Justin Waring1, Fiona Marshall2, Simon Bishop3. 1. Professor of Organizational Sociology, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK justin.waring@nottingham.ac.uk. 2. Research Fellow, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK. 3. Lecturer, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK.
Abstract
OBJECTIVE: Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. METHODS: An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. RESULTS: Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. CONCLUSIONS: Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety.
OBJECTIVE: Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. METHODS: An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracturepatients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. RESULTS: Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. CONCLUSIONS: Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety.
Authors: Eirini Oikonomou; Bethan Page; Rebecca Lawton; Jenni Murray; Helen Higham; Charles Vincent Journal: BMC Health Serv Res Date: 2020-07-01 Impact factor: 2.655
Authors: Rebecca Hays; Gavin Daker-White; Aneez Esmail; Wendy Barlow; Brian Minor; Benjamin Brown; Thomas Blakeman; Caroline Sanders; Peter Bower Journal: BMC Health Serv Res Date: 2017-11-21 Impact factor: 2.655