Patientforløb i praksis - en analyse af en idés oversættelse i mødet med praksis

The objective of this thesis is to study the meeting between reform ideas and practice. In order to realize this objective a model for analyzing the local translation processes involving moving general concepts/ideas from one context to another is developed. The analysis is organized in three sections: 1. Operationalization of a general model for analyzing translation processes based on an analysis and discussion of existing theories. 2. Analysis of the concrete translation processes related to introducing "clinical pathways" in an orthopedic and a psychiatric department at a local hospital in Copenhagen. Variations in local translation processes are identified and the importance of the various aspects of the local context for the course and outcome of the translation process are discussed. 3. Evaluation of the model developed on the basis of the factual analyses with a view to the empirical insight generated and its relevance and its theoretical contributions and possible ways in which the model can be developed. It is concluded that the translation model developed contributes by making it possible to follow relatively close the translation of an idea when it meets with and is translated into local practice. The model makes it possible to identify empirically the translations of a reform idea - the idea of clinical pathways - in two selected cases, whom the translators are, and what the effects are of these translations. Furthermore, the model helps gaining knowledge of the nature of the translation process and answer key questions related to the idea of clinical pathways that were of importance to selected actors in the hospital field. Theoretically, the translation model and the detailed empirical analysis implied provide the foundation for comparing translation processes in the selected cases with the theorizing of new-institutional translation models. Finally the model contribute to facilitate the development of an empirically based translation-, institutionalization, and learning model as an alternative to existing theory of learning,and new-institutional translation and institutionalization models.