Perceptions on the development and implementation of a care pathway for people with schizophrenia
There has been a concerted effort to enable a managed response to the delivery of mental health care. This has been made through various Government in initiatives such as'general management and clinical audit. Methods have developed,such as a care pathway to control the way care is delivered along planned treatment trajectories. In this qualitative study the researcher explored h ow respondent so n a psychiatric ward and community team developed a care pathway for people suffering from schizophrenia, including the process of admission and discharge from hospital. Findings from this study showed that respondents argued for the individuality of the patient in shaping the way care should be delivered. Individual clinician-patient relationships and the unpredictable nature of schizophrenia were also important factors. Other respondents pointed out that some aspects of the systems of care could and should be standardised such as the procedures for finding accommodation upon discharge. The difficulty in describing the process of care influenced perceptions of evidenced-based are. On the whole, respondents were in agreement with the necessity to use evidence to drive the delivery of care. The purpose of a care pathway is to work in a coordinated way and this is reliant on knowing how interventions are known to work. Findings from this study demonstrated that clinicians were not always aware of how or why they carried out psychiatric interventions. Over the span of time covered by the study, while the care pathway was being developed and implemented, various external factors had a significant influence. Particularly influential was the rapid turnover of staff on the study ward and the impact this had on motivation for developing and implementing the care pathway. Important too were the approaches taken by the researcher and how the respondents perceived this. These finding are relevant for other health service areas that employ large numbers of temporary staff and staff groups that feel disenfranchised by managerial approaches. Using a care pathway to deliver care has implications for the training of all discipline members and for the way they work together. Ultimately, the acceptance of a care pathway for psychiatric services will be influenced by the way in which they are perceived by clinicians and managers, each of whom have different interests to be served.