Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

Abstract

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

How Is Quality of Care in Home Healthcare Created? A Qualitative Study of Health Professionals’ Perspectives

“…The goal of healthcare is better outcomes for the patients, and good cooperation between all relevant stakeholders and actors is crucial for patients with complex needs who need multidisciplinary care [ 40 ]. Healthcare professionals, especially nurses in home healthcare, are in a position to be an advocate for the patient, provided they have adequate information about the individual needs of the patient and the context in which the patient experiences [ 41 ]. Having good knowledge of patients’ needs and performing care adjusted to the individual patient is the essence of person-centred care, resulting in quality of care [ 33 ].…”

“…The way the work was organized and how tasks were divided between the staff on a daily basis had tremendous impact on the work situation. In a meta-synthesis, the striking findings were that healthcare professionals struggle to balance patients’ needs and the demands of the organization for efficiency [ 41 ]. It has been found that the healthcare professionals’ working conditions are important for quality of care [ 34 ].…”

“…It has been found that the healthcare professionals’ working conditions are important for quality of care [ 34 ]. Various organizational factors have been found to inhibit person-centred care, and nurses report that the pressured working conditions change the focus to more task-oriented care with emphasis on medical aspects rather than the humanity of care [ 41 , 45 ]. On the other hand, for the patients with less complex needs, short and task-oriented visits provide patients with an assurance that they can continue to live at home, and this could give them a smooth introduction to receiving help from home healthcare services [ 46 ].…”

Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals

“…Although the services are supposed to be holistic and involve the older persons and informal caregivers in decisions about their care, the participants instead described a predetermined clinical pathway with a lack of personal choices regarding both time and place of services, such as hospital discharge, IC services and home care. The patients and informal caregivers called for better information, continuity and predictability, while the HCPs experienced limited professional discretion and structural barriers in daily care to meeting the patients' needs and preferences [39][40][41][42][43][44][45][46][47][48][49][50]. Lilleheie et al stated that patients were commonly discharged from hospitals at an early stage, not always involved in decisions regarding the next level of care and subject to scant information reporting in a system not integrated thoroughly around a patient's own journey.…”

Hospital physicians’ experiences and reflections on their work and role in relation to older patients’ pathways - a qualitative study in two Norwegian hospitals

“…To contribute to a more seamless collaboration and communication across organizations and disciplines in healthcare Doessing and Burau [ 53 ] suggest that such boundaries should be eliminated. Olsen et al [ 54 ] found that healthcare providers experience a conflict between market and public management logics’ ideals of equality, standardization, and efficiency, and health care professionals’ ideals of individualized care. They emphasize the need for situated encounters to enable knowledge sharing between healthcare personnel at different healthcare levels, and also the importance of including older patient’s perspective on the pathway [ 55 ].…”