Afsana Bhuiya is the Cancer GP Lead for the North Central London (NCL) Cancer Alliance.
Sharon Cavanagh is the Personalised Cancer Care Programme Lead for the NCL Cancer Alliance.
Yasemin Hirst is a senior research fellow at the University of Central Lancashire.
The term ‘pathway’ is commonly used within the NHS to describe the sequence of steps and services involved in a patient’s care. They have been developed based on the best available evidence and expert consensus, taking into account the expected trajectory of the illness or treatment process. They have been widely implemented across different specialties and conditions, including acute to long-term conditions, surgical procedures, and preventative care. While ‘pathway’ may be familiar and well-understood among healthcare professionals, this is far from the case with the public.
When working in system improvement in the NHS we have found it fascinating how much debate the use of the word pathway can invoke. In a number of different patient involvement and patient co-design events, the term pathway has been interrogated and questioned by health service patients/users. In our view, the term pathway has been poorly understood, though not necessarily disliked.
When did the term pathway emerge in the NHS?
The use of care pathways within the NHS can be traced back to the 1990s when healthcare professionals and policymakers recognised the need for a more structured approach to patient care.1 The aim was to improve the quality, efficiency, and consistency of care across different healthcare settings. The term pathway was a fitting metaphor to depict the sequential steps or stages involved in delivering care, like following a predefined route. It emphasises the idea of a structured and coordinated approach, where healthcare providers collaborate to guide patients through their healthcare experience.
“… if the public do not understand terms widely used in the NHS then … this needs to be addressed … “
The adoption of care pathways within the NHS has been driven by various factors, including the need for quality improvement, resource optimisation, and enhancing patient experiences. The NHS Long Term Plan (launched in 2019) aimed to empower patients to manage their own health better and have more control over their care.1 The need to understand the language of the healthcare system was even more pressing in this context.
There are many benefits to using care pathways. These include:
Improved quality of care: Care pathways can help to ensure that patients receive the right care at the right time. This can lead to improved outcomes for patients and better patient experience.
Increased efficiency: Care pathways can help to reduce duplication of services and improve communication between different healthcare professionals. This can lead to more efficient use of resources.
Reduced costs: Care pathways can help to reduce the overall cost of health care by improving efficiency and reducing the need for unnecessary treatments.
Evaluation: The differentiation between care pathways is vital for measuring the quality and the effectiveness of care, implementing changes and improving safety.
Innovation: Care pathways are needed to design, test, evaluate, and implement new technologies and innovation in health care, and carry out research activities.
The NHS’s main customer is the public, and if the public do not understand terms widely used in the NHS then we think that this needs to be addressed to improve care and experience. In the social care sector or public health realm, the terminologies may also differ, and alternative terms like ‘patient journey’ may be more prevalent. This also adds to the confusion for some users who may be simultaneously on a NHS clinical ‘pathway’ and a social care ‘journey’.
What can we do to help?
To start we can provide better explanations. For example, describing the process as ‘the journey of care’ or ‘the steps involved in getting screened for cancer’. Indeed, there are a whole host of other terms we have uncovered from users on social media and other organisations; care journey; care process; steps to receiving care; care route; care roadmap; path to recovery; and care itinerary … take your pick. These alternatives can help convey the idea of a structured and sequential approach to health care without relying on technical terminology.
Ideally, we should be co-developing healthcare communications with users, communications teams, and wider stakeholders so that we can ensure the terminology and language aligns with the context and objectives of the service and the specific audience that is being offered the service. The communication outputs should meet accessible information standards too.2
The term pathway in the NHS is here to stay and is fully embedded, but there is work to be done across the health system to socialise this better with residents and perhaps this article may help you think about your part in the ‘pathway’ communication.
References
1. Johnson S. Pathways of care: what and how? International Journal of Care Coordination 1997; 1(1): 15–17.
2. Healthwatch. The accessible information standard. 2022. https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/20220216%20-%20Evidence%20review%20-%20Accessible%20Information%20Standard_0.pdf (accessed 24 Jul 2023).
Featured photo by Johannes Plenio on Unsplash.
