Mental Health Nursing

124 Acute Mental Health Nursing
national and local standards and the application of research evidence.
Ineffective and dangerous practice as a consequence can be eradicated.
5. Managing service availability. Considering anticipated elements of
care for a particular journey through services inevitably begins by
defining who will use services. Implicated are the core aims of the
journey and the outcomes to be achieved. Answering these questions
implicates the nature and volume of how mental health services are
targeted and used. Care pathways serve as an ideal opportunity to
focus upon ‘gatekeeping’ arrangements – defining how services are
accessed and upon what criteria. Additionally, mapping care journeys
incorporates a critique of care processes – identifying delays, duplications,
hold-ups and deficiencies. Pre-defining care to an extent affords
opportunities to ensure that by consensus view measures are taken to
avoid delays and meet targets. Unnecessary are waits for consultants’
ward rounds before treatment decisions or discharge arrangements
are planned or implemented. Professionals and organisations can
exercise their obligation to justify the use of resources and demonstrate
improved quality of care. This ethos is in tune with the Mental
Health National Service Framework for Mental Health (DoH, 1999b)
aiming to ensure equity of access to services and implementation of
standardised protocols for major diagnostic groups.
6. Clinical governance. Care pathways enable organisations to target
effective interventions to effect the greatest clinical benefit. Clear
care processes enable efficient checks to establish whether professionals
are working towards quality standards. As care pathways identify
clinical interventions, timescale and anticipated outcomes they offer
a succinct framework to measure effectiveness. Data for audit are collected
as an integral part of documenting care delivery. Analysis of
variation from the pathway is used to refine practice, update the pathway
and inform organisations about service needs. Regular review of
pathway content and supporting evidence base informs training needs
and ensures that high-quality patient care is maintained. Organisations
can collect data to establish whether outcomes are achieved over
defined periods. This enables a journey of care to be measured in terms
of length of stay and effect upon health outcomes. Not surprisingly,
some stakeholders are suspicious of this viewpoint and perceive that
their position and autonomy are threatened. However, as the structures
and strategies to increase corporate responsibility rapidly grow,
care pathways are a likely vehicle for refining clinical governance
mechanisms.
7. Organisational strategy and corporate philosophy. Care pathways
embody organisational strategy and translate corporate philosophies