Personalizing Pathways

David HughesSeattle Cancer Care Alliance (Seattle, WA) has been a leader in clinical pathways for more than a decade. The treatment center—comprised of clinicians from University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children’s Hospital—was established in 1998 to provide state-of-the-art cancer care to patients in the Pacific Northwest. The hospital has been consistently recognized as one of the top cancer centers in the United States.1

To best understand how a large research hospital implements clinical pathways in day-to-day practice, Journal of Clinical Pathways spoke with Editorial Advisory Board Member David A Hughes, who serves as the director of the clinical pathways program at Seattle Cancer Care Alliance (SCCA). Mr Hughes has worked extensively as both a nursing clinician and as a pathways administrator, which has offered him a unique position to observe how best to utilize pathways.

What inspired you to work primarily with clinical pathways?

I have a broad background and personal commitment which led me to contributing to the advancement of clinical pathways at the SCCA. My work experience includes managing a cardiovascular research lab in college as well as nursing in interventional radiology, neonatal, and adult intensive care. An ongoing obsession with technology and data led to the creation of a software development company that specializes in biosimulations. It is the intersection of these three backgrounds—research, clinical practice, and technology/data—that I believe is where the innovative edge of clinical pathways exists. When I discovered the job posting at the SCCA for clinical pathways, I felt it was my opportunity to apply my experience and interest to advancing health care delivery. I was driven to contribute to the evolution of clinical practice and to make clinical intelligence more accessible to patients as well as providers. On a personal level, the job posting represented a chance to support an organization, and its staff, who were very important to me. My brother-in-law is a cancer survivor and owes his life to the dedicated researchers and providers at the Fred Hutchinson and SCCA. I was inspired by their passion and troubled by the technological, operational, and financial challenges they encountered while providing care. Pathways empower health care teams and address these challenges. Working with pathways, and supporting the SCCA, is what I have come to view as a privilege, and honor, that for which I am eternally thankful.

How do you approach integrating pathway programs into clinical practice in your position as director of clinical pathways for a major cancer hospital?

I approach integrating pathway programs through partnership and support. Integration starts from my perspective that clinical pathways are a framework that empowers patients, their families, and the allied health care team. Our responsibility as a pathways program is to support the efficient delivery of care that results in the best possible outcome given a patient’s clinical presentation. This is achieved through the establishment of evidence-based standards that are operationalized and a reporting platform that surfaces clinical intelligence. Value is a key word these days in many conversations in health care. To me, pathways have to provide value to several audiences including patients, families, providers, the allied health care team, administrators, payers, professional organizations, and increasingly government. Integration, or implementation, requires that the views and needs of each audience is considered and addressed. While we are still discovering how best to accomplish this, one realization has become clear: a pathway program’s implementation success must be built upon a strong partnership and commitment to support and empower each audience.

How important is patient viewpoint in developing and advancing clinical pathways?

A pathway program’s efforts orbit the patient who is at the center of the health care universe. The patient perspective is what drives the definition of “value” in health care. There are many viewpoints to consider in developing a pathways program and several audiences who compete for a program’s attention. The patient is central to the ultimate measure of success. We have focused on developing a reporting platform that delivers clinical intelligence which advances the interest of all audiences. Our initial reporting platform addresses treatment concordance and will progressively incorporate features that are meaningful to all pathway platform audiences.

How has the integration of clinical pathways most affected oncology care in recent years?

I believe the most important outcome of clinical pathways development and integration into health care has been the establishment of evidence-based standards of care. Value begins to be more clearly resolved from a combined focus of improving outcomes (clinical and patient reported), optimizing treatment variation, mitigating cost, and surfacing clinical intelligence based on a clinical standard. The definition of “value” continues to be refined through an iteration of these dimensions as well as others.

How do you see clinical pathways changing the landscape of health care in the next 10 years?

Clinical pathways programs have an opportunity to establish a common language for deriving value from clinical standards. A common language can empower programs to collaborate and advance the key measurement of success, which is delivering superior outcomes efficiently and meaningfully from a patient’s perspective. In the next 10 years, my hope is that as a profession we can refine an agreed upon objective, develop a set of criteria that define a quality pathway program, establish a standard for the components of a quality pathway, and create a software platform which enables data sharing, data portability, and derives clinical intelligence from the implementation of pathways. A realization of these goals could achieve meaningful patient-reported outcomes that are delivered efficiently. Additionally, I believe that pathways have an important role in a population health strategy that empowers not only an institution, but also its primary care partners and stakeholder communities. With the development of a common platform and standards, I believe the next 10 years will see pathways taking on bigger roles in population health management.


1. Best hospitals for cancer. U.S. News & World Report website. Accessed July 13, 2017.