The role of programmed and emergent mechanisms of coordination: How standardized care pathways contribute to coordinate care tasks in hospitals

Hospitals face substantial coordination challenges. To meet this hospitals more and more use standardized work processes such as care pathways. By drawing on recent coordination theory that increasingly emphasizes the role of lateral and emergent interactions alongside traditional, programmed mechanisms of coordination, this paper finds that standardized work processes such as care pathways should be considered as a bundle of coordination mechanisms—plans and rules, objects, routines, roles and proximity—rather than a mechanism of its own. The bundle builds the accountability, predictability and common understanding needed to coordinate standardized care tasks. The analysis lends theoretical insights to the traditional view that see standardized work processes as programmed processes. For health care workers who design, implement and use care pathways to solve care tasks, the analysis calls attention to identify and reinforce those underlying mechanisms. This provides solutions to deal with the fundamental challenge of care coordination in hospitals. The research builds on an in-depth, embedded case study of hospital care pathways. Care pathways are particularly interesting because they mirror standardized work processes, but research also finds that they foster relational coordination. This suggests that standardized work processes could rely on both programmed and emergent mechanisms of coordination.