Service Pathways, Care Pathways, Clinical Pathways, etc.

In a hospital or medical center setting, each department after spelling out its authorized functions and services to provide its clients, will have to formulate a pathway or more more specifically, a service pathway.  Service pathway is course of actions containing a sequential processes and procedures on how the department will provide the services from start to end.

There are many terminologies that one sees in the literature and Internet associated with or related to service pathways.  To name a few: care pathways; clinical pathway; critical pathway; integrated care pathway; care map; clinical practice protocols; standard operating procedures; and citizen’s charter.

Here are some definitions of the terms associated with or related to service pathways:

Critical pathways: “Schedules of medical and nursing procedures, including diagnostic tests, medications, and consultations designed to effect an efficient, coordinated program of treatment.”   Mosby’s Medical Nursing & Allied Health Dictionary, 4th Edition. (

A care pathway is a complex intervention for the mutual decision making and organisation of care processes for a well-defined group of patients during a well-defined period. (European Pathways Association)
Defining characteristics of care pathways include:

  1. An explicit statement of the goals and key elements of care based on evidence, best practice, and patients’ expectations and their characteristics;
  2. the facilitation of the communication among the team members and with patients and families;
  3. the coordination of the care process by coordinating the roles and sequencing the activities of the multidisciplinary care team, patients and their relatives;
  4. the documentation, monitoring, and evaluation of variances and outcomes; and
  5. the identification of the appropriate resources.

The aim of a care pathway is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources.

Source: Vanhaecht, K., De Witte, K. Sermeus, W. (2007). The impact of clinical pathways on the organisation of care processes. PhD dissertation KULeuven, 154pp, Katholieke Universiteit Leuven. (

Care pathways are a way of setting out a process of best practice to be followed in the treatment of a patient or client with a particular condition or with particular needs. They are a distillation of the best available expert opinion on the care process and should be evidence based. Care pathways, which map out the care journey an individual can expect, should be multi-professional, crossing organisational boundaries; and can act as a prompt for care. They can also create a consistent standard of documentation which will provide the basis for ongoing audit. (

A clinical pathway is a map of clinical practice for a particular diagnosis.

A care map describes the steps and decision points in the management of a condition. It is based on medical guidelines, recent evidence, and expert consensus. A care map is made up of one or more pages which together show the complete patient journey for a condition.

Integrated care pathway is the same as care pathway.  It just adds the word “integrated” to give emphasis on the integration of care.

Clinical practice protocols  and clinical practice guidelines are sometimes used interchangeably. Clinical practice guidelines are “systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific circumstances”.  Clinical protocols can be seen as more specific than guidelines, defined in geater detail. Protocols provide “a comprehensive set of rigid criteria outlining the management steps for a single clinical condition or aspects of organisation.” (  Clinical practice protocols are more akin to clinical pathways.

Standard operating procedures are established or prescribed methods to be followed routinely for the performance of designated operations or in designated situations. (

Citizen’s Charter is an official document that outlines service standards to effectively guide the citizens of availing the frontline service.   In a way, it is a service pathway.(,%20Kidjie.pdf)

ROJoson’s Recommendations:

To simplify and facilitate the development of departments in a hospital or medical center, which may be providing medical and non-medical services,  in terms of pathways development, recommendations consist of the following:

  • Use “service pathway” as the basic and generic terminology.
  • Use “clinical pathway” for disease-specified or medical-condition-specified service pathways.
  • At the minimum, for both clinical pathways and service pathways, show the course of actions containing a sequential processes and procedures on how the department will provide the services from start to end.

Note that all service pathways and clinical pathways should have at least a process flow demonstrated, either in narrative form or with diagram (with narrative as needed).  The process flow must be accompanied by detailed description of procedures and work instructions.

In the formulation of the service pathways and clinical pathways, client engagement; performance excellence; quality and safe services; cost-efficient and value-based health care services; and maximal utilization of services should be considered as these will be goals of the pathways.


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