Map Out Your Pathway Before You Commit

The key to success in the Pharma industry is a rigorous understanding of the pathway – the pipeline of patient care that can be broken down into all its constituent parts.

To embed projects into patient pathways, you have to understand the whole pathway, not just the section of it that suits what you want to achieve as a company.

If you don’t pull the pathway apart and make that effort to understand it and embed yourself in it properly, you run the risk of duplication, waste – and ultimately oblivion.

We’re all trying to pursue the right outcome

When seeing a patient, a healthcare professional will often prescribe a drug or refer that patient to a colleague. What they’re actually doing by taking these steps is pursuing an outcome on behalf of the patient.

So when a patient gets referred, the secondary care could be for a diagnostic test or a procedure – that is an attempt by the referrer to get that person back to full health. And the same goes for a prescription – that medicine is being given out to help the patient get better.

So when I’m working on redesigning pathways with practices, primary care networks, GP federations, hospital providers or community services in the NHS, I like to break down every single step in the pathway to ensure I get to that desired outcome.

Understanding the opportunities for redesign

One of three factors usually drives a service redesign:

  • Services are completely overused
  • Services are completely underused
  • Services are being misused

So it could be that a service was commissioned to help 2,000 patients over a year, but 3,000 patients are being referred in. I need to understand why that situation has come about. What is it in the pathway that has led to 50% more people coming forward than we’ve actually been commissioned to support?

And it could be the other way – a commission to deliver something to 1,000 people could only be reaching 500 a year. What’s gone wrong? And the pathway – why are we missing 500 patients that we envisaged coming in?

When it comes to possible misuse of services, maybe they have a big backlog and have got a pinch point where people are trying to refer inappropriately into the wrong pathway. Then, when they reach the hospital, it becomes apparent that they’ve been sent to the wrong place or for the wrong procedure – a potentially distressing outcome for the patient and a waste of NHS time and resources. A service redesign can ensure those people are put onto the correct pathway right from the start.

Start small but aim big

This is where the value-added projects sold in by Pharma and Med Tech come into their own. You could start with one primary care network or one practice, pilot a new pathway before it is implemented and then start to scale it. I discuss this in more detail in this article. And whether you’re starting with one practice or one network, take time to understand every single step in the pathway. That way you completely remove unnecessary steps, duplication and waste – avoidable drains for money and time.

Aim to work with everybody involved – primary care, community services, secondary care and also include the patients if possible. That will provide you with a full picture of the current pathway. As we’re redesigning pathways for clients, I’m always thinking: “If we’re doing A to get the patient to B but B doesn’t happen, what’s the next step? If that’s C to try to get them to D, if D doesn’t happen, what’s the next step?”

At some point in that process, we’ll reach a point on the pathway where we’ve run out of options in primary care and we then have to refer them for secondary care for additional help. But they’ve been through all the right steps and we’ve followed the correct, efficient processes – even if we haven’t got the outcome that we wanted.

Clearly defined pathways will offer the clarity you’re looking for

It’s the same with medicines. If we’re prescribing medicines, and we don’t achieve the outcome, what’s the next medicine to try and what should we be doing? Really clearly defined pathways help us to get clarity on that.

The process is clear – pilot with one network or practice, then start monitoring and reporting back on progress from month one. Within a very short period of time, we can show we’ve delivered an improved patient outcome, reduced workload or cut down on admissions into secondary care.

Whatever it is we set out to do, we can demonstrate we’re doing that through taking our high-quality standardised approach with no unwarranted variation.

Now you’re ready to go big

At that point, you’re ready to scale your redrawn pathway. It could go across an entire area – such as the local authority footprint within an integrated care system – or across the whole system, which could easily be well over a million patients plus.

If I look at my own workload over the last six to 12 months, we’ve had pathway changes in asthma, COPD, diabetes, cardiology, dry eye disease, allergies and wound care, among a number of others.

We’ve delivered some remarkable projects in real collaboration with the pharmaceutical industry because we’ve been able to take a complete pathway approach, not just looking at one bit of a pathway that suits the pharmaceutical company, but actually honing in on the complete pathway of care.

To me, that is key from an industry perspective – a complete pathway approach to deliver something truly remarkable in a given disease area rather than just in something that suits what they want to do and achieve as a company. Feel free to connect with me on LinkedIn if you’d like to discuss any of the points raised in this article.

Scott McKenzie helps pharmaceutical, medical technology and device firms increase revenue by getting their products and services in front of the right NHS decision-makers.If you want to get your products fully embedded into treatment pathways Scott can help you.Scott and his team have doubled revenue for their clients and can share these processes with you too.