Care pathways: an ethnographic description of the field

This paper describes an ethnographic study of the care pathway community. Qualitative data generated through attendance at the annual care pathways conference and a regional group network are assembled in order to present an interpretation of the spread of pathways across the health-care field and identify the stakeholders involved, as well as their interests, aspirations and alignments. The growing popularity of care pathway methodology can be explained by its effectiveness in reconciling clinical and management interests in offering a single solution to shared health service problems. However, this breadth of appeal disguises tensions between clinical and management agenda which creates challenges in inscribing this multiplicity of interests into the pathway design. This helps to explain the challenges of pathway development and the range of interventions to which the term ‘pathway’ is applied. In a second, companion paper, I consider how the community has responded to these concerns and draw on social sciences concepts to offer an alternative approach