Abstract
There is a critical need to improve functional outcomes in hospitalized seniors for both the individual and their caregivers, and to plan for a sustainable healthcare system in the face of an aging population. Over 50% of acute care hospital beds in Canada are occupied by seniors; one-third of these older patients will be discharged at a significantly reduced level of functional ability. Most will never recover to their previous level of independence. This article offers perspectives on research and implementation strategies that take into account the complex, interacting challenges to improving hospital outcomes in seniors. To this end, we describe two cost-neutral strategies with demonstrated successful outcomes. One developed as a focused care strategy and related care processes on a geriatric medicine/rehabilitation unit. The other describes a change in staff-mix and hours of interdisciplinary coverage that resulted in increased hours of direct care and improved outcomes for older adults on acute care units. Both strategies demonstrated reductions in length of stay in the initial context; however, we identified a number of challenges to translating these strategies to a broader context. We contend that this difficulty is understandable given the complexity of seniors’ health, health services and organizational change. Research methods and approaches to change in health service delivery need to take complexity into account. We propose a metanarrative research methodology that combines qualitative and quantitative methods, as one way of taking complexity into account in health service research. Finally, we propose a way of thinking about organizational change that offers an alternative to typical ‘roll-out’ strategies that cannot take into account the inevitable uniqueness of each context in which a strategy may be implemented.
Financial & competing interests disclosure
J McElhaney is supported as Professor of Medicine and the Allan M McGavin Chair in Geriatrics Research, University of British Columbia. E Borycki is Assistant Professor in the School of Health Information Science, University of Victoria. M Briggs is Practice Consultant for Interprofessional Practice, Education and Research, Providence Healthcare. S Bisaillon is Executive Director of Clinical Operations at Trillium Health Centre. R Upshur is Professor of Family and Community Medicine and the Canada Research Chair in Primary Care Research, University of Toronto. K Rockwood is Professor of Medicine and the Kathryn Allen Weldon Professor of Alzheimer Research, Dalhousie University. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Notes
CCbD: Collaborative Care by Design; CQCL: Clinical quality care leader; OT: Occupational therapist; OTA: Occupational therapy assistant; PT: Physiotherapist; PTA: Physical therapy assistant.