A new module about healthcare delivery was recently added to the Clinical Rationale section of TREAT’s educational materials. This is an important addition because studying the healthcare delivery process provides valuable insight into how the clinical ecosystem influences the adoption of rehabilitation innovations. Each aspect of rehabilitation can be conceptualized as occurring within a “clinical pathway” which describes the progression of the patient from experiencing symptoms to receiving treatment. Throughout this progression, each patient encounters various clinical settings and care providers. A thorough understanding of the healthcare delivery process is necessary to recognize when an innovation would be disruptive and therefore less likely to fit within existing clinical pathways. This knowledge will provide context to the value proposition for each stakeholder your innovation impacts.
A literal example of a clinical care pathway can be seen in the time-tested hospital map (as shown below). Designed to guide patients through the labyrinthine hallways of the hospital, the typical stops are highlighted, including parking lots, reception desks, waiting rooms, and treatment areas. The hospital map helps to provide a big picture of where the patients are and where they are headed, in order to reduce the chances of getting lost along the way.
Similarly, it is important for innovators to understand the typical traffic patterns of patients, workflows of practitioners, and the associated payment methods within the field of rehabilitation. Clinical pathways can be complicated, especially in rehabilitation (which is often one of the later stops on a patient’s treatment journey). Consider the simple clinical pathway shown in the diagram below. The patient in this case progressed through five steps before purchasing a piece of rehabilitation equipment out of pocket. If any section of this pathway had been altered, the patient may have ended up using a different type of equipment or treatment which may or may not have been covered by insurance. Understanding each variable in this process would be of vital importance to a company that is looking to develop a new device to alleviate back pain.
Assessing a clinical pathway in the context of commercialization may take the form of answering the following questions:
- What stops on the clinical pathway must be made before patients reach your product?
- Is there a way to streamline this process?
- Are there any areas where the patient might be redirected away from your product?
- What type of information do the clinicians need in order to direct patients toward your product?
- Does your product fit into or disrupt the practitioner’s existing workflow?
- Does your product alter the clinician’s workload, documentation requirements or payment mechanism?
An innovator who asks these questions will better understand the patient experience as well as explore commercialization opportunities within the healthcare delivery process. Familiarity with the clinical pathway also allows the innovator to understand the needs and goals of the clinicians and other stakeholders who work in each type of setting.
The best way to gain an understanding of what it feels like to navigate a clinical pathway is to experience it for yourself. This is one reason why many successful rehabilitation innovators develop their product ideas out of personal experience. However, it is dangerous to assume that any individual’s experience is representative of the typical clinical pathway. Therefore, a range of stakeholder interviews should be conducted to account for the variations that can exist in care pathways for a particular indication. The pathway analogy can provide a useful framework for the interviewing process because it provides context for the stakeholders to tell their part of the story. The pathway can also serve as a useful roadmap for the innovator to ensure they understand the value of their innovation as they navigate real-world rehabilitation landscapes and don’t take a wrong turn down a dead end corridor.
Visit TREAT’s Clinical Rationale educational module to find more information and resources on how your technology fits within the clinical ecosystem via the Healthcare Delivery Module. Lay out the patient care pathway relative to your technology using the Healthcare Delivery Module’s companion Worksheet.
Angela Smalley, PhD is the TREAT Project Leader for Product Evaluation and former TREAT Entrepreneur Fellow. She is a graduate of the University at Buffalo, where she received a PhD in Rehabilitation Science. Her research background is in Biomechanics and she has also worked in the fields of orthotics and prosthetics, where her specialty was in pedorthics. Her clinical experience informs her interest in multidisciplinary collaboration and healthcare innovation.