Mind the Differences: How Diagnoses and Hospital Characteristics Influence Coordination in Cancer Patient Pathways

Per Magnus Mæhle, Ingrid Kristine Small Hanto, Victoria Charlotte Simensen and Sigbjørn Smeland
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Per Magnus Mæhle: Department 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
Victoria Charlotte Simensen: Department of Research Support-Clinical Trial Unit (CTU), Oslo University Hospital, 0424 Oslo, Norway
Sigbjørn Smeland: Comprehensive Cancer Centre, Division of Cancer Medicine, Oslo University Hospital, 0450 Oslo, Norway

IJERPH, 2021, vol. 18, issue 16, 1-25

Abstract: Integrated care pathway (ICP) is a prevailing concept in health care management including cancer care. Though substantial research has been conducted on ICPs knowledge is still deficient explaining how characteristics of diagnose, applied procedures, patient group and organizational context influence specific practicing of ICPs. We studied how coordination takes place in three cancer pathways in four Norwegian hospitals. We identified how core contextual variables of cancer pathways affect complexity and predictability of the performance of each pathway. Thus, we also point at differences in core preconditions for accomplishing coordination of the cancer pathways. In addition, the findings show that three different types of coordination dynamics are present in all three pathways to a divergent degree: programmed chains, consultative hubs and problem-solving webs. Pathway coordination also depends on hierarchical interaction. Lack of corresponding roles in the medical–professional and the administrative–institutional logics presents a challenge for coordination, both within and between hospitals. We recommend that further improvement of specific ICPs by paying attention to what should be standardized and what should be kept flexible, aligning semi-formal and formal structures to pathway processes and identify the professional cancer related background and management style required by the key-roles in pathway management.

Keywords: cancer patient pathways; integrated care pathways; cancer care; coordination; breast cancer; colorectal cancer; ovarian cancer (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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