Care pathways as boundary objects between primary and secondary care: Experiences from Norwegian home care services

Abstract

The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services.

Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts

“…Coordination technologies apply evidence‐based guidelines to the organization of care for specific conditions in order to improve quality and safety. We included three papers on coordination technologies (see Table 1): a systematic review of the effectiveness of integrated care pathways, 89 qualitative research of a care pathway to integrate primary and secondary care, 90 and a historical account and policy analysis of “chains of care.” 6 …”

Facilitating holistic continuity of care for older patients: Home care nurses’ experiences using checklists

“…According to Gawande (), checklists must be designed to turn on individuals’ brains, not turn them off. However, considering that using well‐designed checklists enables nurses to adhere to more evidence‐based approaches (Laurence & Lynn, ) and use language with increased precision to communicate (Haaland et al, ), the checklists could also represent a supplement to their professional competence and clinical glance. Further efforts to develop checklists should be aware of these precautions to ensure that staff maintain or increase their professional competence and independence.…”

“…However, considering that using well-designed checklists enables nurses to adhere to more evidence-based approaches (Laurence & Lynn, 2013) and use language with increased precision to communicate (Haaland et al, 2015), the checklists could also represent a supplement to their professional competence and clinical glance.…”

What matters when asking, “what matters to you?” — perceptions and experiences of health care providers on involving older people in transitional care

“…Previous research on patient involvement in transitional care has revealed that older patients experience a lack of participation during transitions [8][9][10][11]. Transitional care is also characterized by the challenges of coordinating care across organizational and disciplinary boundaries, managing conflicting goals of care, which may be stressful for health care providers (HCPs) [12][13][14]. Dyrstad et al [8] found that the focus on efficiency and time constraints affected patient involvement negatively, and practices were often task-oriented instead of patientoriented.…”