Hospital Discharge

In both cases the challenge for the discharge
team revolved around how to handle the
increased expectations of patients and their
families, since both appeared to trust doctors’
opinion more than the opinion of the discharge
facilitator. It appeared that ward staff’s limited
knowledge of discharge planning and the lack
of a discharge facilitator able to be continuously
present in the wards, contributed to problematic
knowledge sharing and communication in the
majority of wards. Noticeably though, knowledge
sharing and communication between the
discharge team and some ward staff worked
better in certain instances. This was not because
the latter had more knowledge on discharge
planning or because they had a dedicated
discharge facilitator based on their wards, but
because these ward staff viewed the discharge
team as a ‘tool’ that they could use to facilitate
the smooth running and management of the
ward. Our researcher observed that productivity
was improved greatly where professionals
recognised the role of other professionals and
established boundaries to facilitate knowledge
sharing and communication accordingly. Finally,
a small proportion of participants reported that
they felt excluded from the decision making
processes. For instance, when disputes between
the discharge team and staff in certain wards
were observed, it appeared that these disputes
were partially as a result of the limited amount of
information that both the discharge facilitators
and ward staff had received from the managerial
level regarding their collaboration and
knowledge sharing, on many occasions these
miscommunications within the discharge team,
and between the ward staff and the discharge
team, resulted in delayed discharges, as each
had a different opinion regarding the patients’
needs. Hence, there was a disjoint between the
hospital departments.
Whoever has done that
assessment should be able to
then commission and source
the care with a funding stream
that is pulled together.
7.2.3 Finding solutions
to complex processes
Another theme in participants’ talk related
to the complexity of discharge planning and
participants’ efforts to simplify the process and
make it more accessible, with regard to knowledge
and processes, to both patients and ward staff.
Participants identified a range of aspects in
discharge planning that could either be simplified
or streamlined. For example, some participants
reported that the creation of a discharge booklet
and drop-in centre would resolve many of the
communication problems among the discharge
team, families and ward staff. Other participants
described the discharge process as particularly
complex and strenuous; more specifically these
participants reported that they frequently carried
out unnecessary assessments, the majority of
which were particularly lengthy, and hence they
were spending much time duplicating and rewriting
assessments. These participants reported
that health and social care IT systems needed
to be integrated, and assessments, carried out
either by the health or social care team, should be
shared and not considered invalid if they were not
carried out by the agency in charge of patients’
care in the community:
34