Investigating the attitudes of health-care professionals towards the use of integrated care pathways in a district general hospital: a thematic analysis of focus group discussion

Abstract

Context: Integrated care pathways (ICPs) are an increasingly common approach to the standardization and integration of health-care practice in the NHS. They delineate interdisciplinary critical decision points and evidence-based daily treatment regimens for patients in specific disease groups. ICP champions assert that they have the potential to decrease medical errors, increase the accuracy of data capture, increase the efficiency of personnel and ultimately improve the quality of patient care. Despite the theoretical benefits of ICP use, there was anecdotal evidence of staff unease and audit evidence of variable compliance with ICPs at a district general hospital (DGH). Objective: This focus group study was one of the three interdependent methodologies used to investigate the attitudes of health-care professionals towards ICPs in a DGH. It was anticipated that thematic analysis of the focus group discussion would facilitate further the interpretation of qualitative data already analysed in a previous phase of the project, and inform the development of a survey questionnaire investigating the attitudes of the health-care professionals towards ICPs. Design: Ten focus groups comprising on average, six health-care professionals were conducted. The staff involved included doctors, nurses, professions allied to medicine, a member of the Community Health Council and non-clinical managers. The focus groups included staff with a range of seniority and speciality. Results: Analysis of the data achieved facilitated the confirmation and identification of themes underpinning the focus group discussion. These are reported here and illustrated by representative quotations. Conclusion: The focus group study provided a valuable insight into the attitudes regarding ICPs of over 60 health-care professionals. The themes identified were used to facilitate the development of a survey questionnaire to explore them in a quantifiable way. Focus group methodology proved to be a useful way to explore emerging issues in depth, and to observe areas of disagreement among staff.