Loading...
Navigating value complexity in care pathway development: A qualitative case study
Visser,Mildred de Mul,Marleen Ahaus,Kees Weggelaar-Jansen,Anne Marie
Visser,Mildred
de Mul,Marleen
Ahaus,Kees
Weggelaar-Jansen,Anne Marie
Abstract
Objectives Care pathways (CPs) are widely used to standardise and improve healthcare delivery. However, CP development is often shaped by value (or normative) complexity. This study empirically explores how value complexity unfolds in a CP development programme. Design A qualitative single-case study was conducted as part of a 2-year action research programme. The study followed a ‘research-follow-action’ strategy, in which action and learning occurred during the programme phase, followed by retrospective analysis using Greenhalgh et al’s ‘rules of thumb’ as a reflective lens. Setting A Dutch specialised rehabilitation hospital (13 sites, 800 employees approximately, ~16 000 patients annually). In three CP development cycles, 11 multidisciplinary teams were guided in CP development in a quality collaborative approach. Participants 26 respondents participated in 44 reflective conversations; 19 respondents completed reflective questionnaires and 169 participatory observation reports were included. Participants were purposively sampled and included representatives from the leadership triad (rehabilitation physicians, managers and healthcare professionals) and members of senior management involved in CP development. Results Two overarching themes were identified: goal (mis)alignment and prolonged decision-making processes negatively impacted motivation and impeded CP development. Goal alignment between stakeholders was hindered by shifting organisational priorities, creating tensions between improving care quality and ensuring financial viability. Decision-making was challenged by role uncertainty and the complexities of multidisciplinary collaboration in CP development teams. Reflective dialogues, small-scale experimentation and financial modelling supported teams in navigating these tensions to varying degrees. Conclusions This study illustrates how value complexity unfolds in CP development and underscores the importance of ongoing stakeholder management, reflectivity, formative evaluation and dialogue. Greenhalgh et al’s rules of thumb provided interpretive value in exploring these complexities but require a solid theoretical understanding and an awareness of the rules’ interrelationships. A complexity-informed approach integrating ongoing reflection and adaptability can enrich CP development methodologies, enabling healthcare professionals and action researchers to engage constructively with value complexity in complex change processes. Further research is needed to develop and implement practical strategies for enhancing stakeholder engagement and decision-making in diverse healthcare settings.
Description
Date
2025-08
Journal Title
Journal ISSN
Volume Title
Publisher
Research Projects
Organizational Units
Journal Issue
Keywords
Citation
Visser, M, de Mul, M, Ahaus, K & Weggelaar-Jansen, A M 2025, 'Navigating value complexity in care pathway development : A qualitative case study', BMJ Open, vol. 15, no. 8, e098157. https://doi.org/10.1136/bmjopen-2024-098157