This thesis examines the retention of best practices by clinicians after the implementation of an integrated care pathway for patients with congestive heart failure. While the literature suggests there are many reasons why the implementation of best practices is difficult, there is little information on the sustainability of best practices once implemented.<p>Using a qualitative research design guided by Rogers theory of Diffusion of Innovations the researcher interviewed seven clinicians who participated in the implementation of the pathway. A thematic analysis revealed several themes that ran throughout participants responses. <p>While the participants indicated they see value in best practices, they also identified barriers to getting that knowledge into practice and keeping it there. A spectrum of factors, including individual autonomy, time, resources, organizational support and the organization of the system all played a role.<p>In the end, participants revealed that although small pieces of the pathway remain in practice, the pathway itself is no longer used by clinicians to manage patients with congestive heart failure.

This thesis examines the retention of best practices by clinicians after the implementation of an integrated care pathway for patients with congestive heart failure. While the literature suggests there are many reasons why the implementation of best practices is difficult, there is little information on the sustainability of best practices once implemented.<p>Using a qualitative research design guided by Rogers theory of Diffusion of Innovations the researcher interviewed seven clinicians who participated in the implementation of the pathway. A thematic analysis revealed several themes that ran throughout participants responses. <p>While the participants indicated they see value in best practices, they also identified barriers to getting that knowledge into practice and keeping it there. A spectrum of factors, including individual autonomy, time, resources, organizational support and the organization of the system all played a role.<p>In the end, participants revealed that although small pieces of the pathway remain in practice, the pathway itself is no longer used by clinicians to manage patients with congestive heart failure.

Abstract The aim of the thesis is to increase understanding about creation of value in health care. Value is created through knowledge processes in multiprofessional integrated care pathways (ICP) of childhood obesity and defined as health and well-being which benefits the patients, their families, health care organisations and society. An ICP is a practice among Finnish primary and special care which in this study is regarded as the value creating network. Knowledge processes take place in social networks of health professionals and families and information technology (IT) networks. The transdisciplinary study combines theories of Information Studies with theories of customer value in Business and Marketing research. The care and prevention of childhood obesity pursues permanent lifestyle changes through health counselling. Examination of value creation in networks based on knowledge processes has the potential to enhance health professionals’, patients’, and their families’ interaction in counselling. The qualitative case study involves the ICPs of two Finnish University Hospital districts. The empirical data, collected between 2009 and 2012, consists of semi-structured interviews of 30 health professionals in primary and special health care, of three children and their mothers, a family questionnaire (N=13), and care path instructions and memos of an ICP work group. The findings indicate that information practices and IT do not support knowledge processes and organisational learning in the ICP. Along with structural and IT-based boundaries in and between organisations, organisational culture confirms boundaries. Moreover, lack of time restricts the sharing of experiences. Knowing in health care is a complex phenomena; especially the care of childhood obesity appeared to include emotional aspects not addressed in previous research. Thus, the study contributes to theoretical knowledge by suggesting empathetic knowing to be included in the typology of knowing in the context of health care. Even if counselling was perceived well, it does not ensure permanent lifestyle changes. Actual value for the families is created in the everyday practices which should be supported by the environment. The theoretical framework can be tested further in similar constructions in health care organisations or in other ICPs to enhance Knowledge Management and value creation in health care. / Tiivistelmä Tutkimus pyrkii lisäämään ymmärrystä siitä, miten arvoa luodaan lasten lihavuuden hoitoketjun tietoprosesseissa moniammatillisessa yhteistyössä. Hoitoketju on perusterveydenhuollon ja erikoissairaanhoidon välille luotu käytäntö, jota tarkastellaan arvoa luovana verkostona. Arvolla tarkoitetaan hyötyä, joka syntyy potilaille, heidän perheilleen, terveydenhuolto-organisaatioille ja yhteiskunnalle. Tietoprosessit muodostavat arvoverkoston ammattilaisten ja perheiden sosiaalisten verkostojen sekä hoitoketjun tietoverkostojen kautta. Tieteidenvälinen tutkimus yhdistää informaatiotutkimuksen teorioita liiketalouden tutkimuksen teorioihin asiakasarvon luomisesta. Lasten lihavuuden tärkein hoito- ja ennaltaehkäisykeino on terveysneuvonta, joka pyrkii pysyviin elämäntapamuutoksiin. Tietoprosessien tarkastelu arvoverkostoina mahdollistaa ammattilaisten ja perheiden vuorovaikutuksen kehittämisen terveysneuvonnassa. Laadullinen tapaustutkimus toteutettiin kahdessa suomalaisessa yliopistollisessa sairaanhoitopiirissä. Aineisto kerättiin vuosina 2009–2012. Se koostuu 30 terveydenhuollon ammattilaisen, kolmen potilaan ja heidän äitiensä teemahaastatteluista, 13 perheen lomakekyselyvastauksista sekä hoitopolkuohjeistuksista ja kokousmuistioista. Tulokset osoittavat, että tietoverkot ja informaatiokäytännöt eivät tue tietoprosesseja ja organisaatioiden oppimista hoitoketjussa. Rakenteellisten ja informaatio- ja viestintäteknologian luomien rajojen lisäksi erilaiset organisaatiokulttuurit muodostavat esteitä tietoprosessien etenemiselle. Kiire estää kokemusten jakamista. Tietämys ja osaaminen terveydenhuollossa ovat moniulotteisia seikkoja. Tutkimus nostaa esille lasten lihavuuden hoitoon liittyvät tunteet, joita ei ole tarkasteltu aikaisemmissa tutkimuksissa. Siten tulokset täydentävät teoriataustana sovelletun tietämisen typologiaa empaattisen tietämisen tyypillä terveydenhuollon kontekstissa. Perheet kokivat terveysneuvonnan hyväksi, mutta vaikutukset pysyviin elämäntapamuutoksiin eivät nouse vahvasti esille. Hoidon arvo muodostuu perheiden jokapäiväisen elämän käytännöissä, mitä myös ympäristön tulisi tukea. Tutkimuksessa sovellettua teoriaa ja viitekehystä voidaan testata vastaavissa yhteistoimintahankkeissa ja hoitoketjuissa. Niiden avulla voidaan kehittää arvoa luovia tietoprosesseja ja tietojohtamista terveydenhuollossa.