Expanding care pathways: towards interplay of multiple care objects

Purpose – This study seeks to challenge the notions of the standardized care pathway and patient-centred care, both of which provide only a partial view of care as a complex system. In exploring and contrasting the care pathway protocol and an actual care pathway, the study aims to analyze the conceptualizations of care that actors involved in the actual care pathway have. The study makes suggestions on how to expand care pathways and thereby improve patient care.

Design/methodology/approach – A care pathway protocol is contrasted with the actual care pathway of a patient at a university hospital in Finland. Observational ethnography is combined with a narrative approach and activity-theoretical ideas.

Findings – The study depicts the gap between the care pathway protocol and an actual care pathway. The actual care pathway, rather than being a clear-cut process, is ruptured and unpredictable. The conceptualizations of care (i.e. care-objects) held by the doctors, nurses and the patient were fragmented and clashed in their practical work activity. The main message to hospital management is that in order to expand care pathways, the multiple care-objects need to be placed in constructive interplay.

Research limitations/implications – A single actual care pathway is presented and the results are interpreted accordingly.

Originality/value – The study explores the idea of a care pathway and patient-centred care in the analysis of care-objects. A new discursive model is introduced that places different care-objects into interplay and opens up the possibilities for the expansion of care pathways.