Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle

Med Care Res Rev. 2019 Aug;76(4):359-385. doi: 10.1177/1077558718774905. Epub 2018 May 10.

Abstract

The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven's (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners' work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.

Keywords: organizational structure; paradoxes; patient centeredness; practice guidelines; professional expertise.

Publication types

  • Review

MeSH terms

  • Clinical Competence / standards*
  • Delivery of Health Care*
  • Evidence-Based Practice
  • Guidelines as Topic / standards*
  • Humans
  • Patient-Centered Care*