Analysis of Obstacles in the Implementation of the Clinical Pathway in Indonesia: Integrative Review

Abstract

This review aims to analyze the obstacles in the implementation of clinical pathways in Indonesia. Integrative review refers to the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. Literature search used PubMed, ProQuest, DOAJ, Garuda and Google Scholar with the following criteria: 1) studies using a sample of health service staff; 2) studies that present the results of obstacles in the implementation of clinical pathways; 3) published in the last 5 years (2016-2021); and 4) studies conducted in Indonesia, both in Indonesian and English. Studies are excluded if: 1) do not have the full text; 2) duplicate articles; and 3) review articles. Assessment of study quality uses the Critical Appraisal Skills Program Qualitative-Checklist, Mixed Methods Appraisal Tool-Version-2018 and the Critical Appraisal Skills Program Case Study. Six articles were identified in this review, including three qualitative studies, two mixed-methods studies and one case study. We identified a number of obstacles in the implementation of clinical pathways in several hospitals in Indonesia, but the most reported obstacles were the lack of outreach and training related to the implementation of clinical pathways in hospitals and the lack of compliance of officers in implementing clinical pathways. In the implementation of clinical pathways in several hospitals in Indonesia, many obstacles were identified that caused the implementation of clinical pathways to be not optimal. Therefore, evaluation must be carried out routinely so that it can identify various obstacles in the implementation of clinical pathways in hospitals.