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PurposeThis paper aims to explore how healthcare organizations in Denmark transform modern ideas of patient‐centred preventive care into organizational practice. Specific attention is given to the influence of existing organizational practices.Design/methodology/approachA qualitative multiple case study design is used to explore "motivational interviewing", a health behaviour concept that was introduced in preventive consultations in ten Danish clinics. From an institutional perspective, the concept may be understood as an "organizational recipe" that translates into organizational activities. Data are generated by observations, interviews and document reviews. Theory and data provide the framework for an analytical phase model.FindingsThe paper reveals how abstract ideas on preventive care translate into specific activities in organizations following pre‐existing, general rules of medical practice. Disparities between clinics are related to distinctive local practices, such as clinics' conditions and preventive treatment practices that form local sets of editing rules. Differences in clinic performances result in variations in achieving the ideal of patient‐centred, preventive care prescribed by motivational interviewing.Research limitations/implicationsIt is acknowledged in medical practice that there are different conceptions of the ideal of preventive care. The paper points to the value of promoting transparency in clinical practice and of paying attention to the mismatch between external expectations and organizational capabilities.Originality/valueThe paper adds to the understanding of organizational dynamics at the micro‐level.

PurposeThis paper seeks to take a patient‐centred perspective in exploring the treatment of multiple and chronic illnesses in inter‐organizational care practice in Finland.Design/methodology/approachThe theoretical approach of the study is based on the sociology of translation and on cultural historical activity theory. The methodology of multi‐locale ethnography is used to research the translations in one patient's healthcare procedures in multiple care settings.FindingsThe care procedures emerge as unintegrated for the patient in the study. The patient has to take responsibility for his overall care since the medical professionals involved have only limited knowledge of other providers' care procedures. Despite their efforts to collaborate, professionals are lost in translation across healthcare boundaries.Research limitations/implicationsSingle cases are problematic for advancing generalizations on a research topic. The case of this study presents an example of the translations in the care procedures for a patient with multiple and chronic illnesses.Practical implicationsUnintegrated care organization poses a difficult challenge to patient‐centred care if the ideals of consumerism are followed in the health care system. A patient, with limited medical knowledge, may not be able to master an overall pattern of chronic illness care in a sustainable way. Better management and coordination of specialized knowledge are required for patients with chronic illnesses.Originality/valueIn contrast with the many studies that report on patients' experiences of illness, the paper provides new insights into the patient experience of health care organization.

PurposeThis study seeks to challenge the notions of the standardized care pathway and patient‐centred care, both of which provide only a partial view of care as a complex system. In exploring and contrasting the care pathway protocol and an actual care pathway, the study aims to analyze the conceptualizations of care that actors involved in the actual care pathway have. The study makes suggestions on how to expand care pathways and thereby improve patient care.Design/methodology/approachA care pathway protocol is contrasted with the actual care pathway of a patient at a university hospital in Finland. Observational ethnography is combined with a narrative approach and activity‐theoretical ideas.FindingsThe study depicts the gap between the care pathway protocol and an actual care pathway. The actual care pathway, rather than being a clear‐cut process, is ruptured and unpredictable. The conceptualizations of care (i.e. care‐objects) held by the doctors, nurses and the patient were fragmented and clashed in their practical work activity. The main message to hospital management is that in order to expand care pathways, the multiple care‐objects need to be placed in constructive interplay.Research limitations/implicationsA single actual care pathway is presented and the results are interpreted accordingly.Originality/valueThe study explores the idea of a care pathway and patient‐centred care in the analysis of care‐objects. A new discursive model is introduced that places different care‐objects into interplay and opens up the possibilities for the expansion of care pathways.

