Pathways, networks and choice in health care.
OBJECTIVE
The purpose of the paper is to present an alternative to the supply chain model of health care delivery that currently informs most thinking about the design of care processes.


METHODS
The paper draws on arguments from systems theories and public administration, to generate an analysis of the nature of health care processes. It sets out a model of services characterised by treatment and care needs that vary over time, that are inherently uncertain, involve frequent assessment and re-assessment, and provide patients and service providers with choices about treatment and care. Evidence from an evaluation of intermediate care is used to illustrate the analysis.


RESULTS
The analysis suggests that both the supply chain and a more network-like model of health care processes can help us to understand health care processes. The two are complementary.


CONCLUSIONS
Largely conceptual in nature. The empirical evidence is taken from one study. The ideas are presented to stimulate thinking rather than to prove an argument.


CONCLUSIONS
The conceptualisation of care processes as network-like has implications for the way in which we think about the design and performance of health care systems.


CONCLUSIONS
There have been few publications that seek to use both systems and network approaches to understand health care processes.
Keen
Justin
J
Institute of Health Sciences and Public Health Research, Centre for Health and Social Care, University of Leeds, Leeds, UK. j.keen@leeds.ac.uk
Moore
Jeanette
J
West
Robert
R
D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004739:England; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006801:Humans; D007380:Intermediate Care Facilities; D017146:Models, Organizational; D011785:Quality Assurance, Health Care; D013222:State Medicine / Q000458:organization & administration*