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The patient flow performance achievable by care pathways is constrained by competing flow and resource efficiency, which can negatively impact improvements. This paper probes the divergence between resource and flow efficiency and how care pathways can lead to improved patient flow. By framing the problem through the lens of paradox theory, a set of design principles is proposed to assist decision-makers in care pathway implementation. Implications are derived for research and practice.

The authors used conceptual research to develop design principles for care pathways based on a systematic review of relevant care pathway research. The initial search contained 515 unique articles, resulting in a final sample of 56 studies.

When applying care pathways, patient flow may be negatively affected in relation to the dimensions of bottlenecks, non-value-adding activities, and variability. However, the findings also indicate methods that can be applied to manage organizational paradoxes, which can contribute to more efficient patient flow along each of the three dimensions.

The study is limited to care pathways and therefore could have missed relevant studies in similar fields, such as care coordination.

Health care managers, politicians, and IT developers can apply the proposed design principles when developing, implementing, and improving care pathways and supporting technologies.

While existing research has studied care pathways from a medical perspective, this is the first paper to the author’s knowledge that addresses care pathways directly by considering paradox theory and in light of the operations management literature.

While manufacturing digitalization is currently considered an important enabler of competitive advantage, its applicability across the industrial spectrum is unclear. This paper aims to investigate the relationship between the use of digital technologies and different production environments and company sizes. The focus is on three aspects of digitalization: shop floor digitalization, technologies for vertical and horizontal integration and organizational IT competence.

This study is based on data gathered from a survey questionnaire sent to 212 Norwegian manufacturing companies. To test the formulated hypotheses, the two-way analysis of variance (ANOVA) method was used.

This study confirmed that large enterprises (LEs) have a significantly higher level of shop floor digitalization and organizational IT competence than small and medium-sized enterprises (SMEs). Regarding the difference between production environments, no statistically significant difference in the implementation level of the investigated digitalization aspects could be found.

To the best of the authors' knowledge, this is one of the first studies to investigate differences in the adoption of digital technologies between different groups of production environments. This study also provides updated findings related to the relationship between digitalization and company size. The findings presented in this paper provide important insights into directing future research efforts to assist environments that are currently lagging behind in their digital transformation.