Road to nowhere? A critical consideration of the use of the metaphor ‘care pathway’ in health service organisation and delivery

Research output: Contribution to journalArticle


Metaphors are inescapable in human discourse. Policy researchers have
suggested that the use of particular metaphors by those implementing
policy changes both influences perceptions of underlying reality and
determines what solutions seem possible, and that exploring ‘practice
languages’ is important in understanding policy enactment . This paper
contributes to the literature exploring the generative nature of
metaphors in policy implementation, demonstrating their role in not just
describing the world, but also framing it, determining what is
seen/unseen, and what solutions seem possible. The metaphor ‘care
pathway’ is ubiquitous and institutionalised in healthcare. We build upon
existing work critiquing its use in care delivery, and explore its use in
health care commissioning, using evidence from the recent
reorganisation of the English NHS. We show that the pathways metaphor
is ubiquitous, but not necessarily straightforward. Conceptualising health
care planning as ‘designing a pathway’ may make the task more difficult,
suggesting a limited range of approaches and solutions. We offer an
alternative metaphor: the service map. We discuss how approaches to
care design might be altered by using this different metaphor, and
explore what it might offer. We argue not for a barren language devoid
of metaphors, but for their more conscious use.

Bibliographical metadata

Original languageEnglish
JournalJournal of Social Policy
Publication statusPublished - 24 May 2019