Design principles for patient flow improvement in care pathways: a paradox theory perspective

Purpose The patient flow performance achievable by care pathways is constrained by competing flow and resource efficiency, which can negatively impact improvements. This paper probes the divergence between resource and flow efficiency and how care pathways can lead to improved patient flow. By framing the problem through the lens of paradox theory, a set of design principles is proposed to assist decision-makers in care pathway implementation. Implications are derived for research and practice. Design/methodology/approach The authors used conceptual research to develop design principles for care pathways based on a systematic review of relevant care pathway research. The initial search contained 515 unique articles, resulting in a final sample of 56 studies. Findings When applying care pathways, patient flow may be negatively affected in relation to the dimensions of bottlenecks, non-value-adding activities, and variability. However, the findings also indicate methods that can be applied to manage organizational paradoxes, which can contribute to more efficient patient flow along each of the three dimensions. Research limitations/implications The study is limited to care pathways and therefore could have missed relevant studies in similar fields, such as care coordination. Practical implications Health care managers, politicians, and IT developers can apply the proposed design principles when developing, implementing, and improving care pathways and supporting technologies. Originality/value While existing research has studied care pathways from a medical perspective, this is the first paper to the author’s knowledge that addresses care pathways directly by considering paradox theory and in light of the operations management literature.