Abstract
A vital part of standardised care pathways is the possibility to measure performance through different indicators - for example, codes. In this article, based on interviews with health personnel in a project evaluating the introduction of standardised cancer patient pathways (CPPs) in Norway, we explore the specific types of work involved when health personnel produce codes as (intended) signifiers of quality. All the types of work are dimensions of what we define as accountability work - work health personnel do to make the codes signifiers of quality of care in the CPP.Codes and coding practices raise questions of what quality of care represents and how it could and should be measured. Informants in our study advocate for coding as important work for the patient more than for 'the system'. This shows how organising for quality becomes a crucial part of professional work, expanding what it means to perform high quality care.
Highlights
Standardisation of care processes, for example through standardised care pathways, represents a common feature of modern healthcare
Aiming to make a contribution in this respect, in this article, based on interviews with health personnel in a project evaluating the introduction of standardised cancer patient pathways (CPPs) in Norway, we explore the specific types of work involved when health personnel produce codes as signifiers of quality
We have explored the specific types of work health personnel perform when they produce codes as signifiers of quality of care in the CPP
Summary
Standardisation of care processes, for example through standardised care pathways, represents a common feature of modern healthcare. A vital part of many care pathways is the possibility to measure performance through different indicators – for example, codes These codes can be made available to managers, politicians, the media and the public, implying that clinics and hospitals can be scrutinised and compared, and made accountable. Health personnel responsible for coding enter specific, standardised codes, usually in the electronic patient record, indicating the start/completion for each phase in the pathway These codes are comprised in the two main performance goals stated by the Norwegian Directorate of Health: 70% of all cancer patients should be part of a CPP (code OA1), and 70% of all the patients in the CPPs should be taken care of within the indicated maximum timeframes (code OF4). The reporting of accountability is important for further action and interaction between the different actors (for example between health personnel in the care pathway), and involves work (Strauss, 1985). Following Rose (1999), this means that coding shapes the process that is to be audited: cancer care itself
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