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Enhanced Recovery – What’s your pathway like one year after implementation?

2011 March 31
by webmaster

In a follow up to Wendy’s guest blog we would like to highlight an interesting paper written by Kris Vanhaecht. In his research Kris used a validated questionnaire called the Care Process Self Evaluation Tool (CPSET) to assess health professionals perceptions of the quality of their care processes with a clinical pathway. He gave the questionnaire to 309 healthcare workers, working across 49 hospitals who used a variety of different pathways.

The CPSET tool asked for respondents perceptions on the quality of care processes in five previsouly established elements of well-organized care processes. These were ‘patient-focused organization’ , ‘coordination of the care process’, ‘communication with patients and family’, ‘collaboration with primary care’ and ‘follow-up of the care process’.

He analysed group differences on CPSET scores in regard to different experience of pathway implementation: (1) Group A, no pathways in use; (2) Group B, pathways under development; (3) Group C, pathways in use for less than 1 year; and (4) Group D, pathways in use for more than 1 year.

Not surprisingly he found that the group with pathways in use for less than 1 year (Group C) had the highest CPSET overall score (i.e. this group had the tightest and most well managed care processes). Interestingly however, this score then decreased in the group with pathways in use for more than 1 year (Group D).

The findings reflect Wendy’s experiences and emphasise that multidisciplinary teams and managers need to closely monitor the life cycle of enhanced recovery pathways. The critical point for sustainability in enhanced recovery may be around 1 year post implementation.

To avoid regression we think it’s crucial to continuously collect good data and monitor the performance of your pathway. Training for new staff who join is also important, but perhaps the most important aspect is to not stop improving. Keep setting new goals within your unit to improve patient care. We must recognise that implementing enhanced recovery is not a goal in itself, but instead a method and approach we can use to achieve our primary aim of continually improving outcomes for our patients.

To see Vanhaecht’s article click here

How are you sustaining your enhanced recovery pathway?

Have you used the CPSET tool in your hospital? Was it useful in an enhanced recovery setting?

Get in touch to share your experiences and tips with other readers of the blog via a guest post by clicking here


2 Responses
  1. webmaster permalink*
    June 30, 2011

    Dear Kris,
    Thank you for taking the time to comment and sharing your experience and expertise.
    Your points are well made and I completely agree – not every new pathway leads to improvement.
    I had not seen your new paper, but have just downloaded it and look forward to reading it.
    Best wishes

  2. June 28, 2011

    Dear Colleagues,

    Thank you for discussing my paper on your interesting blog. I only want to add that the data we used were cross sectional and not longitudinal, so we have to be carefull with the conclusions that the scores decrease over time.
    Although, based on my experience with pathways, I fully agree with your conclusions. Continuous data analysis will be of major importance to keep pathways alive. A decrease in CPSET score can only awaken the interprofessional team.
    A lower score can mean on the one hand that the care process is not anymore under control, but on the other hand it could maybe mean something else. Based on our experience over the last 11 years within the Belgian Dutch Clinical Pathway Network ( and our work on European level ( working on pathways lead to “opening the eyes of teams”. Before working on pathways the team does not always notice the bottlenecks in the daily organization. So a lower score on CPSET after the implementation of the care process is maybe also possible because the team is more aware of possible bottlenecks or weak links within the proces. We also discussed this in a paper on joint arthroplasty (1).
    Whatever the reason is for a lower CPSET score, the act will have to be to bring the interprofessional team together, discuss the scores and find ways to enhance the quality of care. Pathways are a complex interventions, so let us be carefull with being too enthousiastic about their effect. Pathways can work, but not all pathways will lead to an improvement, as you can read in the new paper published yesterday (2).

    At this moment the CPSET has already been used by more than 2000 clinicians in Belgium and the Netherlands and the results of the validation studies of the French, Norwegian, German, Portuguese, Italian and English version will be published next year.

    If you want additional information, please do not hesitate to contact me.

    (1) Vanhaecht K, Bellemans J, De Witte K, Diya L, Lesaffre E, Sermeus W. Does the organisation of care process affect outcome in patients undergoing total joint arthroplasty? Journal of Evaluation in Clinical Practice 2010; (16): 121-128.
    (2) Vanhaecht K, Ovretveit J, Elliott M J, Sermeus W, Ellershaw J E, Panella M. Have we drawn the wrong conclusions about the value of care pathways? Is a cochrane review appropriate? Evaluation & the Health Professional 2011; first published on June 27, 2011 as doi:10.1177/0163278711408293.

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