Background: Learning health systems (LHSs) pursuing the Quintuple Aim struggle to get knowledge into practice. Care pathways can translate evidence and policy into point-of-care action, but are challenging to implement at scale.

Approach: HealthPathways is a care pathways collaborative that has scaled across health systems in five countries, covering 35 million people. It functions as a procedural memory for LHSs, saving evidence, policy, and local knowledge in a form that directly influences clinical practice. We describe a narrative review of the emerging evidence base.

Results: There is growing evidence of improvements to care team experience, embedding of new models of care, and economic impacts, however most studies have been retrospective and observational. There is a need for prospective, equity-stratified evaluations and economic studies across sites.

Implications: By capturing and supporting continuous improvement of local care HealthPathways enables iterative learning, ensuring that quality and efficiency gains persist despite health system changes. This creates opportunities to reduce unwarranted variation in care, enhance health equity, and scale integrated care across sectors. As a reusable process memory, HealthPathways can stabilise and spread integrated care improvements.

Background
Since 2013, when South Tyneside CCG partnered with New Zealand’s Canterbury District Health Board as part of Norman Lamb’s Integration Pioneers, HealthPathways has acted as a practical enabler of integration. The programme fostered collaboration across secondary, primary, community, and voluntary sectors through shared culture, mutual accountability, and an alliancing approach to system leadership.
Approach
An alliance leadership team was formed between commissioners and providers to co-own system challenges and co-design care pathways. These contextualised pathways were captured within the HealthPathways platform, providing a single, locally agreed source of guidance, available at the point of care for all professionals. The model was subsequently adopted in North Cumbria, Cornwall, and Dartford, Gravesham and Swanley. The combination of the collaborative network of practices coupled with a commitment to continuous learning, ensures that new members benefit from the previous implementations and then go on to inform future programme development.
Results
Implementation demonstrated improvements in care coordination, clinical consistency, and professional relationships, even within a short time frame (6 months post launch). However, sustaining integration proved challenging as repeated changes to commissioning structures disrupted established alliances and funding flows. Despite this, new initiatives in North Kirklees and Wakefield illustrate renewed understanding of the benefits this whole of system working brings, enabled by a commitment to integrated pathway design across hospital and community settings.
Implications
Pathways remain a critical mechanism for enabling integration, strengthening shared decision-making, and supporting the shift from hospital treatment to community prevention. Sustainable integration ultimately depends on investment in relationships, culture, and local ownership. With increasingly flexible implementation options, HealthPathways is looking to support the emerging neighbourhoods and integrated community teams with achieving the system goals via a sustained commitment to collaborative working.

Background: Brief overview of the problem and context- 1-2 sentences
NHS Wales has launched a national programme to create, disseminate, and maintain a comprehensive suite of care pathways. With clinical collaboration across all of its seven Health Boards, pathways define consistent standards and interventions for 3.3 million citizens, supporting the vision that residents remain well in their homes and communities. The programme exploits a ‘Once for Wales’ approach to maximise value of investment through a shared national pathway development process, governance and outcome measures


Approach: Methods, activities or interventions implemented include stakeholder involvement and codesign
Using learning from an implementation in Cardiff and Vale, Welsh Government commissioned the first All Wales approach to the development of integrated pathways supporting care of patients in the community, delivering against the national policy direction of provision of care closer to home. Each pathway describes the interventions and standards for care delivery that all residents, regardless of geography can expect, however, the subsequent localisation ensures the content is contextualised to the local system. Essential programme components include leadership from a national programme management team, working alongside National Clinical Networks who include lived experience representatives and third sector organisations, as well as local leaders from within the individual Health Board ensuring cross system representation from primary, secondary and community services.
This programme is the first time all independent Health Boards have successfully collaborated with a focus on joint success. Agreeing to adopt ‘pathway sharing by default’ required significant levels of trust across the teams, and was done so on the basis that it would deliver the greatest impact for the collective rather than the individual success of any one Health Board
Health Board leaders have recognised this ability to get “independent organisations to work together for a shared purpose” as both innovative and successful. The first of its kind, the programme has demonstrated what can be achieved through collaborative working built on a shared purpose.

Results: Key findings, impact or outcomes
Since the ‘once for Wales’ national programme was launched in 2023, over 320 clinical pathways have been published, with more than 1,500 locally adapted versions. These have generated over 1.2 million page views across all platforms.
Health Boards and GP clusters have used the pathways to review outpatient waiting lists and support GPs in determining whether patients require consultant review or could be managed through integrated community services. In Cardiff, this led to a 10% reduction in consultant outpatient assessments. For example, lumbar spine MRIs decreased by 72% and shoulder ultrasounds by 92%, yielding a theoretical saving of £400,000.

