Question 2 Describe the present patient care delivery system
Did not answer the question
1 ( 1 .63%) participant did not answer the question.
Service
1 4 (22.95%) participants - all nurses - answered explicitly in terms of a service within the CHE.
System
1 5 (24.59%) participants made comments about althe system.
Complete system
3 (4.9 1 %) participant' s descriptions could be related to a complete system of care delivery:
The whole episode of care, that you know, that you get when you first become ill, so I guess it goes from the GP right through to - from your bed at home to your bed at home [ 1 ]
Patient gets sick comes into services; It 's care or cure o r both (or lay them out) and get them home. It's a pretty vague definition but it's the guts ofwhat's happening. [8] It 's a total system. Everything from the cafeteria feeding the staff in order that they are fit and healthy to look after patients .. . The dietician who checks the nutritional value, the orderly who delivers it and the nurse who serves it and who ever cleans up the mess afterwards and the state of the patient themselves [53]
No system
However having described the system, the same person went on to say: There appears to be no system [53]
This view was endorsed by 3 (4.91 %) other participants
I don 't know whether actually, we necessarily have any formal patient care delivery· system at this stage. [2]
There isn 't a system or no-one really understands the system Patient care delivery system there isn 't one [ 1 3]
Essentially we don 't have one. Everything 's separate and getting more so [ 1 9] Multiple systems
5 (8. 1 9%) participants felt there were multiple systems:
Each service is pretty much responsible for its own little entity. It will create and develop its own patient care delivery system [ 1 3]
I don 't believe we have one system right through the CHE [ 1 8]
I guess you could say we 've got lots and lots of patient care delivery systems. We 've got mental health, public health [48]
There are mini systems [50]
It's my understanding that we have multiple systems [56] General terms
3 (4.91 %) participants described the system in general terms:
We 've got a very generic system [4]
We have an eclectic system of patient care [ 1 1 ] It's just an empiric system of delivery [52]
Historical
6 (9.83%) participants felt it was historical:
It 's very, very little changed since I started 40 years ago [5] In some areas it 's historical [ 1 8]
It 's fairly traditional having evolved not enormously from that which has been practised in the past [30]
I don 't think the system has changed all that much [37]
I guess we have the one that has been within the organisation for a long time [41 ] It's fairly traditional at the moment. To my knowledge that system has existed for 40
years [44]
I think it's something that just happened and it's grown over the years rightly or wrongly [46]
Medical practice
6 (9.83%) participants felt system is built around medical practice:
I still think it 's organised on an individual basis by [medical] clinicians who decide who 's in and who 's out in terms of the care spectrum [2]
Patients are grouped according to their, not so much their disease process but sort of by discipline of medical staff [ 1 4]
The traditional thing of being assigned to a medical person. I think our patient care delivery system is focused around professionals [ 1 6]
How patients receive their care is based around the demands of the medical people. At the moment the planning of care is very based on the individual disciplines [28] It's fairly traditional at the moment in that patients with a particular diagnosis come under a particular clinical team [441
One thing that has become very clear is the splitting up of the care delivery process around medical teams [57]
Medical influence
3 (4.91 %) participants believed there was strong medical influence: At present it is still very medical [ 1 0]
The medical staff dominate the system [27]
Well I think it's a medical model [5 1 ]
Future plans
9 ( 1 4.75%) participants referred to a future plans:
Moving towards patient focused care
4 (6.55%) participants believed the organisation was moving towards patient focused care:
Focused patient care and case management [22]
We have to move increasingly to a patient focused care delivery model [30]
Moving to care that has the patient as its focus . . . trying to create a continuous episode of care and they don 't perceive any bumps [40]
We have a project which is focusing on putting the patient in the centre and straightening the path for the patient [4 1 ]
Moving towards integrated care
3 (4.91 %) participants believed the organisation was moving towards integrated care: We are trying to move into planned integrated care rightfram primary referral to the community services [2]
Trying to get an integrated delivery system [55]
We tried to set it up as a service based model. We 're very much trying to focus on services. There 's a lot of work being done in determining clinical pathways and to
integrate the services that are provided so they are seamless for the patient [9]
Moving towards critical pathways
2 (2.37%) participants believed the organisation was moving towards patient focused care:
We 're moving to a more multi-disciplinary approach and to critical pathways [ 1 0] We 're progressively moving to clinical pathways [22]
Moving towards a greater emphasis on health
1 ( 1 .63%) believed there was a move towards a greater emphasis on health:
We 're trying to put more emphasis on health rather than an institutional basis [52]
Remaining
I don 't think it is a fixed static system I think the system keeps changing [ 1 8] 1 participant couldn' t describe it because it is too fragmented [59]
The phrase 'patient care delivery system' does not have a universally accepted definition.
It is however a phrase well known to the researcher and one that is used in the literature. Participants who asked the researcher 'what is a patient care delivery system?' were asked to determine this for themselves.
Used within a general systems frame of reference it could be expected that participants would describe eRE system inputs, process, outputs and feedback loops. Used less formally it could describe a patient' s pathway through the system. In either
case essential to the description of a system is information about the various components and their interrelationships.
It was expected that participants would recognise the centrality of the patient and describe in some way patient inputs and outputs e.g. patients in need as an input and treated, referred or deceased patients as an output. An unexpected finding was that only 3 (4. 9 1 %) participants acknowledged the importance of patient need as a primary input. It is now apparent that the majority of participants could not readily conceive of an entity they could label as a PCDS.
14 (22.95%) participants answered in terms of a service. Giv�n that a service is a subsystem of the PCDS answers to subsequent questions do provide relevant information . If for example the subsystem is not evaluated the PCDS is not evaluated.
Participants who referred to integrated systems and/or patient focused care and/or critical pathways indicated a change in their frame of reference. Instead of structure and efficiency dominating business of the organisation effective patient care and health professional clinical education were becoming central to planning.
The influence of medical structures and decision-making processes was commented on by 1 0 ( 1 6.39%) participants but a link was not made to future plans.