Trust in pathways? Professionals’ sensemaking of care pathways in the Norwegian mental health services system

Abstract

Background In January 2019, care pathways within specialist mental health and substance abuse treatment services were officially launched in Norway. The care pathway introduced timeframes for assessment and treatment, allowing a maximum of 6 weeks to finish assessment and provide the patient with a diagnosis, in addition to allowing a maximum of 6 weeks from diagnosis to the first evaluation. The different action points required coding. The system was based on goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, improvement of equal access to services regardless of geographic location, and increased emphasis on physical health and lifestyle. The purpose of our study was to examine how mental health professionals made sense of care pathways and furthermore, how issues of trust affected the process of implementation. Methods Our multiple case study included four outpatient clinics for adults in four community mental health centres (CMHCs) in different parts of Norway. Qualitative data were collected through in-depth individual and focus group interviews and analysed using systematic text condensation. The informants were treatment personnel and leaders in four different outpatient clinics for adults. Results The results indicated four distinct themes or reactions to the care pathway and its implementation: 1) lack of clarity regarding the overall goals and content of the care pathway; 2) the increased burden of coding, registration and administrative work, which professionals experienced as a stressor; 3) an IT and medical record system that did not correspond to the coding of the care pathway; and 4) an unrealistic distinction between assessment and treatment. These themes/reactions increased the health professionals’ distrust towards the care pathway, and a process of sensemaking encouraged them to reduce the importance of the care pathway system and its implementation. Conclusion Theories of trust help in understanding how mental health professionals interpret care pathway implementation. Distrust and resistance towards the care pathways overshadow some of the overall quality goals of the care pathway, a view that was indeed shared by mental health professionals.

Supported decision‐making interventions in mental healthcare: A systematic review of current evidence and implementation barriers

“…Distrust has been identified as a key barrier for other new interventions in the mental healthcare field. For example, Tørseth and Ådnanes 104 found that in the implementation of a new care pathway approach to mental health services in Norway, distrust by clinicians played a considerable role in creating resistance to the adoption of the new approach. Similarly, for service users, distrust has been identified as a key barrier in mental healthcare, where coercion 105 and the fear of negative consequences as well as lack of fairness, transparency and accountability 89 impact on a service user's trust in their care provider and the system.…”

Perspectives on Coordinating Health Services for Individuals with Serious Mental Illness – A Qualitative Study

“…This view seems consistent with another study that documents how patient pathways have increased the burden of administrative work and reduced the professionals’ time dedicated to treatment and care. 45 In addition, there is a lack of clarity regarding the overall goals and contents of the pathways.…”

Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta‐analysis

“…Clinical nursing pathway refers to the nursing mode of patients during hospitalisation, which is a schedule planner made for patients with the horizontal axis of time and the vertical axis of nursing means such as admission guidance, assessment and diagnosis, examination and medication, treatment and nursing care, dietary guidance and health education. 5 In recent years, there have been more and more studies on the application of clinical nursing pathway in the perioperative period of knee and hip arthroplasty, but there is a lack of relevant comprehensive evidence to support it. We therefore conducted this study to investigate the effect of clinical nursing pathway applied to knee or hip arthroplasty patients on their postoperative wound infection, pain and complications via meta‐analysis, so as to provide an effective evidence‐based basis for clinical work.…”

“…As a new nursing model, clinical nursing pathway can clarify the strictness and accuracy of nursing work, reduce the blindness and arbitrariness in nursing work, improve the quality of nursing care, and standardise the role of medical behaviour. Clinical nursing pathway refers to the nursing mode of patients during hospitalisation, which is a schedule planner made for patients with the horizontal axis of time and the vertical axis of nursing means such as admission guidance, assessment and diagnosis, examination and medication, treatment and nursing care, dietary guidance and health education 5 . In recent years, there have been more and more studies on the application of clinical nursing pathway in the perioperative period of knee and hip arthroplasty, but there is a lack of relevant comprehensive evidence to support it.…”