Critical Success Factors for Clinical Pathway Implementation Identified

Despite research supporting the usefulness of clinical pathways for reducing the variability of care in clinical practice, a large percentage of clinical pathway initiatives have been unsuccessful. In a new report, researchers have attempted to identify the critical success factors (CSFs) necessary for effective clinical pathway implementation.

To build and implement a successful clinical pathway, it is necessary to first identify CSFs, which are the various potential organizational, technological, and operational factors that could influence the implementation of a clinical pathway. Uncovering these CSFs can help health care organizations determine solutions as well as ways to eliminate or avoid the most common causes of failure in clinical pathway implementation.

The report, published in Applied Clinical Informatics, presents a quantitative cognitive mapping approach for analyzing CSFs of clinical pathway implementation.  Wei Dong, MD (Chinese PLA Hospital, Beijing, China), and Zhengxing Huang, PhD (Zhejiang University, Hangzhou, China), conducted literature reviews as well as interviews with a number of clinical experts to identify CSFs as well as the relationships among them. From their literature review, researchers identified four aspects of clinical pathways generally identified as CSFs for pathway implementation: hospital administration level; clinical staff involvement and collaboration; patient condition and engagement; and the role of health information technology. All variables considered as possible CSFs were categorized as being related to one or more of these four aspects.

Next, the researchers assembled a panel of diverse individuals with expertise in clinical pathway use and implementation. Ten clinical experts employed at Chinese PLA General Hospital were chosen: 2 hospital managers, 3 physicians, 3 nurses, and 2 health information technology experts. The authors explained: “These experts belong to different professional scales and have a rich knowledge and experience in the field of clinical pathway implementation. Owing to the diversity of the expertise of the selected experts, the panelists provided viewpoints from the perspective of a variety of relevant stakeholders.” 

The individual assessments of each panelist regarding each of the potential CSFs were then combined and analyzed using a group decision-making model. The model was used to evaluate the overall relative importances of the different variables as well as any causal relationships between them. 

The model identified the following four factors as being most important to the success of clinical pathway implementation: (1) an advanced level of hospital administration; (2) participation in a hospital accreditation system; (3) the effectiveness of clinical staff; and (4) the provision of feedback regarding clinical pathway implementation. The advanced level of hospital administration and participation in a hospital accreditation system, which were the two highest scored variables, also were found to have significant effects on other CSFs.

Factors associated with health information technology and communication between patients and clinical staff also were found to warrant attention during clinical pathway implementation, although they did have strong relationships with other CSFs. 

“The results of this study indicate that the proposed method can measure importance of CSFs and the ordinal relationships among CSFs, so as to provide initial insights into clinical pathway implementation,” the authors concluded.

The authors acknowledged a few limitations of the study. Most notably, CSFs may change dramatically over time, especially depending on the phase of clinical pathway implementation. Additionally, the judgments of panel experts, which formed the basis of the model used to evaluate the relative importance of the CSFs, may be subjective. The authors highlighted a need for more standardized measures of evaluating potential CSFs. 


Dong W, Huang Z. A method to evaluate critical factors for successful implementation of clinical pathways. Appl Clin Inform. 2015;6(4):650-668.