The social construction of care pathways : a nursing management initiative towards operationalising continuous quality improvement in a children's hospital
The literature is dominated by prescriptive accounts of the application of Continuous Quality
Improvement and care pathways in the acute hospital services sector. The authors assume
that the organisation is a designed artefact (Scapens, Otley and Lister, 1984): goals can be
This thesisr eports on the nature, processa nd consequenceso f a Nurse Manager introducing
care pathways in a Children's Hospital It believes, in opposition to the conventional view,
that the organisation is a culture. The actions and interactions of individuals and groups
shape initiatives. This is within context and within time.
The research investigation was conducted over a twenty-five month period, from February
1996 to April 1998. It was ethnographic in nature. Interviews were conducted with
managers, nurses and doctors, formal meetings and activity in the Children's Emergency
Department observed, and documentation collected. The findings are, however, presented
from the nurses' perspective using their words. Files for newspaper clippings were created
The thesis contributes to the literature in three ways. In the main, it represents the first
contextual and critical account of the implementation of care pathways than that believed to
be contained in the literature. Further, it purposefully utilises for the first time two
conceptualf rameworks in order to explicate the changep rocessesin the Children's Hospital.
These are Watson's (1994) Strategic Exchange Perspective and Dawson's (1994) Processual
Framework. It presents the descriptive part of the findings in the form of a narrative.
The Nurse Manager established a project to multiskill experienced nurses in the diagnosis
and treatment of minor conditions using care pathways as the vehicle. Her role changed
during the process of implementation, but the project had little, if no, impact on power
structures between and decision making of doctors and nurses