Development of a checklist for ensuring the successful implementation of integrated care pathways

Abstract

Introduction: Integrated Care Pathways are a proven effective intervention to improve care coordination and quality of care, however their effective implementation presents important challenges and barriers at the clinical , meso and macro level. There is ample literature on actions and elements to be considered to ensure the success in the implementation of the ICPs, however they have not been ordered or systematized. This work develops a checklist to be applied in the implementation of ICPS with a systemic perspective, contemplating the actions to be developed at the macro, meso and micro levels. Theory: Checklists are an algorithmic listing of actions to be performed in a specific setting, to ensure that no step will be forgotten. Although a seemingly simple intervention, checklists have a sound theoretical basis in principles of human factors engineering and have been successfully applied in the health sector. On first place a checklist tool was created to support the implementation of ICPs based on a literature review, previous experiences on ICPs implementation in the Spanish contexts and a consensus by the core research team. Secondly, a multidisciplinary group of key opinion leaders 19, including practitioners, healthcare managers and policy makers from 9 Spanish regions validated and improved the tool for its successful application on a real setting. An individual reflection was followed by a moderated group discussion. Three aspects were evaluated: the validity of the proposed structure and approach, the utility of the checklist for the different and the content of the phases and items including proposals for improvement. Results: The tool has been created as a checklist comprising 25 items grouped in the following 7 phases: health policies, organizational readiness, awareness, leadership alignment, local deployment, support and evaluation & improvement. The final validated and improved version of the checklist including the 25 items will be presented at ICIC18. Discussions: The developed checklist has a high face-validity for more than 20 integrated care experts of different Spanish healthcare subsystems that consider it as a useful tool to help implementers to follow on a quick and simply way what things need to happen to successfully implement ICPs in a local context. However the checklist has still to be tested in real policy and practice. Conclusions: A checklist for guiding ICP implementation has been developed and validated for the context of the spanish health system that seems useful for other kind of systems but particularly in those NHS-like and with dominant public provision. Lessons: The application of checklists in healthcare management is possible and accepted by managers, although the approach cannot seem as mechanistic as in more structured, simple and sequential kind of interventions. Limitations: By standardizing the list of steps to be followed, and formalizing the expectation that every step will be followed this checklist has the potential to greatly minimize failures; however ICP implementation is a complex intervention where other complementary tools and change management approaches are required to ensure success. Suggestions: It would be recommended to pilot this checklist in different healthcare organisations and contexts.