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Related Experiment Video

Updated: Sep 11, 2025

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Navigating value complexity in care pathway development: a qualitative case study.

Mildred Visser1, Marleen de Mul2, Kees Ahaus2

  • 1Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands visser@eshpm.eur.nl.

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Summary

Value complexity in healthcare delivery hinders care pathway (CP) development by causing goal misalignment and prolonged decision-making. Addressing these requires ongoing stakeholder management and adaptable strategies for effective healthcare improvement.

Keywords:
Change managementDelivery of Health Care, IntegratedHealth ServicesQUALITATIVE RESEARCHQuality ImprovementQuality in health care

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Area of Science:

  • Healthcare Management
  • Health Services Research
  • Organizational Behavior in Healthcare

Background:

  • Care pathways (CPs) are crucial for standardizing healthcare delivery but their development is often complicated by value (or normative) complexity.
  • Understanding how value complexity influences CP development is essential for improving healthcare processes.

Purpose of the Study:

  • To empirically explore the unfolding of value complexity within a care pathway development program.
  • To identify challenges and facilitators in CP development influenced by competing values and stakeholder dynamics.

Main Methods:

  • A qualitative single-case study employing an action research strategy over two years.
  • Retrospective analysis using established 'rules of thumb' for reflection.
  • Data collection included reflective conversations, questionnaires, and participatory observation reports from 26 respondents across 11 multidisciplinary teams in a specialized rehabilitation hospital.

Main Results:

  • Goal (mis)alignment and protracted decision-making processes significantly impeded motivation and CP development.
  • Tensions between enhancing care quality and ensuring financial viability, alongside role uncertainty in multidisciplinary teams, challenged decision-making.
  • Reflective dialogues, experimentation, and financial modeling offered partial support in navigating these complexities.

Conclusions:

  • Value complexity significantly impacts CP development, highlighting the need for continuous stakeholder management, reflectivity, and dialogue.
  • Greenhalgh et al.'s rules of thumb offer interpretive value but require theoretical grounding and awareness of interrelationships.
  • A complexity-informed approach integrating reflection and adaptability can enhance CP development methodologies for constructive engagement with complex change processes in healthcare.