Some people switch off when we talk about pathways of care, but focusing on pathways enables us to appreciate what actually happens to patients and puts each stage of the journey that patients take into context and perspective.


Have you physically walked a pathway from emergency or elective admission to discharge?  Have you walked from the car park to the OPD, from the OPD to X-Ray, back to the OPD, onto to the POA Department, to the Admissions Ward and to the Discharge Lounge?  Do you know how far or confusing it is for patients or their carers?  Do you know how straightforward the departments are to find?  I realise that most patients do not follow this exact pathway in one day, but they do at least a part of it.


Until this year I had never walked a patient pathway from admission to discharge.   I always thought I was quite visible, going out and about to wards and departments as often as I could, but I think that physically walking the pathway is one of the most powerful things that we can do.  Sound basic?  It is.  


I’ve walked a number of pathways this year; each is unique and informative.  Listening to staff in charge of each area explaining what happens, together with physically walking, highlights what patients have to do and where there is opportunity for improvement.  It also shows where the process works well.  Walking the pathway gives us insight, this is not intended as a criticism but often staff delivering services do not understand what actually happens. 


Some might consider this a waste of time; I can hear some saying that this is a poor use of resource but not knowing what the department next to you really does, not knowing where certain departments are situated and not understanding how everything fits together isn’t ideal either.  Staff generally find it enlightening to understand the significance and impact of their area on the overall pathway and it helps those who might think that theirs is the most important area in realising that might not be the case; this often removes resistance to change because it becomes very obvious.


I appreciate that for Executive and Senior Management Teams it is impractical to walk every pathway, however most Executive Teams schedule out and about time to visit wards and departments so some of this time could perhaps be used.   It is also something that could easily be worked into staff induction.  Generally it takes no longer than one hour to walk a whole pathway (providing of course the entire pathway is on one site).


The one hour challenge:


Find a time when key members of the multidisciplinary team are all available to walk the entire pathway together (use an existing meeting); OPD, POA and Ward Nurses, Therapists (Physio and OT), Surgeons, Anaesthetists, Admissions Officers, Pharmacists, Service Managers, Porters and the Ward Housekeeper.   This is the team.   No-one could do their job as effectively on their own; it is the collective team that delivers quality patient care and good patient experience.


I know this is basic but it helps staff gain an insight into services; enables people to understand the role of other departments and to start thinking differently.  It does not cost a penny other than an hour of time and depending on the size of the site slightly sore feet, which is hardly a hardship when gaining insight into what patients have to do on a daily basis, many of whom have a lot more than sore feet. 


Before you dismiss this as too basic and / or a waste of time please just try it, even for one pathway.   You will be surprised what you learn.