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An overview on the history and concept of care pathways as complex interventions
was published by Kris Vanhaecht*, Massimiliano Panella†, Ruben van Zelm‡ and
Walter Sermeus* in the International Journal of Care Pathways.
(*Catholic University, Leuven, Belgium; †Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; ‡QConsult, Arnhem,
The Netherlands)

Care pathways, also known as clinical pathways, critical pathways or integrated care pathways, are used all over the world.
Although they are used internationally, there are still a large number of misunderstandings. The goal of this paper is to
provide an overview on the history of pathways and how pathways are actually perceived and defined. Pathways are
more than just a document in the patient record. They are a concept for making patient-focused care operational and supporting
the modelling of patient groups with different levels of predictability. Pathways are a method within the field of
continuous quality improvement and are used in daily practice as a product in the patient record. This paper explains
these different issues and provides an extensive list of references that should support pathway facilitators, clinicians, managers
and policy-makers in their search for excellence.

Some major historical steps on Clinical Pathways:

Clinical pathways were not invented in Healthcare, they were already used in the 1950's in industry (aviation and construction work). In industry Critical Path Methods (CPM) and Program Evaluation and Review Techniques (PERT) were used to control and manage complex procesess.

Prof. Dr. Luc Delesie found a book by Moder & Philips (published in 1964) where they wrote:

(Moder & Philips, 1964) - MODER J.J. & PHILLIPS C.R. Project Management with CPM and PERT. Reinhold Industrial Engineering and Management Sciences, Textbook Series. Reinhold Publishing Corporation, New York 1964. Critical Path Method (CPM) in connection with maintenance and construction work and other developed Program Evaluation and Review Technique (PERT) as a management control system for the development of the Polaris Missile System.

Polaris Missile System - In 1957, Rear Admiral William Raborn Jr., an extremely capable and forceful man, was appointed to what became known as the Polaris program (Navy missiles are often named after stars) . He was given a status level unprecedented for a peacetime military leader: "Brickbat One." What it meant was, whatever Raborn wanted, he got. He'd need it.

If you want more information on the Polaris, click here.
If you want more information on CPM and PERT click here.

In the mid 80's Karen Zander & Kathleen Bower translated critical pathways into case management plans and later clinical pathways. Karen & Kathy, who now are pricipals of the Center for Case Management (CFCM) in Boston, worked at the New England Medical Center (I participated in an Intensive Workshop on Care Management, Case Management & Clinical Pathway at the CFCM in April 2000). Clinical Pathways were used in those years as plans to help case managers. The use of pathways had a high financial incentive (introduction of DRG system in USA in 1983).

Karen Zander & Kathleen (Kathy) Bower - Principals of the Center For Case Management and board members of our European Pathway Association.

First book on Clinical Pathways - In 1987 Zander & Bower wrote the book: Nursing Case Managment, Blueprint for Transformation where they describe Nursing Case Management Plans. (Center for Nursing Case Management, New England Medical Center, Departement of Nursing, Boston, Massachusets)

In 1997, Sue Johnson edited the book: Pathways of Care.

Pathways of Care, Edited by Sue Johnson - This book on Pathways of Care or Integrated Care Pathways, was the first book on this concept in the United Kingdom.

Developing Care Pathways: the handbook by De Luc. - Dr. Kathryn De Luc wrote the handbook on Integrated Care Pathways together with other members of the National Pathway Association.

In 1997 Walter Sermeus wrote the first article in Belgium on clinical pathways (The use of clinical pathways for nursing practice).

In 1998 the first studies in Belgium on the development, implementation and evaluation of clinical pathways were performed by students at Leuven University. All these studies were supervised by Sermeus and took place within the University Hospitals Leuven.

In 2000 the Belgian Dutch Clinical Pathway Network started. Nowadays more than 80 organisations from Belgium and The Netherlands are member of this Network.

NKP Logo - The Belgian Dutch Clinical Pathway Network (www.nkp.be)

In 2002 the Smartgroup on Clinical Pathways- was founded by Jen Guezo.

In 2004 we started the European Pathway Association.


In 2005 we conducted a first international survey on the prevalence and use of clinical pathways in 23 countries.
You can download a pdf file with the most important results here [340 KB] .

23 countries participated in the first EPA survey. -

Use of pathways nowadays and maybe in the future. - for more detailed information about this slide, please contact me by e-mail or telephone.

If you want more information on the spread of pathways within Europe, please visit the website of the European Pathway Association.

Karen Zander gave a key-not lecture on the history of pathways at the ICP 2003 conference in London. She published the paper in the Journal of Integrated Care Pathways.(JICP)

In 2009, the European Pathway Association was asked by the Royal Society of Medicine Press (UK) to take over the JICP. The journal was restructured and theInternational Journal of Care Pathways was launched.

The International Journal of Care Pathways. - is the official journal of the European Pathway Association. Editor in Chief: Massimiliano Panella, Associate Editor: Kris Vanhaecht.