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Organizational culture: an important context for addressing and improving hospital to community patient discharge

Organizational culture: an important context for addressing and improving hospital to community patient discharge
Organizational culture: an important context for addressing and improving hospital to community patient discharge
Background: Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown.

Objectives: To explore aspects of organizational culture to develop a deeper understanding of the discharge process.
Research Design: A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data.

Subjects: In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses.

Results: Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and
work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a “here and now” situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices.

Conclusions: On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.
0025-7079
90-98
Hesselink, Gijs
8c2e5d5b-d2bc-4534-8282-ab09496ede37
Vernooij-Dassen, Myrra
a8064c09-be69-47e6-b1b4-270f6c5c88b0
Pijnenborg, Loes
b0001858-f36b-48c7-b2b2-d15c5deeec43
Barach, Paul
ea11b49f-9b86-40d9-9434-cf6f4de877c9
Gademan, Petra
156064cb-00c0-4970-8abf-f88ca752c323
Dudzik-Urbianak, Ewa
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Flink, Maria
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Orrego, Carola
2fb83cc6-e391-4517-adac-b9adae88b211
Toccafondi, Giulio
2f137c15-b2b7-4cbb-9d31-1e68c3c92360
Johnson, Julie K.
9dea247d-9c4a-417a-900f-abf60e27349a
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Wollersheim, Hub
dd3b6ecf-2096-4baf-ab60-5357b246499f
Hesselink, Gijs
8c2e5d5b-d2bc-4534-8282-ab09496ede37
Vernooij-Dassen, Myrra
a8064c09-be69-47e6-b1b4-270f6c5c88b0
Pijnenborg, Loes
b0001858-f36b-48c7-b2b2-d15c5deeec43
Barach, Paul
ea11b49f-9b86-40d9-9434-cf6f4de877c9
Gademan, Petra
156064cb-00c0-4970-8abf-f88ca752c323
Dudzik-Urbianak, Ewa
0872f924-5a93-429c-8b87-c41445470db2
Flink, Maria
51473454-48f6-4585-a5ae-48622a4d9c7f
Orrego, Carola
2fb83cc6-e391-4517-adac-b9adae88b211
Toccafondi, Giulio
2f137c15-b2b7-4cbb-9d31-1e68c3c92360
Johnson, Julie K.
9dea247d-9c4a-417a-900f-abf60e27349a
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Wollersheim, Hub
dd3b6ecf-2096-4baf-ab60-5357b246499f

Hesselink, Gijs, Vernooij-Dassen, Myrra, Pijnenborg, Loes, Barach, Paul, Gademan, Petra, Dudzik-Urbianak, Ewa, Flink, Maria, Orrego, Carola, Toccafondi, Giulio, Johnson, Julie K., Schoonhoven, Lisette and Wollersheim, Hub (2013) Organizational culture: an important context for addressing and improving hospital to community patient discharge. Medical Care, 51 (1), 90-98. (doi:10.1097/MLR.0b013e31827632ec). (PMID:23132202)

Record type: Article

Abstract

Background: Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown.

Objectives: To explore aspects of organizational culture to develop a deeper understanding of the discharge process.
Research Design: A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data.

Subjects: In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses.

Results: Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and
work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a “here and now” situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices.

Conclusions: On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.

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Published date: January 2013
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 351733
URI: http://eprints.soton.ac.uk/id/eprint/351733
ISSN: 0025-7079
PURE UUID: e8f077f1-f219-4455-955e-4fe33c841b73
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 30 Apr 2013 11:32
Last modified: 15 Mar 2024 03:41

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Contributors

Author: Gijs Hesselink
Author: Myrra Vernooij-Dassen
Author: Loes Pijnenborg
Author: Paul Barach
Author: Petra Gademan
Author: Ewa Dudzik-Urbianak
Author: Maria Flink
Author: Carola Orrego
Author: Giulio Toccafondi
Author: Julie K. Johnson
Author: Hub Wollersheim

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