190 - From 990 to 163 Days: Transforming Clinical Pathway Program Processes for Timely Care

Publication Number: 3182.190

Leigh Anne Bakel, Children's Hospital Colorado, Golden, CO, United States

Background: Clinical pathways (CPs) are essential for standardizing care and improving outcomes, yet our previous development and revision process was prolonged and heavily dependent on resourcing from the Clinical Effectiveness team, which often created bottlenecks and delayed updates, reducing stakeholder satisfaction.

Objective: To redesign the CP program to streamline processes, clarify roles, and strengthen governance while maintaining high-quality clinical content.

Design/Methods: Using quality improvement principles and change management strategies, we conducted process mapping to understand the existing workflow and design a streamlined approach. Key interventions included assigning clinical champions as primary owners for CP development and revisions; reserving process improvement support for pathways requiring workflow changes; and establishing a Clinical Pathways Council to review requests, support development, remove barriers, and approve final products. Standardized checklists, templates, and project management tools were introduced to improve transparency and tracking.

Results: In the first year post-revamp, over half of our 80+ pathways were updated or revised, outdated revisions decreased from 26 to 4, and median completion time dropped from 990 days to 163 days (an 84% reduction). Qualitative feedback indicated providers preferred the new process, citing greater control and clarity.

Conclusion(s): Role clarity, targeted resource allocation, and structured governance significantly improved efficiency and user experience in CP development and revision. Critical conversations were essential to create buy-in and engagement in the new Clinical Pathways Council structure. Meeting with champions to understand their development and revision needs proved more effective. Bringing pathways to the council early helped assess unintended consequences and scope, enabling champions to work more autonomously. Finally, using process improvement staff at the top of scope for new workflows was more effective than relying solely on project management. Future work will focus on addressing technical build delays related to linking order sets and resource constraints, which remain a limiting factor despite improvements.

Measures Table
Outcome, Process, and Balancing Measures

Median Time to Completion for Each Phase


Clinical Pathway Status
Number of pathways that are current, in process, and outdated