Since its inception 10 years ago, Mid and North Coast HealthPathways (M&NC) has developed more than 700 localised pathways and receives over 20,000 page views a month from over 1,000 users. 

To gain insights into the impact of HealthPathways in their local health system, Healthy North Coast (HNC), with support of partners Mid North Coast Local Health District (MNCLHD) and Northern New South Wales Local Health District (NNSWLHD), commissioned The Science of Knowing to undertake a process and outcomes evaluation of the Mid and North Coast HealthPathways programme. 

“The Mid and North Coast programme team wanted to explore the overall value of our HealthPathways programme, and investigate the hypothesis that HealthPathways contributes to the Quintuple Aim of healthcare by providing a process for improved collaboration between different parts of the health system. We also wanted identify opportunities for programme improvements and future investment,” says HealthPathways Clinical Lead, Dr Sarah Mollard.  

“The evaluation report highlighted that HealthPathways can play a significant role in relationship building and collaboration across the different levels of the local health system,” she says.  
 

Left to right: 
Dr Kate Allan, GP Clinical Editor; Dr Grace Leung, GP Clinical Editor; Dr Sarah Mollard, GP Clinical Editor Lead; Jane Moye, Project Officer, HealthPathways; Kerrie Keyte, Northern NSW Health Pathways Lead; Fiona Ryan, MNC HealthPathways Program Coordinator; Dr Claire Cooper , GP Clinical Editor; Dr Susan Roberts, GP Clinical Editor.

Key findings 

The evaluation provided the M&NC HealthPathways programme team with some useful insights for managing their programme, explains Dr Mollard.  

The report found that awareness of HealthPathways was high and increasing amongst the local GPs and registrars surveyed, but that there was a need for better integration at higher levels. It also noted that while the programme has contributed to improvements in local models of care and regional systems, its capacity to meet full potential was being impeded by limited high-level integration.

Further work to integrate HealthPathways within MNCLHD, NNSW, and Healthy North Coast organisational policies and initiatives is now a key priority for the Mid and North Coast programme team, says Dr Mollard. 

The evaluation report also highlighted the need to balance the benefits of content sharing and lead region following with opportunities to use HealthPathways as a tool to facilitate conversations around fixing pain points. GPs pointed out that by not having the right people at the table to discuss specific pathways and problems on the ground, pain points could not be identified and addressed.  

Difficulties in maintaining accurate referral information was identified as a key challenge and the project team is continuing to work with the LHDs to find ways to facilitate referral information sharing.

Other evaluation report recommendations included: 

• developing a joint communications plan with partner organisations to enable a tailored engagement approach to promote the benefits of HealthPathways to GPs, LHD clinicians, and other health professionals
• exploring technological barriers and opportunities 
• reviewing programme processes to ensure ongoing usefulness and quality 
• implementing a monitoring and evaluation framework. 

“We’ve already implemented many of the recommendations made around how the programme can be improved,” says Dr Mollard. 

“We’re working closely with our partners at Healthy North Coast, Mid North Coast LHD, and Northern New South Wales LHD to leverage the programme and further support coordination and integration across different levels of our local health system.” 

Enabling health system change 

The evaluation found that HealthPathways was able to support integration and health system improvements at micro, meso, and macro levels.  

Examples of collaborative work in HealthPathways to initiate conversations and address concerns about how patients are managed in the health system were also highlighted in the report. These included: 

• Termination of Pregnancy (TOP) Follow-up pathway
  Face-to-face meetings between the Obstetrics team and local GPs established rapport and ongoing relationships, which led to improvements in pathway design. 
• Suicidal Ideation or Intent pathway
  A working group of health professionals, including LHD mental health clinicians, psychologists, psychiatrists (private and hospital-based), and the PHN (Primary Health Network), led to a major overhaul of the pathway, and inaccuracies in other pathways being addressed. As a result, further conversations enabled pathway updates to occur beyond the initial suicide risk pathway development. 

“We want to embed HealthPathways across the region as a tool that can drive health system improvements by bridging the gap between primary and tertiary care, and by providing trusted localised clinical, referral, and health systems information,” says Dr Mollard. 

“We’re proud of the contributions we’ve already made to improvements in local models of care, and system changes in the region over the past 10 years, and look forward to taking our work further.”  

Lessons learned  

Undertaking the evaluation process was a valuable learning experience for the team. Dr Mollard shared some of her key learnings from the process, including:

• the value of having stakeholders on the same page regarding the intended use of the evaluation 
• the importance of having a clear research question during the design phase 
• the importance of reaching out to partner organisations early to understand processes and approvals required to undertake research, finalise any reports, and apply for publication 
• the value of qualitative data in demonstrating the impact of the programme in the context of a complicated health system where outcome measurement is difficult to link directly to programme activities.  

Next steps and more information 

Dr Mollard will present some of the evaluation findings at the WONCA conference, hosted by the Royal Australian College of General Practitioners (RACGP) in Sydney from Thursday 26 to Sunday 29 October.

Read the full evaluation report on the HealthPathways Community Research and Evaluation Hub

Find out about the new Outcome Evaluation Toolkit that supports local HealthPathways teams to demonstrate the value and impact of HealthPathways. 

If you have any questions, or would like to know more about conducting an evaluation of your HealthPathways programme, please contact your community success manager.