Investigation into coordinating dependencies between care pathways within mental healthcare: A qualitative case study and pilot testing of a new theoretical framework

Introduction
Aiming to improve quality of care and reduce costs, mental healthcare organizations implemented care pathways. These pathways have mostly been evaluated as single entities. However, evidence suggests that improvements in individual pathways do not necessarily lead to better performance within the whole care process due to dependencies between pathways. Limited empirical research has been devoted to this theme. The aim of this study was to examine how departments coordinate dependencies between pathways, to discern types of coordination used and to construct a theoretical framework.
Methods
In a comparative case study of three departments within two mental healthcare organizations, 27 employees were interviewed on the subject of coordination of pathways. A document review was performed to gain general insights into the departments and their pathways. Interviews were transcribed and analyzed using content analysis, based on criteria derived from the theoretical framework. The cases were compared through pattern analysis.
Results
Findings indicate a lack of awareness among team members regarding the theoretical pathway structure within their department and that all departments deployed a function or system to monitor coordination practices. Within the departments, flow dependencies were found. Although departments coordinated pathways differently, these mostly were horizontal and programmed in nature.
Discussion
The findings suggest more explicit and structured communication about pathways can be helpful in organizations. Also, outcomes were better if coordination was monitored. Further research is warranted to verify and evaluate the preference for horizontal and programmed ways of coordinating pathway dependencies within mental healthcare.