Road to Nowhere? A Critical Consideration of the Use of the Metaphor 'Care Pathway' in Health Services Planning, Organisation and Delivery
Author
Checkland, K; Hammond, J; Allen, P; Coleman, A; Warwick-Giles, L; Hall, A; Mays, N; Sutton, MDate
2020-04-01Source Title
Journal of Social PolicyPublisher
Cambridge University Press (CUP)University of Melbourne Author/s
Sutton, MatthewAffiliation
Melbourne Institute of Applied Economic and Social ResearchMetadata
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Journal ArticleCitations
Checkland, K., Hammond, J., Allen, P., Coleman, A., Warwick-Giles, L., Hall, A., Mays, N. & Sutton, M. (2020). Road to Nowhere? A Critical Consideration of the Use of the Metaphor 'Care Pathway' in Health Services Planning, Organisation and Delivery. Journal of Social Policy, 49 (2), pp.405-424. https://doi.org/10.1017/S0047279419000400.Access Status
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https://researchonline.lshtm.ac.uk/id/eprint/4652639/1/checkland_etal_2019_Road%20to%20nowhere.pdfAbstract
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.
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