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Trust Testing in Care Pathways for Neurodevelopmental Disorders: A Grounded Theory Study
Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. (Research group for neurocognition)
Lund University, Swedn.
2016 (English)In: The Grounded Theory Review, ISSN 1556-1542, E-ISSN 1556-1550, Vol. 15, no 1, p. 45-58Article in journal (Refereed) Published
Abstract [en]

Building care pathways for the expansive, heterogeneous, and complex field of neurodevelopmental disorders (ND) is challenging. This classic grounded theory study conceptualizes problems encountered and resolved by professionals in the unpacking— diagnosis and work up—of ND. A care pathway for ND in children and adolescents was observed for six years. Data include interviews, documentation of a dialogue-conference devoted to the ND care pathway, 100+ hours of participant observations, and coding of stakeholder actions. Trust testing explores whether professional unpacking collaboration can occur without being “stuck with the buck” and if other professionals can be approached to solve own unpacking priorities. ND complexity, scarce resources, and diverging stakeholder interests undermine the ability to make selfless collaborative professional choices in the care pathway. ND professionals and managers should pay as much attention to trust issues as they do to structures and patient flows. The trust testing theory may improve the understanding of ND care pathways further as a modified social dilemma framework. 

Place, publisher, year, edition, pages
Sociology Press, 2016. Vol. 15, no 1, p. 45-58
Keywords [en]
Neurodevelopment; health care services; care pathways; autism; ADHD
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Social Sciences, Psychology
Identifiers
URN: urn:nbn:se:lnu:diva-62806ISI: 000378328000005OAI: oai:DiVA.org:lnu-62806DiVA, id: diva2:1092712
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2019-08-27Bibliographically approved
In thesis
1. Conceptualizing professionals' strategies in care pathways for neurodevelopmental disorders
Open this publication in new window or tab >>Conceptualizing professionals' strategies in care pathways for neurodevelopmental disorders
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Neurodevelopmental disorders (ND), are complex neuropsychological functional impairments. About 3-5% of all children meet criteria for attention deficit and hyperactivity disorder (ADHD), and about 1% for autism spectrum disorder – along with intellectual developmental disorder the most common ND diagnoses. Degree and type of functional impairment vary greatly within and between patients, necessitating multi-professional assessment and treatment. Using classic grounded theory (Glaser), this thesis offers a new theory of professionals’ practices in care pathways for ND. It also contains a pilot evaluation of a new, tablet-based, clinical test of attention.

Study I shows that care pathways for ND are characterized by social dilemmas. What is rational for an individual professional, team or clinic, is not always rational for the care pathway as a whole. Collective action therefor requires development and sustainability of inter-professional trust. The study highlights strategies used by professionals to decide on whether to act collectively or unilaterally. Such trust testing strategies are couched in the frameworks of social dilemma-theory and game-theory.  

Study II emphasizes the importance of professional control over strategies, structures and methods in the care pathway for ND (unpacking control) to deal with ND-related complexity. Lack of such control can short-circuit the ability to work successfully as a professional. Unpacking control is understood mainly in the light of professions theory.

Study III evaluates the new MapCog Spectra test as a rapid method to detect and assess clinical problems of attention. Four groups of children and adolescents took the test. Two groups were comprised of patients with either ND or other psychiatric problems. Two groups were comprised of school children without known clinical conditions. The MapCog Spectra test separated clinical from non-clinical groups with good precision.

In the thesis, concepts from studies I and II are integrated and extended to form a unified theory about professional practices in care pathways for ND. The latters are suggested to be a particular form of commons, which can be collectively managed by professionals in more or less successful ways. A quantitative model for the dynamics in the care pathways is presented.

Abstract [sv]

Neuroutvecklingstillstånd (NU-tillstånd) är komplexa neuropsykologiska funktionsnedsättningar. Omkring 3-5% av alla barn har uppmärksamhets- och hyperaktivitetsstörning (ADHD) och cirka 1% av alla barn autismspektrumtillstånd (AST), som tillsammans med intellektuell funktionsnedsättning utgör de vanligaste NU-diagnoserna. Grad och typ av funktionsnedsättning varierar stort inom och mellan individer. Utredning och behandling är därför med nödvändighet multiprofessionell.

Denna avhandling använder klassisk grundad teori (Glaser) för att begreppsliggöra professionellas beteenden i vårdkedjor för NU-tillstånd. Den innehåller också en pilotutvärdering av ett nytt, surfplattebaserat test för uppmärksamhetsproblem.

Studie I visar att vårdkedjor för NU-tillstånd kännetecknas av sociala dilemman. Det som är rationellt för en enskild professionell, eller enhet, är inte alltid rationellt för vårdkedjan som helhet. För att kunna agera kollektivt när intressen inte alltid sammanfaller, krävs tillit. Studie I påvisar strategier som professionella använder för att kunna avgöra om de ska agera kollektivt eller mer individuellt/lokalt. Det övergripande namnet på sådana strategier är tillitstestning. Fynden sätts i relation till spelteori och social dilemma-teori.

Studie II visar på vikten av att ha professionell kontroll över strategier, strukturer och metoder (eng. Unpacking control) för att hantera komplexitet i NU-vård i vårdkedjan. Att sakna kontroll över upplevt viktiga professionella prioriteringar kan kortsluta förmågan att jobba framgångsrikt med patienter.  Dessa fynd sätts i relation till professionsteori.  

Studie III utvärderar ett nytt, snabb-administrerat, surfplattebaserat screening-test för uppmärksamhetsproblem. Syftet är att bidra till utvecklingen av metoder som kan hjälpa professionella att göra mer effektiva kliniska bedömningar av komplexa variabler, som uppmärksamhetsförmåga. Fyra grupper av barn och ungdomar fick utföra testet. Två av grupperna utgjordes av patienter med antingen NU-problematik eller annan klinisk problematik. Två grupper utgjordes av skolbarn utan känd problematik. Resultaten visade att testet med god precision kunde skilja de kliniska från de icke-kliniska grupperna.

I kappan integreras resultaten från studierna I och II till en sammanhållen teori om professionellt beteende i NU-vårdkedjor. Ur ett professionellt perspektiv föreslås NU-vårdkedjor vara en särskild form av allmänningar, som kollektivt kan förvaltas mer eller mindre väl av de professionella. En kvantitativ modell för dynamiken i vårdkedjorna presenteras.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2019. p. 93
Series
Linnaeus University Dissertations ; 348/2019
Keywords
neurodevelopmental disorders; autism; ADHD; care pathways, neuroutvecklingstillstånd; autismspektrumtillstånd; ADHD; vårdkedjor
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-88758 (URN)978-91-88898-51-7 (ISBN)978-91-88898-52-4 (ISBN)
Public defence
2019-05-23, Weber, Universitetsplatsen 1, Växjö, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-30Bibliographically approved

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Waxegård, GustafThulesius, Hans

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