Review, renew, refresh – HealthPathways Sydney reviews redesign

HealthPathways is a web-based clinical decision support tool that provides primary care clinicians with evidence-based guidance on the assessment and management of medical conditions consistent with local systems and resources. Each pathway outlines clear and concise steps for assessing and managing a patient with a particular symptom or condition in the local health system. ¹ Optimising the patient care journey is a core tenet of HealthPathways, aiming to ensure that patients receive the right care at the right time in the right setting.

Originally developed in Canterbury, New Zealand, HealthPathways is now used across New Zealand, Australia and the UK. The HealthPathways Sydney (HPS) program has been operational since 2013 and runs in partnership with Sydney Local Health District (SLHD) and Central and Eastern Sydney Primary Health Network (CESPHN). To date, the HPS has developed over 1000 pathways and is recognised as a leader in the HealthPathways community. A formal review process exists to maintain pathways at regular intervals, ensuring they are clinically safe, align with current evidence-based practice and accurately reflect the local health system. Reviews also serve as a quality improvement opportunity to reformat content in line with the evolved HealthPathways style. In recent years, the gap between what is required for review and what the program team can realistically review has widened exponentially, resulting in a significant backlog of pathways “overdue” for review. Underlying this outdated content are unknown clinical safety risks which may potentially compromise the patient care journey.

Improving the effectiveness of the HPS periodic reviews process

This project aims to improve the effectiveness of the HPS periodic reviews process by February 2025, using SLHD diabetes services to foster integrated patient care through improved clinician understanding. Diagnostics explored two key aspects:

1. The relationship between the use of HPS content and the patient care journey – through patient surveys and interviews, primary care survey and a primary care referral audit and associated interviews.
2. Investigating the barriers and facilitators to an efficient pathway review process – through process mapping, value stream mapping, operational team interviews and focus groups, interviews with SLHD Subject Matter Experts (SMEs), and an interview with the product vendor.

The key issues identified during the project diagnostics were aggregated into the following categories:

• lack of operational procedures
• roles and responsibilities and overall staff wellbeing
• senior management executive (SME) engagement and lack of SME capacity
• vendor-associated issues including platform and technology limitations, support and communication
• lack of operational team capacity
• over-processing
• governance and broad scope of work.

Addressing lack of operational procedures and senior management involvement

Upon further consultation, priority was given to the lack of operational procedures, SME engagement and lack of SME capacity and governance. To address these, the following activities will be explored as potential solutions:

• Development of operational team manuals and further refinement of existing processes, including a dedicated clinical editor’s guide
• Implementation of an alternative activity to pathway reviews that specifically addresses clinical risk
• Enhancing existing program governance and reporting frameworks to better support SME participation in the maintenance of HPS content.

Implementation of solutions is planned to commence from January 2024, with evaluation of the project to begin from late 2024.

View this project's poster from the Centre for Healthcare Redesign graduation December 2023.

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