On the right path. Collaborative case management makes nurses partners in the care-planning process

The quality improvement movement in healthcare has given nurses a greater role in developing and implementing collaborative case management processes. In the case management model, nurses no longer simply take orders but actively participate in designing a plan of care. At Mercy Health Center, Oklahoma City, nurses play a leading role in the development of "clinical pathways," plans of care for a single diagnosis as directed by a specific physician or group of physicians. The pathways promote multidisciplinary, interdepartmental cooperation in patient care. Since August 1992, Mercy has developed clinical pathways for five inpatient and outpatient procedures, and more are being considered. Once a plan has been created, its key points are rewritten in lay terms and printed in a brochure for the patient. During the treatment, nurses and other healthcare professionals document when specific steps in the plan have been completed. In follow-up evaluations Mercy's steering committee for the collaborative care process has found that the clinical pathways have maximized quality, improved efficiency, increased patient satisfaction, and enhanced collaborative team practice.