Managing Patient Discharge to Home: The Challenges of Achieving Quality of Care

Discharging older patients from hospital to care at home presents considerable challenges for those concerned about the current mandate of quality management. A great many professionals with different priorities and organizational commitments are involved. The policies and procedures of at least two...

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Bibliographic Details
Published in:International journal for quality in health care 1994-06, Vol.6 (2), p.147-161
Main Authors: MCWILLIAM, C. L., SANGSTER, J. F.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Canada
case management
Continuity of Patient Care - organization & administration
continuous quality improvement
Discharge care
Female
Follow-Up Studies
Health Services Research
Home Care Services - organization & administration
Hospitals, Rural - organization & administration
Hospitals, Urban - organization & administration
Humans
Male
Patient Discharge
Patient Education as Topic
Physician's Role
Physician-Patient Relations
Quality Assurance, Health Care - organization & administration
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Summary:Discharging older patients from hospital to care at home presents considerable challenges for those concerned about the current mandate of quality management. A great many professionals with different priorities and organizational commitments are involved. The policies and procedures of at least two agencies, a hospital and a home care agency, play a role in shaping the whole process. The purpose of this study was to explore and describe factors other than medical condition and treatment which shaped the quality of the discharge experiences of older patients. Qualitative research methodology was used to document the discharge process from the perspective of 12 rural and nine urban patients, and a purposeful sample of 22 family caregivers and 117 professionals involved in their care. As well, 24 agency administrators with an overview of related policies and procedures provided data. Findings provide an in-depth description of the different implementation approaches and related quality issues in rural and urban settings. Quality management was undermined by role confusion, compromised and overly zealous pursuit of efficiency, fragmented work, variable physician practice style, and communication and coordination problems. Several readily implemented solutions to these problems are recommended. The implications of the more difficult leadership challenges related to achieving reasonable efficiency and maintaining a humane orientation in the complex care system are addressed.
ISSN:1353-4505
1464-3677
DOI:10.1093/intqhc/6.2.147