[Implementation of multidisciplinary clinical pathways in a highly complex health institution]

Clinical pathways or structured multidisciplinary care plans are a tool to standardize clinical practice. The aim of this article is to describe and propose a methodology for the development of clinical pathways in a highly complex health institution. We used the guidelines of the European Quality of Care Pathway, which are based on a 4-stage model: definition and diagnosis, development, implementation and continuity. To make this process operational, we incorporated the project management methodology (PMO). The implemented methodology contemplates the generation of an institutional governance structure responsible for the coordination of the project and the prioritization of the clinical processes to be standardized. The implementation of each clinical pathway was carried out in four steps, namely team generation, development, planning and implementation, and continuous improvement. With this methodology, 23 clinical pathways were developed between 2014 and 2018. Their implementation significantly reduced hospitalization days and their variability, optimized the use of resources and standardized clinical records. The standardization of clinical processes allowed the development of new skills such as the generation of clinical projects, an institutional methodology for managing change and sustainability through cycles of continuous improvement.