Organizing as negotiation. The making of a pathway in Norwegian psychiatry.

The purpose of this article is to provide a thorough examination on the making of a pathway in Norwegian Psychiatry. During the last decades, much research has examined implementations and outcomes of different public health sector reforms and services in Western societies. However, there has been a lack of research on the process and the making of these reforms and/or services, in particular how they emerge as constructs in context policy, profession and practice. Based on qualitative data and theories on institutional logics, it shows how the two main actor groups are guided by values belonging to a specific logic when understanding the concept of a clinical pathway. The findings show that actors within the political field believe in control and efficiency, in contrast to actors in psychiatry guided by values of discretion and autonomy. This led to a debate of the concept of clinical pathway and psychiatry. The discussion became a polarization between concerns for patients as opposed to efficiency concerns. The making of the pathway was led by the Directorate of health, health professionals operating in the political domain, and with knowledge on both logic`s values. The end result became a logistic pathway were both “logics” got to keep their values, but where the original aims were highly negotiated.