Hospital Discharge Planning: How Professionals Collaborate in Team Structures to Coordinate a Patient’s Discharge Plan

Abstract

This PhD study explores the behaviors of collaboration within a hospital discharge planning team. Discharge planning is a process, whereby the professionals involved in a patient’s care must collaborate to coordinate the patient’s healthcare services when admitted, cooperate to identify the level of care that is needed upon discharge, work together to determine when it is medically appropriate to transition the patient to the next level of care, and to arrange any post-hospitalization services. Furthermore, in 2023, The Organisation for Economic Co-operation and Development (OECD) published the latest Health at a Glance, which acknowledged that “both premature and delayed discharges worsen health outcomes and increase costs” (OECD, 2023, p. 112). In order to facilitate collaboration in discharge planning, hospitals often utilize multi-professional teams, which are often referred to as multi-, inter-, or intradisciplinary or professional teams in the literature. One of the challenges to multiprofessional collaboration is the reality that most healthcare professionals are trained independently of one another, with little to no formal education in the roles and responsibilities of other healthcare professionals, or how to collaborate within multiprofessional teams. As a result, most healthcare professionals’ first encounter with the interdependent nature of healthcare and the critical importance of multi-professional collaboration takes place on the job when they join a multi-professional team for the first time. Hospital discharge planning is a legal mandate in many countries and can impact health outcomes. The effectiveness of discharge planning also directly impacts hospital bed availability. Because a hospital has a limited number of beds available at any given time, with little control over increased demand for the available beds, the hospital bed is considered a scarce resource that must be closely managed. One way that hospitals proactively manage the resource of hospital beds is to focus on the coordination of patient care through the use of multi-professional teams, which can be referred to as the discharge planning team. While there is an abundance of literature discussing the need for, benefits of, and barriers to multi-professional collaboration within healthcare, there is a significant gap discussing specific behaviors that facilitate or hinder collaboration, specifically in a discharge planning team. To address this gap, this PhD study utilized a qualitative interpretivist descriptive single-site case study to conduct direct observations of the discharge planning team meetings. Specifically, data was collected through the document analysis of federal and hospital-specific discharge planning policies and the direct observations of 21 in-person and 14 electronic discharge planning team meetings. As a result of the data collection, this research identified the following key findings. First, that discharge planning is a process that can be categorized as two distinct, yet interdependent acts: the coordination of a patient’s care among multiple professionals while the patient is admitted to the hospital, and the coordination of a patient’s post-hospitalization services. In examining the process of coordinating a patient’s care among multiple professionals while the patient is admitted to the hospital, this research study illuminates the complexities of collaboration at the organizational, team and professional level, which in turn provides a rich understanding of the behaviors, facilitators and barriers of collaboration. Second, this research provides new insights into how organizations, teams and professionals utilize their physical space and tools, such as a rounding guide and color-coding system, to communicate professional buy-in to the discharge planning process. Furthermore, this research highlights how professional buy-in and hierarchy are interconnected and directly impact collaboration within the discharge planning team. Finally, this research provides the novel findings of how the secure chat function within the electronic health record can be utilized as a discharge rounding tool and platform to facilitate interprofessional collaboration. As a result of the findings, this research study is able to make recommendations at the organizational, discharge planning team and professional team level. In order to mitigate barriers to collaboration, healthcare organizations and professionals must have an understanding of what collaboration is and how to collaborate; specifically, the behaviors that facilitate or hinder collaboration. Just as hospitals are complex organizations and the discharge planning process is multifaceted, understanding how the professionals in a hospital discharge planning team collaborate requires a dynamic approach that considers the history and complexity of the organization and the team; an approach for which the researcher is uniquely qualified to assess.