Conflicts and ambivalences: a case study of clinical pathways in Norway

Abstract

Without any introduction, I asked one of the doctors: ‘What do you think when you hear the word “clinical pathways”?’ Still working at his computer and not looking at me, he said with contempt: ‘I shiver!’

This article examines a significant contemporary feature of the increasing economic rationality in healthcare, and exemplifies this in the activity model: clinical pathways; further it argues that the role of emotions in developmental processes is often underestimated. Clinical pathways (CP) in Norway can be translated into something like ‘a treatment line’, although quite a few professionals associate this with ‘assembly lines’. The CP model facilitates a focus on patient welcoming in healthcare services, but is also associated by professionals with lower ranked values such as administration, documentation, logistics, standardization, measurements and ‘good enough’ service at minimum cost. This stands in contrast to traditional values such as autonomy, high professional practice, relational care and empathic attitudes, thus sharpening the contradictions between being a care versus a service worker. The article examines a multidisciplinary CP project and points to hidden and ambivalent emotions and opinions about CP that the informants never discuss in their project meetings. The hidden emotions never came to the surface, thereby functioning as an energy leak instead of a valuable dimension of developmental processes.

Keywords:

• multiprofessional interactions
• healthcare
• ambivalent emotions
• word meaning
• clinical pathways