PurposeOne prominent translation of patient‐centred care is public sector consumerism by which patients may influence the services provided by acting like consumers. The focus of this study is the extent to which technological devices in national public healthcare portals in the UK and three Nordic countries transform patients so that they can act as healthcare consumers.Design/methodology/approachThe paper applies a comparative case study methodology.FindingsAs national healthcare portals, Norway's technological devices, to some extent, and the devices in the UK and Denmark, to a greater extent, equip patients to act as consumers. At present, Sweden's technological devices are much more limited. In Denmark and the UK, these devices that use quality indicators are in the forefront in the development of national healthcare portals.Originality/valueA theoretical framework is applied that emphasizes the role of technological devices in the construction of calculating consumers as described by Michel Callon. This perspective, which promotes patient‐centred care, enhances the understanding of fundamental design issues related to the role of technology as the individual forms his/her relationship with healthcare systems.

PurposeThis paper sets out to examine how private health insurance (PHI) supports the private interests of consumers of healthcare services. The focus is on how insurance companies promote PHI to consumers.Design/methodology/approachUsing interviews with insurance company marketing managers and others, the paper is a case study on the introduction of PHI in Sweden.FindingsThe interviewed insurance company managers argue that PHI supports two types of consumers' private economic interests. One type is the employers' interest in managing their total health‐related costs for their employees and the promise of PHI to reduce these costs. The second type relates to the interests of employees, particularly sports professionals, in managing economic risks and the promise of PHI to limit such risks.Research limitations/implicationsThe paper focuses on how insurance companies promote PHI to consumers. There is no exploration of how PHI policyholders actually use their insurance. The study focuses on Sweden where private companies are the major PHI policyholders. In other European countries, PHI may be adapted to other consumer groups in order to develop other private interests. The paper points to the value of short waiting times in public healthcare.Originality/valueThe paper provides valuable insights for academics and practitioners who are interested in how the private interests of consumers may affect the healthcare sector.

PurposeThis paper seeks to explore the challenges and transformations in healthcare resulting from building information infrastructures for patient‐centred care.Design/methodology/approachFour types of information infrastructures are analysed with special attention given to the efforts and controversies related to their mobilization and to their consequences for patient‐centred care. Data are gathered through a literature review and by empirical research.FindingsThe development of information infrastructures for patient‐centred care requires mobilization of technical, legal, clinical and ethical standards as well as a change in organizational and professional boundaries. Furthermore, the mobilization of information infrastructures entails unexpected transformation in the nature of patients, professionals, health records and consultations.Practical implicationsPatient‐centred information infrastructures call for institutional innovation and decision making regarding basic structures and relationships in healthcare. At the same time, the ambitions of patient‐centred care should be broad enough to learn from the consequences of emerging infrastructures for the patient and professional identities and for the quality of care.Originality/valueThe paper contributes to the understanding of healthcare governance by conceptualizing and empirically exploring the role of information infrastructure as a formative part of patient‐centred care.

PurposeThis paper aims to offer a critical pathway to understanding recent changes and improvements in organizing and managing healthcare – such as the emerging "patient‐centred care" (PCC) approach.Design/methodology/approachThe research is based on fieldwork performed as a mobile ethnography of translations of everyday healthcare work at a Swedish healthcare institution in which an analysis of the significance of contemporary accounting practices for disciplining action and thought was carried out.FindingsAccounting is increasingly interlinked with medical practices today, with more and more people involved in translating action and thought into accounting‐based terms and values at all levels of their work lives; as this happens, accounting "produces" a way of thinking and valuing that even modifies professional identities. The discipline of medical knowledge is played out differently as accounting‐based valuation measures become internalised into the performance of medical professionals and as additionally their images of themselves and their patients change. Patient‐centred care is thereby seen not as a means of generating a pure or positive value for patients, expressed in the form of greater efficiencies and nation‐wide performance indicators. The loosely coupled forms of patient‐centred care are about how nurses, having translated accounting practices into their work and selves, use them as a means of managing the constraints and "cracks" in the PCC approaches.Originality/valueAccounting allows the dynamics of the PCC approach to be understood and acted on in new ways. Accounting as a discipline involves both accounting professionals and medical professionals who circulate accounting numbers and values. Accounting, thus, is an activity that takes place inside and outside the self.

The articles in this e-book represent various although complementary theoretical and methodological perspectives. Together, they give an overall picture of health care policy work and describe what happens when new governance models meet reality. Some articles describe the situation in a single country while others make cross-country comparisons