2 March 2012) on MidCentral's pathway development.

 

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Programme Phases

The CCP project will be undertaken in phases.

 

Figure 1: CCP Programme Phases

The objectives of the CCP Programme phases are outlined below. Each phase will have a detailed Programme phase implementation plan.

 

Phase One

1. Develop a criteria for selecting the 33 pathways

2. Investigate MidCentral’s current state against best practice descriptions (stocktake), and identify the 33 pathways that will be developed;

3. Ensure up to seven staff undertakes the required CCP training in February 2012

4. Develop a local approach to pathway development

5. Develop processes for clinical governance approval

6. Develop a process for engaging with clinical groups

7. Develop a process for selecting clinical pathways

8. Develop a mechanism to ensure appropriate managerial support to achieve any necessary changes to budgets/staffing resulting from the collaborative pathways

9. Develop and implement a Communication and Marketing Plan

10. Provide a report to the ALT of progress to date.

Phase One of the Programme concluded on 28 February 2012.

 

Phase Two - Part One

Commence the development of the Chronic Kidney Disease (CKD) pathway with clinical support

1. CKD Pathway completed and CCP Executive Team approval for launch

2. Commence the development of the Atrial Fibrillation (AF) pathway with clinical support

3. AF Pathway completed and CCP Executive Team approval for launch

4. Commence the development of the Cellulitis pathway with clinical support

5. Cellulitis Pathway completed and CCP Executive Team approval for launch

6. Risk and Issues register monitored and maintained

7. Benefits Realisation Plan monitored and maintained

8. Maintain website

9. Implement Communication Plan

10. Provide a report including recommendations of the pathways to be undertaken to the ALT

 

Phase Two, Part One of the Programme is expected to be completed by 1 May 2012.

 

Four additional pathways have been identified for Phase Two – Part Two:

1. Chest pain

2. COPD

3. Gastroenteritis

4. Methadone

 

Phase Three

Ensure integration of the changes within the organisation into “business as usual”.

 

Phase Four

Sustain and evaluate the outcomes while continuously improving.

 

These are a guide and Phases 2, 3 and 4 may change as a result of conclusions from Phase 2.

 

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Collaborative Clinical Pathway Development Processes and Governance

The BSMC Business Case is supported by four Collaborative Groups (Older persons, Acute Care, Integrated Family Health Centres (IFHCs), and Whanau Ora). These Collaborative groups report to the Alliance Leadership Team (ALT).

 

In addition, MDHB developed a clinical network structure in early 2011 made up of a number of District Groups. Clinical Networks provide a formal structure to enable effective partnerships to: share information, review clinical management, enhance communication and processes, and ensure equitable and ongoing provision of safe, effective services occurs as close to the patient as possible. To date, three District Groups have been established (Child Health/Tamariki Ora, Mental Health & Addictions, and Cancer & Palliative care).

 

A component of the Collaborative and District Groups’ work programme is to contribute to the development of collaborative clinical pathways.

 

The CCP Executive team will work in partnership with the Collaborative Groups and Clinical Networks/District Groups to select the 33 CCPs based on selection criteria. 

 

Figure 2 illustrates the clinical and programme governance structure for the CCP programme. The sponsor for the programme is the Alliance Leadership Team (ALT). This governing body provides programme governance with effective links through to MidCentral DHB Executive Leadership Team and Compass Health Regional Leadership Team (RLT).

 

Figure 2: CCP Clinical and Programme Governance Structure

Clinical governance of the programme is through the two Clinical Boards and through to the MidCentral DHB Clinical Leadership Council.

 

Clinical governance of the individual pathways is as close to the front line as possible. The pathway development process sees the Editor sign off the functional aspects of the particular pathway and the Clinical Expert(s) sign off the content. The executive team authorises the launch after ensuring that the appropriate supporting structures (staffing etc) are agreed and in place.

 

Ongoing monitoring of how the pathways are utilised and their effectiveness is the responsibility of the Clinical Boards through normal clinical governance processes.

 

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