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Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals
- Source :
- International Journal of Integrated Care; Vol 18: July-September 2018; 5, International Journal of Integrated Care, International Journal of Integrated Care, Vol 18, Iss 3 (2018)
- Publication Year :
- 2018
- Publisher :
- Ubiquity Press, 2018.
-
Abstract
- Introduction: In response to increase of patients with complex conditions, policies prescribe measures for improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian hospitals that have proven challenging to implement. Methods: This qualitative study of policy documents employed a discourse analysis inspired by Carol Bacchi’s ‘What‘s the problem represented to be?’. We analysed six legal documents (2011–2016) and selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician roles in hospitals. Results: The ‘problem’ represented in the policies is lack of coherent pathways and lack of stable responsible professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts. System measures to support and orchestrate the individual patient’s pathway (e.g. resources, infrastructure) are scarcely addressed. Conclusions and Discussion: We suggest that the policies’ construction of the ‘problem’ as a responsibility issue, result in that neither diversity of patients’ coordination needs, nor heterogeneity of hospital contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways for patients with complex needs. © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
- Subjects :
- Health (social science)
Sociology and Political Science
Policy Paper
media_common.quotation_subject
Discourse analysis
coordinated care
03 medical and health sciences
0302 clinical medicine
continuity of care
Statutory law
Health service research
Political science
Moral responsibility
030212 general & internal medicine
Set (psychology)
media_common
integrated care
lcsh:R5-920
business.industry
030503 health policy & services
Health Policy
VDP::Medical disciplines: 700::Health sciences: 800
Public relations
Integrated care
VDP::Medisinske Fag: 700::Helsefag: 800
Rhetoric
care pathway
complexity
hospitals
lcsh:Medicine (General)
0305 other medical science
business
Diversity (politics)
Qualitative research
Subjects
Details
- Language :
- English
- ISSN :
- 15684156
- Database :
- OpenAIRE
- Journal :
- International Journal of Integrated Care (IJIC)
- Accession number :
- edsair.doi.dedup.....d382b106c2631d7613f6d43496148653