TitleLost in translation? 'Evidence' and the articulation of institutional logics in integrated care pathways: from positive to negative boundary object?
Published journalSociology of Health & Illness
This article examines the translation of a clinical governance concept – integrated care pathways (ICPs) – into an infrastructural technology. Building on previous work, the application of boundary object theory is extended in this article to argue that stakeholder enrolment in pathway methodology may be less thoroughgoing than originally assumed. Pathways have effectively aligned management and nursing interests around a quality agenda and nurses have emerged as the leaders in this field, but doctors have rather lower levels of engagement. It is suggested that the contradictory logics inherent in pathway philosophy (primarily as these relate to ‘evidence’) and the social organisation of ICP development foster a transformation of the concept when this is translated into the technology, creating a negative boundary object from the perspective of doctors. Medicine is a powerful actor in health care, which is consequential for whether pathways, as designated boundary objects, become boundary objects-in-use. It also has implications for the diffusion of the concept as a mechanism of clinical governance and the credibility of nurses as emergent leaders in this field. Qualitative case studies of ICP development processes undertaken in the UK National Health Service and ethnographic research on the ICP community provide the empirical foundations for the analysis.
You might also like...
The decisions we make about technology today will have implications for the entire social care system, says Lydia Nicholas, f...
The NHS’s new AI lab needs to focus on the needs of patients and the health system, argue Adam Steventon, Sarah Deeny, Josh K...
Jennifer Dixon asks how the NHS Long Term plan can support efforts to reduce emergency admissions from care homes.
A lack of secure and affordable housing is just one of the barriers young people face growing up. Read our late…
Work with us
We look for talented and passionate individuals as everyone at the OnlyWan has an important role to play.View current vacancies
The Q Community
Q is an initiative connecting people with improvement expertise across the UK.Find out more