The integration between health and social care organisations is an acknowledged public policy problem. Issues such as delayed discharge, also known as ‘bed blocking’ have become matters of public debate. Despite government efforts at implementing ‘joined up thinking’, government have found this area frustratingly ‘policy resistant’. Government proposals on fining local authorities over ‘bed blocking’ had to be withdrawn when a systems thinking based report showed their deficiencies. The thesis considers the effectiveness of information systems and the utility of systems thinking approaches in assessing the likelihood of a successful information system led intervention in this area. It relates specifically to social care provision for the elderly, since elderly people are the most significant proportion of patients that experience delayed discharge. A case study approach has been applied looking at the health and social care team responsible only for elderly patients. This concerns the elderly care wards from hospitals at two NHS trusts and a social services department. System dynamics and the use of a rich picture from the Soft Systems Methodology are used. The rich picture has captured the problem situation and informed the building of the system dynamics model, such as of the delays and patient process that exists. The system dynamics model has allowed rigorous testing of the effects of information system policies. These methodologies are used to test the proposition that information systems can achieve a significant improvement in reducing delayed discharges. The focus of this thesis is to look at the effect that integrated health and social care information systems can have on delayed discharging of elderly patients in the UK National Health Service (NHS) and Social Services. This thesis asserts that there has been a need for better information systems not just within separate health and social care industries, but a need for better information systems that span both sectors. Social care and health sectors have both shown a poor history of implementing information systems. There has been a lack of understanding shown of the impacts of information systems using systems thinking approaches, largely by those who use the information systems. This thesis makes the assertion that although information systems will not eradicate all health and social care organisational problems, information systems will make a significant beneficial difference to the way in which organisations operate. Integrated information systems have shown to be useful in informing the capacity changes that are needed throughout the health and social care system. This informs management action to change capacities based on backlogs of patients waiting for services. This led to reduce delayed discharging, as numbers of patients experienced delayed discharges dramatically fall. System dynamics has shown to be useful in allowing the complex behaviour of delayed discharges over time to be understood, by making use of feedback loops and time delays. A rich picture has been useful in capturing stakeholders’ views and the problem situation of delayed discharging. The rich picture has been used as a communication tool to aid stakeholders understanding the problem situation. The conclusions are that these methodologies provide a sound test bed for the proposition that integrated information systems can be useful. However, this is only if they stimulate action across the health and social care sectors, when capacity is limited. Integrated information systems should be used by managers to inform them of the capacity changes that need to be made throughout the patient process, helping to ensure there is a greater response and action to reduce delayed discharges.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:635912 |
| Date | January 2011 |
| Creators | Sardiwal, Sangeeta |
| Publisher | London South Bank University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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