What's in a care pathway? Towards a cultural cartography of the new NHS

Bibliographic Data

ID2265732
AuthorsRuth Pinder (0000-0002-7010-6009, Brunel University of London), Roland Petchey (City University), Sara Shaw (0000-0002-7014-4793, Queen Mary University of London), Yvonne Carter (University of Warwick)
Year2005
Volume27
Issue6
Pages759-779
Publication date2005-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSociology of Health & Illness (JOURNAL)
Journal identifiersISSN: 0141-9889 • E-ISSN: 1467-9566
PublisherWiley (PUBLISHER • GB)
DOI10.1111/j.1467-9566.2005.00473.x
PMID16283898
OpenAlexW2008558619
LanguageEN
Citations received33
References cited28

Maps are increasingly understood as socio-cultural and political constructs, rather than mirrors of nature. Drawing on the insights of cultural cartographers, this paper presents a critical analysis of a specific instance of map-making in health policy, namely the growing use of care pathways in care planning and service delivery. Widely regarded to date as devices for ensuring quality of care, equity of treatment, optimal resource allocation and a rational division of labour between healthcare professionals, they have been seen as helpful - and technically neutral - tools for routing patients through the system. By contrast, we argue that the metaphors are misleading: lived experience and its objectification in pathway maps continually re-create one another, as we explore the slippage between map, map-making and mapping. This paper is based on interviews and observations with a variety of healthcare workers in three areas of south eastern England. We trace the development of a series of pathways-in-process, and show how they configure the patient, highlighting some aspects of their experiences, whilst silencing others. We also analyse the role of pathways in the carving up and surveillance of space round the emergence of the 'hybrid professional', particularly new practitioners such as GP specialists, specialist nurses, extended scope therapists and others. In considering the wider implications of care pathways as part of the contemporary discourse on policy, the paper critiques the rationalist, and sometimes evangelical assumptions underpinning their current popularity. In particular, we suggest that a critical and processual understanding of pathways might contribute to a more informed appreciation of their potential (and their limitations) as mechanisms for healthcare policy implementation

Health care · Objectification · Political science · Politics · Popularity · Public relations · Scope (computer science · Sociology · Clinical practice guidelines implementation · Computer Science · Data Analysis and Archiving · Healthcare Quality and Management · Law · Psychology · Social Psychology

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