Clinical paths have demonstrated their value in support of patient care management throughout the last 25 years of use. With over 25 years of experience in using clinical paths, a number of lessons have been learned. The remainder of this article will outline 12 of those lessons. Clinical paths provide continuity of plan that needs to be augmented by continuity of provider, particularly for patients with complex issues. Clinical paths of the future will be simultaneously more simple and more complex. This dichotomy is related to increasingly complex treatment modalities; increasing numbers of care sites; and rapid infusion of evidence and research findings. Clinical paths must help simplify and focus care for providers who are engaged in providing individualized, evidence-based, focused and comprehensive care to diverse patients. And most importantly, they must make a difference to patients and their families. Clinical Path originsClinical paths have demonstrated their value in support of patient care management throughout the past 25 years of use. They originated at New England Medical Center (Boston, MA, USA) in 1984, at the dawn of the newly introduced DRG (Diagnostic Related Group) system. DRGs introduced an approach for Medicare (the government funded health-care reimbursement system for American citizens 65 years and older) -a case-based payment for care based on diagnoses within groupings of diseases and conditions that use similar resources. This shift to a casebased payment methodology created a new imperative for hospitals to more effectively manage length of stay while also managing quality. This is because a case-based reimbursement system establishes an 'usual' or average length of stay based for each DRG and that, in turn, sets the reimbursement amount. Hospitals are reimbursed for a diagnosis no matter the length of stay. Moreover, if the hospital's length of stay (and ultimately cost) is under that established for the diagnosis, it may retain the excess revenue. However, if care takes longer or costs more than that established for the diagnosis, the hospital loses money because it cannot request additional funding. DRGs became (and continue to be) the stimulus to develop strategies to manage length of stay within defined parameters.Simply defined, clinical paths are a tool designed for clinicians to use as they provide care to populations of patients. As such, they are part of a larger process. They are the means to the end. . . they are NOT the end in and of themselves. They are a tool for care management, a process that efficiently and effectively aligns patient needs/issues with resources to meet quality, satisfaction, clinical and cost outcomes. The goal of care management is to manage individuals at their maximum level of comfort, functionality and independence while at the lowest (and most appropriate) level of intensity of service. Rationale for clinical path useThe underlying rationale for clinical paths has remained the same since their inception: Support quality care and patient/ family ...
Effective and efficient patient management is important in all health care environments because it influences clinical and financial outcomes as well as capacity. Design of care management processes is guided by specific principles. Roles (e.g., case management) and tools (e.g., clinical paths) provide essential foundations while attention to outcomes anchors the process.
Although innovation is critical to success in today's tumultuous environment, health care is slow to embrace it, and there is significant variability in strategic adoption of innovation across organizations. Nurse leaders do not need to be innovators themselves but must engage in, and have the ability to create, an organizational culture of innovation. Twenty-six leadership behaviors specific to innovation leadership were identified through a Delphi study to develop competencies as well as the knowledge, skills, and attitudes that support nurse leaders in acquiring or expanding the capability of nurse leaders to create a culture of innovation. It was demonstrated that nursing innovation experts were able to differentiate between general leadership behaviors and innovation leader behaviors. In addition, the need to acquire basic leadership competencies before mastering innovation leader competencies was identified. Five strategies to initiate or expand a culture of innovation in organizations were identified, including (1) assessment of organizational capacity for innovation; (2) acknowledgement of the responsibility of all leaders to create an innovation-rich environment; (3) provision of education, skill building, and coaching; (4) encouragement of an ongoing practice of innovation, even in the face of failure; and (5) development of a sustainable culture of innovation.
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