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Shifting stroke care from the hospital to the nursing home: explaining the outcomes of a Dutch case
Author(s) -
van Raak Arno,
Groothuis Siebren,
van der Aa Robert,
Limburg Martien,
Vos Leti
Publication year - 2010
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2009.01295.x
Subject(s) - negotiation , work (physics) , action (physics) , nursing , supply chain , service (business) , process (computing) , business , medicine , computer science , sociology , marketing , mechanical engineering , social science , physics , quantum mechanics , engineering , operating system
Rationale, aims and objectives Supply chains can contribute to better care for stroke patients and more efficiency. However, such outcomes are hampered when links in the chain are weak. The article aims to further the knowledge about the causes and possible improvements of weak links thereby using theory about rules for action and routines (action patterns). Method We executed a single case study of a chain of service delivery to stroke patients by a university hospital and a nursing home in the city of Maastricht, the Netherlands. Methods included document study, interviews, observations, process mapping, use of data matrices and performance of t ‐tests. Results In the case, the care delivery process in the chain was redesigned to improve the flow of patients and to reduce the length of hospital stay. Length of stay was reduced. However, transfer of patients from the hospital to the nursing home was hampered. At this weak link in the chain, the redesign clashed with the routines of hospital paramedics who did not want to work according to the redesign. Conclusions The applied theory is useful to understand why a link in a supply chain is weak. Negotiations can be used to strengthen a link.