Expansive learning during a care pathway revision process – an analysis of discourse in an interprofessional change laboratory intravention

Studies in Continuing Education, pp. 1–26

Abstract

Patients with complex chronic conditions require integrated care provided by professionals who collaborate across the boundaries of various organisations. To guide complex care, medical professionals establish care pathways described in Collaborative Patient Care Agreement (CPCA). We studied the process of establishing a CPCA for patients with heart failure as a Change Laboratory ‘intravention’. We collected discourse data from four meetings. We analysed data using a coding framework identifying discursive manifestations of contradictions and steps of the expansive learning cycle. We compared the discourse with the final CPCA-document, their agreed new collaborative patient care. Discursive manifestations of contradictions arose and participants regularly followed the steps of expansive learning during care pathway negotiations. The final CPCA describes three phases. The changing needs of the patients (object) were underestimated given limited appropriate representation of the patients’ perspective in later phases. Additionally, the required professionals (subjects) needed to achieve a suitable level of multivoicedness were not always invited, resulting in unresolved tensions. Our results are significant for those involved in change processes, where collaborating professionals from multiple organisations redefine existing responsibilities and define new responsibilities for future collaborative work. We advocate for more differential involvement of patients and professionals with diverse relevant perspectives.

Authors 6

1. Loes Meijer corresponding

   Utrecht University

   Affiliation as printed

   Utrecht University

2. Roger A M J Damoiseaux

   Utrecht University

   Affiliation as printed

   Utrecht University

3. Margot Barry

   Utrecht University

   Affiliation as printed

   Utrecht University

4. Vera V. Vinck Aachen

   Leiden University

   Affiliation as printed

   Leiden University

5. François Schellevis

   Netherlands Institute for Health Services Research

   Affiliation as printed

   Nivel (Netherlands Institute for Health Services Research)

6. Esther DE GROOT

   Utrecht University

   Affiliation as printed

   Utrecht University