Skip Navigation

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by MCWILLIAM, C. L.
Right arrow Articles by SANGSTER, J. F.
Right arrow Search for Related Content
PubMed
Right arrow Articles by MCWILLIAM, C. L.
Right arrow Articles by SANGSTER, J. F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

International Journal for Quality in Health Care 6:147-161 (1994)
© 1994 International Society for Quality in Health Care

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

C. L. MCWILLIAM, Assistant Professor* and J. F. SANGSTER, Professor{dagger}

* Centre for Studies in Family Medicine, The University of Western Ontario Canada
{dagger} Department of Family Medicine, The University of Western Ontario Canada

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.

Keywords: Discharge care, continuous quality improvement, case management

Dr C. L. McWilliam, KI, Kresge Building, Centre for Studies in Family Medicine, The University of Western Ontario, London, Ontario, Canada N6A 5C1.

Received for publication September 1, 1993. Accepted for publication January 28, 1994.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Int J Qual Health CareHome page
L. J. G. G. PANIS, M. GOOSKENS, F. W. S. M. VERHEGGEN, P. POP, and M. H. PRINS
Predictors of inappropriate hospital stay: a clinical case study
Int. J. Qual. Health Care, February 1, 2003; 15(1): 57 - 66.
[Abstract] [Full Text] [PDF]

Home page
 Journal of Applied GerontologyHome page
M. J. Bull and R. L. Kane
Gaps in Discharge Planning
Journal of Applied Gerontology, December 1, 1996; 15(4): 486 - 500.
[Abstract] [PDF]

Home page
 Qualitative InquiryHome page
C. L. McWilliam
Creating Understanding That Cultivates Change
Qualitative Inquiry, June 1, 1996; 2(2): 151 - 175.
[Abstract] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.