The “hard, relentless, never-ending” work of focusing on discharge: a qualitative study of managers' perspectives
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 19 August 2021
Issue publication date: 4 March 2022
Abstract
Purpose
Interventions to hasten patient discharge continue to proliferate despite evidence that they may be achieving diminishing returns. To better understand what such interventions can be expected to accomplish, the authors aim to critically examine their underlying program theory.
Design/methodology/approach
Within a broader study on patient flow, spanning 10 jurisdictions across Western Canada, the authors conducted in-depth interviews with 300 senior, middle and frontline managers; 174 discussed discharge initiatives. Using thematic analysis informed by a Realistic Evaluation lens, the authors identified the mechanisms by which discharge activities were believed to produce their impacts and the strategies and context factors necessary to trigger the intended mechanisms.
Findings
Managers' accounts suggested a common program theory that applied to a wide variety of discharge initiatives. The chief mechanism was inculcation of a sharp focus on discharge; reinforcing mechanisms included development of shared understanding and a sense of accountability. Participants reported that these mechanisms were difficult to produce and sustain, requiring continual active management and repeated (re)introduction of interventions. This reflected a context in which providers, already overwhelmed with competing demands, were unlikely to be able (or perhaps even willing) to sustain a focus on this particular aspect of care.
Originality/value
The finding that “discharge focus” emerged as the core mechanism of discharge interventions helps to explain why such initiatives may be achieving limited benefit. There is a need for interventions that promote timely discharge without relying on this highly problematic mechanism.
Keywords
Acknowledgements
This study was funded by the Canadian Institutes of Health Research, with partnership funding from the Michael Smith Foundation for Health Research, Alberta Innovates, Saskatchewan Health Research Foundation and Research Manitoba. All are public agencies and had no role in the design, conduct, or reporting of the research.
We are grateful to Sarah Bowen for her invaluable assistance with the process of transforming a report chapter into an article. We also thank the full WeCanFlow researcher/decision-maker team for their critical review, and Reena Kreindler for her editorial advice.
Citation
Kreindler, S.A., Hastings, S., Mallinson, S., Brierley, M., Birney, A., Tarraf, R., Winters, S., Johnson, K., Nicholson, L., Anwar, M.R. and Aboud, Z. (2022), "The “hard, relentless, never-ending” work of focusing on discharge: a qualitative study of managers' perspectives", Journal of Health Organization and Management, Vol. 36 No. 2, pp. 164-177. https://doi.org/10.1108/JHOM-04-2021-0132
Publisher
:Emerald Publishing Limited
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