In 2015, a decision was made to implement clinical pathways in Norwegian mental health services. The idea was to construct pathways similar to those used in cancer treatment. These pathways are based on diagnosis and evidence-based medicine and have strict timeframes for the different procedures. The purpose of this article is to provide a thorough examination of the formulation of the pathway “mental illness, adults” in Norwegian mental health services. In recent decades, much research has examined the implementations and outcomes of different mental health sector reforms and services in Western societies. However, there has been a lack of research on the process and creation of these reforms and/or services, particularly how they emerge as constructs in the contexts of policy, profession and practice. A qualitative single case study design was employed. A text and document analysis was performed in which 52 articles and opinion pieces, 30 public hearing responses and 8 political documents and texts were analysed to identify the main actors in the discourse of mental health services and to enable a replication of their affiliated institutional logics and their views concerning the clinical pathway. Additionally, ten qualitative interviews were performed with members of the work group responsible for designating the pathway “mental illness, adults”. This article shows how the two main actor groups, “Mental health professionals” and “Politicians”, are guided by values associated with a specific logic when understanding the concept of a clinical pathway (CP). The findings show that actors within the political field believe in control and efficiency, in contrast to actors in mental health services, who are guided by values of discretion and autonomy. This leads to a debate on the concept of CPs and mental health services. The discussion becomes polarized between concern for patients and concern for efficiency. The making of the pathway is led by the Directorate of Health, with health professionals operating in the political domain and who have knowledge of the values of both logics, which were taken into consideration when formulating the pathways, and explains how the pathway became a complex negotiation process between the two logics and where actors on both sides were able to retain their core values. Ultimately, the number of pathways was reduced from 22 to 9. The final “Pathway for mental illness, adults” was a general pathway involving several groups of patients. The pathway explains the process from diagnosis through treatment and finalizing treatment. The different steps involve time frames that need to be coded, requiring more rigid administrative work for compliance, but without stating specific diagnostic tools or preferred treatment strategies. This article shows that there is also a downside of having sense making guided by strong values associated with a specific institutional logic when constructing new, and hopefully better, mental health care services. This article demonstrates how retaining values sometimes becomes more crucial than engaging in constructive debates about how to solve issues of importance within the field of mental health care.

中文翻译：

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组织谈判：挪威精神卫生服务路径的构建


2015年，挪威决定在精神卫生服务中实施临床路径。这个想法是构建类似于癌症治疗中使用的途径。这些途径基于诊断和循证医学，并对不同程序有严格的时间表。本文的目的是对挪威精神卫生服务中“精神疾病，成人”路径的制定进行彻底审查。近几十年来，大量研究考察了西方社会不同精神卫生部门改革和服务的实施情况和成果。然而，缺乏对这些改革和/或服务的过程和创建的研究，特别是它们如何在政策、专业和实践背景下作为结构出现。采用定性单一案例研究设计。进行了文本和文件分析，其中分析了 52 篇文章和观点、30 份公开听证会答复以及 8 份政治文件和文本，以确定精神卫生服务话语中的主要参与者，并能够复制其附属机构逻辑和他们对临床路径的看法。此外，我们还对负责指定“成人精神疾病”路径的工作组成员进行了十次定性访谈。本文展示了两个主要参与者群体“心理健康专业人员”和“政治家”在理解临床路径 (CP) 概念时如何受到与特定逻辑相关的价值观的指导。研究结果表明，政治领域的参与者相信控制和效率，而精神卫生服务领域的参与者则以自由裁量权和自主权价值观为指导。 这引发了关于 CP 和心理健康服务概念的争论。讨论在对患者的关注和对效率的关注之间变得两极分化。该途径的制定由卫生局领导，卫生专业人员在政治领域运作，了解这两种逻辑的价值观，在制定途径时考虑了这两种逻辑，并解释了该途径如何成为一个复杂的途径两种逻辑之间的谈判过程，以及双方参与者能够保留其核心价值观的过程。最终，路径数量从 22 条减少到 9 条。最终的“成人精神疾病路径”是一条涉及多组患者的通用路径。该路径解释了从诊断到治疗再到最终治疗的过程。不同的步骤涉及需要编码的时间框架，需要更严格的行政工作以确保合规性，但没有说明具体的诊断工具或首选治疗策略。本文表明，在构建新的、希望更好的精神卫生保健服务时，以与特定制度逻辑相关的强烈价值观为指导的意义建构也有一个缺点。本文展示了保留价值观有时比参与如何解决精神卫生保健领域重要问题的建设性辩论更为重要。