Read the rest of this series of blogs about designing and planning population based systems of care here.

Step 7: Defining the pathway

The pathway is the route the patient usually takes through the system. NICE produces pathways, but these need to be localised using the Map of Medicine or the Pathways for Health software.

The benefit of defining the pathways lies in the debate that is involved in its creation, often the clinicians involved, from different parts of the network. Pathway design is a social process and it is important to appreciate that pathways are not necessarily to be consulted in every consultation, but they represent an agreement about what should happen in a population

When modifying a national template there are three issues that need to be discussed:

1. what must not be changed e.g. a key drug dosage.

2. what must be changed e.g.key local telephone numbers—prepare the pathway with a newly arrived member of staff in mind.

3. what is uncertain and can be localised one way or another, or perhaps be the subject of research—the views of patients and carers are, as always, valuable.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.