In healthcare, there is often a gap between what we know to be true in terms of effective clinical interventions and what clinicians do in their day-to-day practice. Bridgeable refers to this as the ‘know-do’ gap (or research/knowledge to practice gap), and studies have shown it takes an average of 17 years for newly discovered evidence-based practices to be implemented at scale. Therapeutic inertia is a powerful force. Well-intentioned clinicians may develop ingrained mental models for how care is delivered over time, which become difficult to change as new therapies, evidence, and interventions become available.

Even health systems that are open to changing the way they deliver care may also be impeded by these barriers in doing so, including:

• Siloed departments limiting collaborative care
• An increasingly complex reimbursement landscape
• High administrative burden
• Physician burnout
• Limited appointment times
• Lack of incentives and capacity for preventative care
• Challenges recruiting and retaining advanced practice providers and support staff
• Therapeutic inertia among providers

These all pose very real obstacles for healthcare leaders and clinical champions who are looking to innovate but might not have a clear picture of how to do so.

Achieving change is complex, but a great way to start is aligning internal stakeholders around what great care looks like for a particular disease or patient population.

Gaining a holistic view of care

Much like how patient journey maps provide an understanding of the end-to-end experience from the perspective of a patient, care pathways can offer a systemic view of how to manage a complex condition, treatment, or patient population. Care pathways can help health systems kick-start their readiness for change by aligning on what ideal care looks like, and providing a view of the supporting resources and enablers required to achieve it.

A holistic understanding of a care ecosystem can be a critical resource for health leaders to implement and operationalize new ways of delivering care. Having an outlined “what”, “where”, “who”, and most importantly, “how” for care delivery can be used to stand up new models of care or transform existing ones. With a care pathway in hand, a healthcare leader can more easily pinpoint where different departments and service lines are involved, where new medicines or protocols can be introduced, where pain points exist, and where they can improve outcomes. This can not only rally buy-in across the organization but also enable collaboration with clinicians and other ecosystem stakeholders by giving them a clear understanding of the end-to-end care pathway, any proposed changes that may solve pain points, and much more.

Illustrated example of a Care Pathway Map.

Care pathways should be system-specific

Care pathways prove to be valuable assets to not only the health systems that need them, but also to adjacent organizations like pharmaceutical companies. For pharmaceutical companies looking to support health systems get ready to adopt new medicines at scale, co-designing a care pathway can be invaluable for beginning a mutually beneficial relationship. They represent another angle on the evolving relationship between pharmaceutical companies and health systems, moving towards a value-based partnership that is more focused on achieving shared healthcare goals than transactional product-focused discussions.

For a health system, the standardization can help in delivering high-quality and cost-effective care, improving administrative and operational efficiencies and improving overall patient experiences. For a pharmaceutical company, they can support with the engagement of key stakeholders, market access, and the adoption of and adherence to medications. But ultimately, these benefits become aspirational if the care pathway is too generalized and doesn’t account for system-specific considerations.

Health systems need to make the care pathway their own. Whether they produce their own unique versions or co-brand and adapt a generalized care pathway, each one should consider local contexts. The most obvious standout differentiator is local resources. Hospitals and clinicians in one area might have access to different equipment, support staff, and infrastructure than another. Another consideration might be patient populations and demographics. A specific health system might serve a patient population with higher rates of a specific disease or be in a geographic region that is home to a larger population with language and cultural adaptation needs.

Carefully adapting care pathways to meet the specific needs of each individual system is critical to achieving their full potential.

Co-designing care pathways that work

Designing insightful and effective care pathways starts with enlisting organizational leaders and stakeholders who are willing to (or already) champion healthcare innovation. It’s best to include clinical champions who were part of standing up new models of care or advocating for addressing specific healthcare challenges. Teams should engage these leaders, decision makers, and clinical champions within the healthcare ecosystem to gain rich insights and a detailed qualitative understanding of their expertise in the model of care or disease we are focused on. This might include steps that they’ve taken to get it started, things that might be unique to the specific health challenge, and more.

Following a deep dive with these stakeholders, coupled with further research, we can establish and design a care pathway overview. This is a highly collaborative and iterative process that involves designing alongside these stakeholders based on their input. Initial designs are continually updated to get the right systemic view, maintain local relevance, and provide the necessary details. 

Alongside the care pathway overview, we design accompanying tools that depend largely on the specific problems faced in bringing it to life. For example, if the challenge is building health system leader confidence in the business case, a patient population estimator that predicts how many patients a system might expect in their local area to enter the care pathway can help. Alternatively, if the health system is bought in but is concerned about how to identify and triage the right patients, we could design patient personas that showcase the different populations that might benefit from this type of care. Together, the care pathway and toolkit can demonstrate that change is feasible and support leaders in readying their system for it.

From care pathways to next steps

With their care pathways in hand, some healthcare leaders gain buy-in early and are ready for next steps—often requesting additional tools to support them with integration and implementation. Other systems and healthcare leaders request the care pathways as a starting point and way of identifying these steps, taking some time to analyze and plan.

The common thread is that all of these systems are now one step closer to change; change that starts with a care pathway, followed by implementation, integration, and iteration.