The battlefield: discharge planning and multidisciplinary team work

Discharge planning is remarkable in that despite government legislation and research which stretches back over twenty years it remains problematic. Furthermore it is an activity which requires collaboration between health and social care agencies. Indeed many researchers have highlighted problems associated with collaboration and joint working, which remain problematic. The aim of this thesis is to explore whether teamwork and discharge planning are compatible concepts and whether the team process influences the outcome of discharge decision making. The research design encompasses a case study approach which focuses on three individual cases within medicine, orthopaedics and elder care. It was necessary to combine both qualitative and quantitative techniques which included structured observation (Bales Interaction Analysis), in-depth interviews (critical incident approach) and a national discharge survey.
The data from the research found that the social aspects of the discharge process are often ignored or neglected and that assessments are rarely coordinated. There was considerable cynicism surrounding multidisciplinary team work and that lack of time was reported to be the biggest barrier which effected interprofessional working. Non decision making frequently occurs in teams as professionals are reluctant to voice their opinions as its members choose not to participate. This is referred to as the 'multidisciplinary orchestration game.' Research is of little value if it does not make an impact on clinical practice or on health and social care policy thus the data from the research study was used to formulate a new model of practice in orthopaedics with fractured neck of femurs using a Delphi survey (postal questionnaire method) and action research. Despite the implementation of the
interprofessional discharge model, professionals are failing to place the needs of the patient first the 'multidisciplinary orchestration game' continued. Thus discharge planning will remain problematic unless many of the problems identified in the study are resolved.

A thesis submitted to Middlesex University in partial fulfilment of the requirement for the Degree of Doctor of Philosophy.