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Department: Pathway to Excellence®

A framework for culture transformation in international healthcare organizations

Harris, Patience BSN, RN; Pena, Maria Rosario “Cherry” G. MAN, RN; Pabico, Christine MSN, RN, NE-BC; Dans, Maricon MSN, RN

Author Information
Nursing Management (Springhouse): October 2018 - Volume 49 - Issue 10 - p 8-10
doi: 10.1097/01.NUMA.0000546209.78197.84
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Numerous changes impacting healthcare settings globally have heightened the focus on improving quality of care and patient safety. Global health leaders increasingly recognize that creating an organizational culture and a practice environment that empowers and engages nurses is essential to improve patient care quality and safety. Nurse leaders look to the Pathway to Excellence® Program to develop high-performing teams and a culture of sustained excellence. We discuss how the Pathway framework, effective in transforming organizational culture in the US, is also applicable and attainable in international healthcare settings.1


The Pathway framework is relevant wherever nurses are employed and particularly suitable to help address rising global healthcare challenges by improving the nursing practice environment. A recent report from the Organisation for Economic Co-operation and Development noted that the health shift in aging populations and the growing burden of chronic conditions among people who are living longer have important implications for how care can be organized and delivered.2 A strong nursing workforce, supported by a positive practice environment, is key to the effective delivery of quality healthcare amidst growing challenges. A study of hospitals in Sweden found that adequate staffing, good leadership, and support for nurses were crucial to staff members' mental health.3 Improved nursing practice environments are also important to the quality of care. For example, a multinational study of 34 hospitals in Cyprus, Finland, Portugal, Sweden, Turkey, and the state of Kansas found that elements of the nursing practice environment were associated with improved care individualization.4

Pathway to Excellence designation recognizes healthcare organizations for supporting an enriched nursing practice environment in which nurses excel. The Pathway framework promotes positive work conditions characterized by greater autonomy and participation in decision-making, supportive leaders, interprofessional collaboration, and a focus on patient and caregiver well-being. To become designated, organizations must demonstrate that the six Pathway standards are incorporated into their daily operations: shared decision-making, leadership, safety, quality, well-being, and professional development. The presence of these essential elements of a positive practice environment is also validated by nursing staff through a confidential and voluntary survey, giving all nurses in the organization a voice in the designation process. The survey reflects a real-time snapshot of the organization's current state. To make the journey successful and more meaningful, organizations are encouraged to conduct an internal self-assessment involving frontline staff and leaders to identify opportunities for improvement as an initial step. This process engages frontline staff members early in the development, implementation, and integration of processes and policies to close the identified gaps.

Success in the Philippines

The Pathway to Excellence Program is gaining more recognition globally as healthcare organizations recognize the benefits of creating positive work environments for nurses. Currently, there are eight Pathway-designated organizations in five countries outside of the US: Australia, Mexico, the Philippines, Switzerland, and Thailand.5 St. Luke's Medical Center–Global City (SLMC-GC) became the first hospital in the Philippines to achieve Pathway to Excellence designation in April 2018. SLMC-GC is a highly recognized healthcare institution in the Philippines and remains competitive with other healthcare organizations around the world. The Pathway framework served as SLMC-GC's blueprint to engage their nurses and align them with the organization's mission and vision and opportunities for innovation. Their success was deeply rooted in getting staff members to work together toward the common goal of being an exemplar for international quality of care.

Nursing staff at St. Luke's Medical Center–Global City, Philippines

Clinical nurses at SLMC-GC discovered the value of their Pathway journey and are eager to share their personal testimonials of its benefits. As Katrina R. Valbuena, BSN, RN, stated, “Our journey to Pathway to Excellence made us realize the importance of involving ourselves in the hospital's decision-making process. [A] high level of camaraderie is apparent as we all work towards achieving the goal. I believe that what we've learned in this journey has a big impact on our patients.”

Other comments from SLMC-GC's nurses emphasize how the Pathway to Excellence Program strengthened the organization's culture and environment. Ramon Victor G. Roxas, BSN, RN, remarked, “The Pathway framework increases the success and effectiveness of the company by ensuring that both the needs of the patients and then the staff come first.” Expressing how Pathway provides a foundation for nurses' voices to be heard, Jayvee B. Montaya, BSN, RN, stated, “I would say that, most important, I feel valued as a nurse. A Pathway to Excellence-designated institution means that the organization cares for you and allows you to grow. There's a positive working environment that makes me more enthusiastic to do my job. There's joy in working knowing that your efforts are appreciated.” As Aireen V. Calimutan, BSN, RN, further explained, “The Pathway journey strengthened the interprofessional teamwork, allowing employees to feel more engaged and empowered.”

