Integrated Care Pathways A practical approach to implementation Edited by Sue Middleton and Adrian Roberts Butterworth-Heinemann 155 pages £16. 99 paperback

A key theme of the NHS plan is the need for health professionals to work in new ways to break down dysfunctional demarcations between professions and services. Redesigning healthcare systems and processes around the patient lies at the heart of the modernisation programme.

While notions like integrated care pathways and the seamless patient journey are well established in the NHS lexicon, people still struggle with their implementation.

This book could not have appeared at a better time. It lives up to its title but is more than just a practical guide to implementing ICPs. It is rich in insights into the criteria for success and the reasons for failure. The editors, who are also authors of five of the 10 chapters, are both immersed in the application of ICPs. An introductory chapter explains what ICPs are. The following chapters review why care pathways are useful and how they might be introduced. Practical guidance is offered on getting started, the documentation needed, maintaining momentum, evaluation and clinical benchmarking. There is also a case study of crossing professional and service boundaries.

The fundamental principle of ICPs 'is to make explicit the most appropriate care for a patient group, based on the available evidence and a consensus of best practice'.

The appeal and importance of care pathways lie in their relevance to a range of current initiatives aimed at improving the quality of healthcare. These include clinical governance, the new performance assessment framework, evidence-based practice, the use of outcome measures to achieve demonstrable improvements in care, and the development of partnership working.

The book is full of useful tips, most of which amount to sound common sense, although are all too often ignored or overlooked. Importantly, the success of an ICP often depends on the choice of client group, together with the reasons why a particular group is chosen. Project management skills are essential for successful ICPs.

Among other critical success factors are the need for ownership of the pathways by clinicians and a rolling programme of education and support.

Before yet another fad carries the NHS away, a note of caution is sounded. For all the claims made for them, current evidence relating to the success of ICPs is limited and often anecdotal. The book makes a plea for sound, systematic and independent evaluation in the UK.

If ICPs are the key to so many problems besetting the NHS, it seems surprising that they are not more commonplace. The book is not concerned with possible obstacles to their introduction, although it makes passing reference to some of these. Yet unless we understand and confront them, it is unlikely much progress will be made. Understanding professional subcultures (often referred to as tribes) is critical. Not all professional groups are in favour of work process control leading to care pathways if this threatens their preferences and beliefs based on individual clinical judgement. Nurses are likely to adopt a less individualistic ethos and subscribe to a collective conception of clinical work. ICPs, therefore, can only succeed if champions for change are identified and groomed. Then this book is likely to come into its own.