Creating a flow in general hospitals. An evaluation on the redesign of clinical pathways at the Radboud University Medical Centre

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The aim of this research was to evaluate the clinical pathways at the Radboud UMC in order to analyze the differences and to examine if these differences are problematic for this general hospital. This was done by connecting clinical pathway literature to design-theory literature in order to contribute to the understanding of how clinical pathways should be designed as a flow, which requires to meet certain criteria following from design-theory literature. This led to the following research question: “How can the clinical pathways at Radboud UMC be evaluated with the use of criteria based on design-theory literature?” By first understanding the definition and characteristics of clinical pathways, a criteria list regarding clinical pathway literature was developed. As clinical pathways can be seen as flows, structure design theories were connected to the healthcare sector in order to create a criteria list based on structure design. The two criteria lists were combined into an evaluation framework. With the use of a qualitative research, employees from already implemented clinical pathways as well as employees from yet to implement clinical pathways within the Radboud UMC were interviewed. As the criteria in the evaluation framework were used to guide the interviews, these interviews were analyzed in a way to fill out the evaluation framework. Many of the criteria were met by the Radboud UMC, as the clinical pathways consist of multidisciplinary teams who distinguish different patient groups based on their conditions. These conditions are based on either easy procedures or complex cases. Activities in these clinical pathways are sequenced in a flow which is well-coordinated by a team of professionals. However, more complex cases are grouped into less homogeneous groups, are less standardized, and require more regulatory potential within the team. Many criteria do however lack guidance regarding the design of the clinical pathways and can benefit from better communication and the better use of technical systems such as the electronic patient records. Criteria which are not met, could lead to alignment issues between different clinical pathways and a potentially bad clinical pathway design by teams themselves. In addition, differences in activity flows and discharge times could lead to differences in how patients experience the clinical pathways, which could lead to patient dissatisfaction.
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