Working concepts
Language for what happens
around the patient.
These concepts name forces that are often visible only after a care pathway has already begun to break.
Named so they can be measured, piloted, studied, and implemented.Primary working construct
The hospital-state effect
The change in a person’s internal state caused by entering and remaining within a healthcare environment.
What it names
The care environment is not a neutral container. Waiting, uncertainty, dependence, discomfort, altered time, and loss of control may change the person who must make decisions there.
Governing question
How does the internal state produced by the care environment change a person’s ability to receive, understand, tolerate, and complete care?
What it could make visible
Primary working construct
The care-seeking threshold
The ongoing boundary a person negotiates while deciding whether to approach, delay, enter, abandon, or continue seeking care.
What it names
Care-seeking is not one decision made at a doorway. A person repeatedly weighs bodily danger against cost, access, legitimacy, time, uncertainty, and the possible consequences of letting care begin.
Governing question
What must become understandable, available, or tolerable before a person can convert a bodily concern into an institutional encounter?
What it could make visible
Primary working construct
The care-retention threshold
The point at which a person repeatedly determines whether remaining inside a care process is still possible.
What it names
Entering care does not guarantee that a person can stay. Outside obligations, uncertain waiting, transportation, work, dependents, cost, discomfort, and loss of agency may make leaving feel increasingly necessary.
Governing question
What pressures might make remaining in care harder than leaving—and can they become visible before the patient reaches the exit?
What it could make visible
A necessary distinction
Care can be professionally arranged and still fail to become traversable.
Continuity of care asks whether relationships, information, and clinical management remain coherent across time and professionals.
Care pathway integrity asks whether that care remained reachable, timely, understandable, executable, and complete in the patient’s life.
These are proposed working concepts—not finished diagnoses.