Mental Health Nursing

Stage 13
Stage 14
Integrated care pathways: the ‘acute’ context 133
Quarterly variance analysis. Present data to identified members of the
multi-professional team and organisation. Consider in light of the analysis
review of clinical activity and care processes. Develop action plans and
the pathway to address adverse variances.
Annual review. Revise and upgrade pathway content according to
emerging evidence, variance analysis and organisational developments.
Note: Considering the evolutionary nature of pathway development it is acknowledged that
this model is not an entirely linear process.
records to establish practice patterns. The approximate time, problems,
issues and parallel processes at each step are identified. The NHS Modernisation
Agency (2002) describes parallel processes as non-direct interventions
that contribute to the patient journey; i.e., referral processes. Loops,
complexities, roles and relationships are acknowledged.
After the focus, time frame, outcomes and mapping have been completed,
there is enough data to identify keywords and search for evidencebased
interventions. A thorough and critical review of the literature is
completed. Established guidelines, systematic reviews, meta-analyses and
national recommendations which influence the expected integrated care
pathway content are identified. The pathway development team then critically
review the process map. Each step is critiqued for appropriateness
and timeliness – determining roles, duplications, delays and added value.
Interventions are compared with established clinical guidelines and
benchmarked across other organisations. This enables the process map to
be re-conceptualised, identifying key areas for development. The process
is then redesigned around the experience of receiving care. Processes are
revised in terms of coordination and preplanning, and steps with no added
value are removed. Evidence-based interventions are incorporated, roles
defined and capacity matched to demand. A sustainable, feasible vision of
the pathway based upon best available evidence is developed and disseminated
for consultation.
The redesigned care process is moulded with the corporate pathway
template, variance analysis system and prevailing clinical documentation.
Each integrated care pathway has its own implementation plan which considers
dissemination/consultation, staff education, establishing champions in
the clinical areas, pilot duration, monitoring and variance analysis. The pathway
is piloted then reviewed in respect of usability, content and influence upon
outcomes. The pathway is then revised and fully implemented. Quarterly
variance analysis is performed with data presented to specified members of
the multi-professional team and organisation. In light of the analysis, clinical