On discharge planning: dynamic complex processes – uncertainty, surprise and standardisation

Abstract

How can discharge planning (DP) for patients who require care in the home following a period in hospital be understood and developed through the lenses of complexity theory? With the help of complexity theory and practice-based narrative research this study discloses the formal routines and complex dynamic practices that are associated with DP. A study of the literature established that there was an almost total absence of complexity-theoretical perspectives on interpreting and developing DP. The researchers collected narratives about the DP processes using qualitative interviews with the nurses responsible for this in a hospital ward: these were audio-recorded and transcribed verbatim. They also participated in and documented meetings where these nurses, as a group, discussed DP. The findings show that nurses have to continuously deal with uncertainty, surprises and the unknown. They have to make sense and take charge of dynamic complex events and new knowledge, and manage complex relations and information. The researchers argue that looking upon practice from the lenses of complexity theory, and therefore accepting the complexity of practice, could facilitate the development of nurses' skills in order to guarantee good quality in DP.

Complex caring needs without simple solutions: the experience of interprofessional collaboration among staff caring for older persons with multimorbidity at home care settings

“…They attempted to manage this uncertainty by finding structural solutions which clarified division of responsibility for different tasks. According to Hjern and Augustinsson et al , the healthcare system of today is so complex that there is no predetermined route to meeting the patient's needs. The fragmented healthcare system leads to various tasks and responsibility being shared among various individuals in different organisations.…”

Making Sense of Assignment

“…Relationships and communication are part of complex dynamic systems and processes and involve genuine uncertainty. To be more precise, the result of the communication between people lies in the details, and its extension over time is fundamentally uncertain (Augustinsson & Petersson 2015).…”

Customer Context and Social CRM: A Literature Review and Research Agenda

“…Thus, a variety of stakeholders and influencing factors are to be considered in this decision. While the implications and requirements of effective discharge planning have been analysed in various studies (Armitage & Kavanagh, 1998;Augustinsson & Petersson, 2015;Chadwick & Russell, 1989;Goncalves-Bradley, Lannin, Clemson, Cameron, & Shepperd, 2016;Mukotekwa & Carson, 2007), the specific time of patient discharge that leads to the best outcome has not yet been considered in detail (Matis, Farris, McAllister, Dunavan, & Snider, 2015). Finding the optimal time of discharge can lead to fewer unnecessary readmissions, enable cost reductions and therefore allow for a better allocation of resources within the hospital.…”