Sammendrag
Introduction: In response to increase of patients with complex conditions, policies prescribe measures for
improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian
hospitals that have proven challenging to implement.
Methods: This qualitative study of policy documents employed a discourse analysis inspired by Carol
Bacchi’s ‘What‘s the problem represented to be?’. We analysed six legal documents (2011–2016) and
selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician
roles in hospitals.
Results: The ‘problem’ represented in the policies is lack of coherent pathways and lack of stable responsible
professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed
solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts.
System measures to support and orchestrate the individual patient’s pathway (e.g. resources, infrastructure)
are scarcely addressed.
Conclusions and Discussion: We suggest that the policies’ construction of the ‘problem’ as a responsibility
issue, result in that neither diversity of patients’ coordination needs, nor heterogeneity of hospital
contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric
from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways
for patients with complex needs.
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