Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz Standards

Per Magnus Mæhle, Ingrid Kristine Small Hanto and Sigbjørn Smeland
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Per Magnus Mæhle: Institute of Health and Society, Faculty of Medicine, University of Oslo, 0314 Oslo, Norway
Ingrid Kristine Small Hanto: Comprehensive Cancer Centre, Division of Cancer Medicine, Oslo University Hospital, 0450 Oslo, Norway
Sigbjørn Smeland: Comprehensive Cancer Centre, Division of Cancer Medicine, Oslo University Hospital, 0450 Oslo, Norway

IJERPH, 2020, vol. 17, issue 24, 1-32

Abstract: The goal of coordinating pathways for cancer patients through their diagnostic and treatment journey is often approached by borrowing strategies from traditional industries, including standardization, process redesign, and variation reduction. However, the usefulness of these strategies is sometimes limited in the face of the complexity and uncertainty that characterize these processes over time and the situation at both patient and institutional levels. We found this to be the case when we did an in-depth qualitative study of coordination processes in patient pathways for three diagnoses in four Norwegian hospitals. What allows these hospitals to accomplish coordination is supplementing standardization with improvisation. This improvisation is embedded in four types of emerging semi-formal structures: collegial communities, networks, boundary spanners, and physical proximity. The hierarchical higher administrative levels appear to have a limited ability to manage and support coordination of these emerging structures when needed. We claim that this can be explained by viewing line management as representative of an economic–administrative institutional logic while these emerging structures represent a medical–professional logic that privileges proximity to the variation and complexity in the situations. The challenge is then to find a way for emergent and formal structures to coexist.

Keywords: integrated care pathways; cancer care; coordination; uncertainty; complexity standardization; improvisation; professional communities; professional networks; boundary spanners (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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