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Road to Nowhere? A Critical Consideration of the Use of the Metaphor ‘Care Pathway’ in Health Services Planning, Organisation and Delivery

Published online by Cambridge University Press:  24 May 2019

KATH CHECKLAND Open the ORCID record for KATH CHECKLAND [Opens in a new window] ,
JON HAMMOND ,
PAULINE ALLEN ,
ANNA COLEMAN ,
LYNSEY WARWICK-GILES ,
ALEX HALL ,
NICHOLAS MAYS  and
MATT SUTTON
KATH CHECKLAND
Affiliation:
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK email: Katherine.checkland@manchester.ac.uk
JON HAMMOND
Affiliation:
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK email: jonathan.hammond@manchester.ac.uk
PAULINE ALLEN
Affiliation:
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK email: pauline.allen@lshtm.ac.uk
ANNA COLEMAN
Affiliation:
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK email: anna.coleman@manchester.ac.uk
LYNSEY WARWICK-GILES
Affiliation:
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK email: lynsey.warwick-giles@manchester.ac.uk
ALEX HALL
Affiliation:
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK email: alex.hall@manchester.ac.uk
NICHOLAS MAYS
Affiliation:
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK email: nicholas.mays@lshtm.ac.uk
MATT SUTTON
Affiliation:
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK email: matt.sutton@manchester.ac.uk
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Abstract

Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring ‘practice languages’ is important in understanding how policy is enacted. This paper contributes to the literature exploring the generative nature of metaphors in policy implementation, demonstrating their role in not just describing the world, but also framing it, determining what is seen/unseen, and what solutions seem possible. The metaphor ‘care pathway’ is ubiquitous and institutionalised in healthcare. We build upon existing work critiquing its use in care delivery, and explore its use in health care commissioning, using evidence from the recent reorganisation of the English NHS. We show that the pathways metaphor is ubiquitous, but not necessarily straightforward. Conceptualising health care planning as ‘designing a pathway’ may make the task more difficult, suggesting a limited range of approaches and solutions. We offer an alternative metaphor: the service map. We discuss how approaches to care design might be altered by using this different metaphor, and explore what it might offer. We argue not for a barren language devoid of metaphors, but for their more conscious use.

Keywords

care pathwayshealth system changecommissioningmetaphorservice designpolicy implementation
Type
Article
Information
Journal of Social Policy , Volume 49 , Issue 2 , April 2020 , pp. 405 - 424
Copyright
© Cambridge University Press 2019

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