Changing Practices for an Innovative Care Pathway, the Mediating Role of the Coordinator

ABSTRACT

Getting professionals who have been selected and trained to perform individually to work together is a major challenge. The objective of the article is to identify the mechanisms by which a coordinator can ensure a mediation and boundary spanning role to enable the achievement of a project. Adopting a comprehensive approach, this article is based on the case of an innovative hospital project ‘One-Day Diagnosis’ (1DD) – one day instead of several weeks – of hepatobiliary and pancreatic pathologies, for which the professionals had to change their practices. Based on the results of the study, the findings show that the mediating role of the coordinator consists in making things happen and guiding health care professionals through the innovative pathway until it becomes a routine process. The study contributes to the literature on collaboration and relational coordination by highlighting that the change of practices for collaboration is compatible with personal excellence, by outlining the active role of the boundary spanner in the change of these practices and by demonstrating that the organizational stability of projects based on disembodied procedures is a necessary illusion that requires complementary interindividual relationships and a living leadership.

MAD statement

Extending the understanding of the ways to get individual performers to work together, the study highlighted how the change of health care professionals’ practices is helped by the coordinator, a boundary spanner who makes things happen and accompanies the innovative pathway until its routinization. The study shows that collaboration is possible without giving up personal excellence and that the processual stability aim is an illusion which requires complementary interindividual relationships and a living leadership.

KEYWORDS:

• Coordinator
• one-day diagnosis
• care pathway
• relational coordination
• innovation

Acknowledgements

We would like to thank the FastPath team (Integrated Health Solutions, Medtronic) for their help in conducting this study. We are also grateful to the interviewees of this study, members of the French University Hospital and Institute of Strasbourg. This study wouldn’t have been possible without the active participation of all the above-mentioned people.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki. Ethical review and approval were waived for this study as it is routine.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Additional information

Funding

This work was supported by French state funds managed within the ‘Plan Investissements d’Avenir’ and by the ANR (reference ANR-10-IAHU-02).