Several SLMC-GC clinical nurses also discussed how nurse well-being and work-life balance impact patient care. Jessa Marie S. Villanueva, BSN, RN, remarked, “An institution where nurses create a positive environment can produce happy nurses and happy patients as evidenced by high nurse and patient satisfaction. Pathway also aims to promote work-life balance for nurses and secure their health and wellness as they provide quality care to patients and families. Providing opportunities for nurses to promote professional growth strengthens their advocacy toward patient safety.” R. Caraan, BSN, RN, stated, “Pathway to Excellence provides opportunities to increase not only patient satisfaction, but also nurse satisfaction in terms of balanced lifestyle for nurses and [a] positive work environment that promotes ideal nursing practice.” Jobert Roy Rodelas, BSN, RN, has discovered a new appreciation of himself and his colleagues as members of effective care teams. He remarked, “The Pathway journey has honed us to be a better version of ourselves in terms of giving excellent service.” It isn't unusual to hear such enthusiastic accolades from Pathway nurses; these engaged staff members are excited to share the great work they do.

Creating a positive nursing practice environment plays a key role in staff satisfaction and patient safety. It's critical that frontline nurses can envision positive outcomes, feel empowered, affect the culture, and know that their voices are heard and an infrastructure for shared decision-making and processes is in place to lend ongoing support. To this end, SLMC-GC placed a high priority on frontline nurse involvement to develop innovative engagement strategies and ensure the hardwiring of structure and processes as defined by the elements of performance in each Pathway standard. Consequently, it isn't surprising that staff engagement and satisfaction are evident in SLMC-GC nurses' testimonials. Staff members speak of the Pathway journey as a happy mission that inspired them to go above and beyond to achieve the organization's goals. Hardwiring the Pathway standards in the organization provided a foundation that positively impacted staff and patients. Among recent improvements, SLMC-GC has accomplished the following:

  • 40% decrease in patient falls with injury in 2 years
  • 0 catheter-associated urinary tract infections on 14 out of 20 units over 2 years
  • 15% reduction in central line-associated bloodstream infections (CLABSIs) over 2 years
  • 0 CLABSIs on all units in the third quarter 2017
  • 10% decrease in hospital-acquired pressure injuries (stage 2 and above)
  • medication error rates of 0.28 from 0.30 per 1,000 patient days
  • outperformed the National Database of Nursing Quality Indicators® (NDNQI®) global mean for RN satisfaction: professional development opportunities
  • outperformed NDNQI global mean for RN satisfaction: autonomy.

Nurses at SLMC-GC refer to their newly found passion to constantly improve as addicting, continuously looking for better and more efficient ways of doing things. As a result, SLMC-GC received awards at Healthcare Asia in 2018 for Management Innovation of the Year, Service Innovation of the Year, and Employee Engagement of the Year. These awards are a testament to SLMC-GC's world-class quality medical services and have provided the organization with more visibility and well-deserved recognition for their achievements.

Global teamwork

Driven by common needs and unique experiences, the success of international healthcare organizations committed to creating a healthy workplace environment for their nurses is an inspiration and model for other organizations. The Pathway to Excellence Program supports their efforts to become global leaders for nursing and healthcare. Because the Pathway designation must be renewed every 4 years, nurses know that Pathway organizations must sustain the foundational elements they've developed and implemented to build a positive environment that helps nurses provide safe patient care and achieve their personal best.

The Pathway framework offers a blueprint that can positively impact the delivery and quality of care in international healthcare organizations. As global interest in Pathway designation grows, the Pathway to Excellence Program will continue to focus on being responsive to the unique needs of international applicants. Revisions to the standards, introduced every 4 years by the Commission on Pathway to Excellence, will continue to take changes in healthcare into account and apply to wherever nurses work.6 Despite the variation in health systems around the world, the Pathway standards will remain relevant, meaningful, and attainable.


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5. Pathway to Excellence. Find a Pathway organization.
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