Background
Wales is seeking solutions to help make health and social care community services more accessible, coordinated, and home-focused, aiming to prevent unnecessary hospital admissions and support timely, safe discharges. In 2024/25, the Care Action Committee and the 50-Day Integrated Care Winter Challenge shifted the focus from reactive hospital care to a proactive, enhanced community-based model. This intervention successfully tested new approached for building community capacity, integrated planning and system delivery, and provided proof-of-concept, which is now being adopted through the Integrated Community Care System (ICCS) to enhance person-centred community care, further improve outcomes, and build resilience through collaboration and shared system responsibility.
Approach
The 50-Day Challenge targeted ten high-impact actions, including optimising hospital flow, implementing proportionate 7-day working across health and social care, building community capacity, establishing integrated navigation hubs, and providing proactive support for high-risk groups. £19 million was invested in boosting community capacity, creating transition beds, and enhancing reablement and domiciliary care services.
Welsh Ministers led the CAC, brought together leaders from health, social care, and government to create joint solutions and shared accountability. Regional Partnership Boards and Senior Accountable Officers provided both strategic and operational oversight. Data-driven delivery was ensured with combined health and social care dashboards, regional reporting, and an ‘adapt, adopt or justify’ approach, driving responsive learning and continuous adaptation. Stakeholder workshops and feedback informed improvements. The ICCS blueprint was co-designed through cross-sector engagement, aligning national programmes and integrating digital and population health initiatives.
Results
The 50-Day Challenge and CAC achieved a 17% reduction in people delayed in hospital by March 2025 (target ↓15%), while delays to assessments dropped by 22% (target ↓20%). 92% of those experiencing the longest waits at the start (395 people) were discharged by March 2025. Over 2024/25, reablement support access increased by 31%, and domiciliary care waiting lists fell by 33%.
Proactive care and anticipatory planning for high-risk groups saw 5,343 people reviewed in the community and 2,670 Future Care Plans created to prevent escalation and hospitalisation. Emergency admissions for those aged 70+ dropped by 3–5% (the lowest in four years), and care home hospital transfers reduced by 12% compared to the previous year. This progress resulted from a collaborative culture at national/regional levels, enhancing integration, prevention, and continuous improvement.
Implications
Sustaining improvements relies on embedding integration and strengthening regional accountability. Wales has introduced new ICCS governance structures, replacing CAC, with a National Leadership Group (Ministerial), an Integrated Care Delivery Group (Operational leads), and regional Building Community Capacity meetings (Delivery partners). The focus is on preventive interventions, enhanced community care, and proactive support to further reduce admissions and improve outcomes.
Standardised datasets enable consistent evaluation and evidence-based decisions. Sharing case studies and impact summaries supports peer learning and ongoing development. Aligning funding and priorities across programmes ensures sustainable integrated care, with continued emphasis on joint winter planning, regional integration, and strategic change. Wales’ experience demonstrates the value of cross-sector leadership, agile governance, and community care, providing useful lessons for other systems aspiring to integrated, preventative, person-centred care.

Background:
Ontario Health Teams were introduced by the Government of Ontario, Canada, in 2019 to transform the delivery of healthcare by creating a more integrated, person-centered system. Their core mandate is to advance population health and equity, develop integrated care pathways, improve chronic disease management, and strengthen primary care. In 2024, three Ontario Health Teams—Burlington, Greater Hamilton Health Network, and Middlesex London—came together to implement HealthPathways an internationally established care pathways methodology and digital platform that serves as a “one-stop shop” to support primary care providers and other clinicians in delivering up-to-date, evidence-informed, standardized, and locally contextualized care. In less than one year the three OHTs undertook a shared procurement and contracting process; engaged and trained clinical editors (family physicians and nurse practitioners) and subject matter experts; and validated, localized and disseminated 46 care-pathways, with an additional 54 pathways expected by March 2026. The adoption and implementation of HealthPathways—the first in North America—required adaptive and systems leadership, the leveraging of collaborative networks, continuous learning, innovation and improvement, and a commitment to equity and diversity.
Audience:
Integrated care leaders, implementers, evaluators, policymakers, and researchers.
Approach:
This interactive workshop will function as a “living lab” where participants will work through the 4 stages of a complex implementation – Exploration, Preparation, Implementation, Sustainment (EPIS, Moullin et al, 2019). Theory and key concepts from network theory, adaptive and systems leadership will be intermixed with real-world case studies that illustrate implementation challenges, solutions, and lessons learned. Participants will be presented with opportunities for individual reflection, small group discussion, and action planning to promote knowledge exchange, practical learning and application to their own contexts. 
Timing (90 minutes):
- Introduction (15 min) – Framing the problem: challenges within Ontario’s health system from the perspective of patients, providers, and health system leaders with a focus on access, navigation, and equity. 
- HealthPathways Overview (10 min) – Presentation on methodology, design, and global outcomes. 
- Ontario Implementation Experience and the EPIS framework (50 min) – Brief theoretical and case-based presentations highlighting planning and implementation, adaptation, and early outcomes intersected with breakout discussion where participants will explore potential enablers, barriers, and strategies for local adoption in their own regions. 
- Lessons Learned – Spread, Scale, Sustain (10 min) – Facilitated reflection and co-creation of an approach for scale and spread to other jurisdictions.Outcomes
Outcomes:
- Reflect on the balance needed between standardization (i.e. fidelity to model) and adaptability to local context in healthcare system implementation.
- Identify and prioritize key barriers (e.g., governance challenges, clinical engagement issues, equity gaps, technical integration hurdles) and enablers (e.g., adaptive leadership, collaborative networks, continuous learning) in the Canadian HealthPathways implementation process and reflect on applicability to other complex intervention implementations.
- Describe and assess how shared governance structures and pooled resources across the three OHTs facilitated the adoption and adaptation of HealthPathways in Ontario.