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Seamless pathways of care – integrating Community and Hospital HealthPathways

Published on 07 Dec, 2022 | Return|

In August 2021, we shared an update with community members about the whole of system approach for healthcare delivery at Te Pae Hauora o Ruahine o Tararua MidCentral, and their plans to align their Hospital HealthPathways implementation.

Since then, the MidCentral Community and Hospital HealthPathways teams have been working hard to realise their vision for seamless care pathways.

Combining the fundamentals

As the team has implemented Hospital HealthPathways, they have kept cohesiveness between their Community and Hospital programmes top of mind.

“From the first joint meeting of the Community and Hospital HealthPathways groups, we established as a principle that collaboration is at the core of what we do. At subsequent meetings, we confirmed our vision for a single pathway that will support the "Home to Home" health journey. This is achieved through combined governance, standardised pathway prioritisation frameworks, strong clinical editor relationships, and consistent reporting,” says Dr David Sapsford, Lead Clinical Editor.  

Lead Clinical Editor Dr Paul Cooper adds “Certainly, the collaboration between the clinical editors on pathways is beneficial in a number of ways, including optimising the use of limited Subject Matter Expert (SME) time, ensuring alignment of pathways, and potentially reducing development time, a real bonus in terms of being economic as regards to development time and SME time.” 

Clinical editors working on Hospital and Community HealthPathways hold combined pathway collaboration meetings on a six-monthly basis. The meetings are well attended and provide an opportunity for the clinical editors to share ideas and learn from each other. 

“Clinical editor feedback is that they find these meetings valuable, and this is certainly evidenced by the increasing participation with both programmes,” says Catherine Marshall, Project Manager. 

HealthPathways coordinators from both programmes also work closely together. Reporting has been streamlined and is consistent across both programmes.  

Localisation through challenging times

“One of our biggest challenges has been the impact of COVID-19 on the timelines of our programme. This increased demand on hospital services has been further impacted by the response to winter illness and acute presentations,” says Dr David Sapsford.

Despite this, the team have continued to localise pathways in readiness to be published on the Hospital HealthPathways site. Interest across the organisation has been strong, and the team have built on this by attending departmental meetings with clinicians, and meeting with them one-on-one.

Eight clinical editors are dedicated to the Hospital HealthPathways programme and are developing strong relationships with the clinical editors in the Community HealthPathway Programme.  

“By applying the MidCentral whole of-system approach to the delivery of health care across our region, we’re able to make our primary and secondary care services more integrated and where appropriate, more standardised. As pathways of care for our communities become more seamless, this also benefits our health providers, as it enhances their experience in providing care,” says Dr Paul Cooper.


(Left) Catherine Marshall, Project Manager, and (Right) Sherry Toia, Administrator/Coordinator promote HealthPathways at a Hospital HealthPathways Hub located in the hospital main foyer. 

Early days

While it’s relatively early for impacts to be visible at the community health level, it’s clear that the joined-up Community and Hospital HealthPathways programmes are already having a positive effect, says Catherine. Secondary and primary care clinicians working more closely together on pathway development leads to improved understanding of their respective roles and smoother transitions of care - a key positive outcome. 

Positive feedback from clinicians has undoubtedly borne this out and is rewarding for the team, as they look forward to their next priorities of continuing to strengthen the joined-up collaborative work.

“I think this is a fantastic resource to benefit all clinicians and ultimately our patients and families.” – Sue Dunn, Nurse Practitioner, (Primary Care) and Clinical Editor.

More information

To find out more about the work of the MidCentral Hospital HealthPathways team, please email CathMa@mdhb.health.nz

If you have any other questions about this update, please have a chat with your lead writer.

Find out more about HealthPathways

If you’d like to know more about HealthPathways, or if your health jurisdiction hasn’t yet joined the HealthPathways Community please:

  • See HealthPathways Global for an overview
  • Email info@healthpathwaysglobal.org or phone:
    • Within the United Kingdom: +44 20 3519 1964
    • Within Australia: +61 7 3559 2744
    • Within New Zealand: +64 3 595 2830