When Personalization Does Not Change Care: A Critical Narrative Review and an Organizational Decoupling Framework

Abstract

Background/Objectives: Patient-centred practices do not by themselves show whether an individual’s priorities influence care. This review asks how organizational decoupling theory can inform a traceable response to those priorities and locate a loss of influence. Methods: A theory-informed critical narrative review used a purposive analytical bibliography of 63 publications. The authors’ preliminary categories, professional experience, and organizational theory guided interpretation. A source-to-claim matrix separates published findings, conceptual arguments, and proposed mechanisms. The framework was refined through comparison with literature, without independent inductive coding. Results: Three candidate mechanisms concern influence over service design, the expression and recognition of patient goals, and the organizational response to experience and outcome data. They may overlap and do not exhaust the possible explanations. A proposed loop links the goal, decision, action, outcome, and review. Its assessment distinguishes evidence of lost influence from justified plan retention and insufficient information. A hypothetical care pathway and a research programme specify how to test these distinctions while accounting for changing preferences, implementation fidelity, and documentation burden. Conclusions: The contribution is an account of where patient influence may be lost and what a considered response would involve. The three mechanisms and the order of the loop are conceptual propositions. Their reliability, explanatory value, and effects on care require independent evaluation before use as performance indicators.