Abstract
BackgroundHealthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice.AimThis study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged.MethodsThis qualitative study arises from a hermeneutical stand within the interpretative paradigm.Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines.ResultsThe analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”.ConclusionDissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.
Highlights
Healthcare services have become more complex, globally and nationally
The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”
The analysis of the practice and interactions of the healthcare professionals in this study revealed four main themes: 1) “The end justifies the means – ‘I know what is best for you’”, 2) “Basic needs of care overruled by system effectiveness”, 3) “Treatment as a bargain”, and 4) “Healthcare professionals as solo detectives”
Summary
Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. Placing the patient at the center of care and treatment served to enhance the individual patients’ needs and uniqueness [15], which created a less linear and more complex clinical care pathway [17]. Despite this complexity, patient involvement was popular and included in many organizations’ mission statements [15]. The World Health Organisation (WHO) acknowledged that formal patient participation and engagement contributed to improvement of healthcare services, care culture [18], and patient safety [19]. Based on the idea that patients have important resources and needs contributing to a better safety culture [19], tools such as models of ‘shared decision-making’ were encouraged as a central point in treatment [11]
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