title: An ethnographic study of intermediate care services in Wales: the hidden work.
abstract: OBJECTIVE
  To explore the perceptions of staff working in and referring to community-based intermediate care teams in Wales.
  
  
  BACKGROUND
  Central and devolved governments have high expectations of intermediate care to promote independence and quality of life for older people and to solve the system pressures within the acute hospital sector. Developing an evidence base of the effectiveness of a model of care that is characterized by diversity and difference in practice is problematic.
  
  
  METHODS
  Fourth generation ethnographic evaluation involving focus groups, non-participant observations and semi-structured interviews with people working within and referring to intermediate care teams. PRELIMINARY FINDINGS: Strong evidence of interprofessional working demonstrated by shared responsibility, coordinated rather than parallel services, understanding of other organizations and recognition and resolution of conflict areas. This generated work which traditional measures would not identify.
  
  
  CONCLUSIONS
  Evaluation is inherent in the work of healthcare professionals and managers. Managers need to aware of the systems and structures within which they are required to manage. This is important for intermediate care services as the heterogeneity contributes to the challenges encountered by managers when seeking to describe services and measure their effectiveness. Applying an appropriate evaluation framework will facilitate both.
authors.affiliation: School of Health Science, Swansea University, Swansea, UK. v.thomas@swansea.ac.uk
authors.forename: Valerie
authors.initials: V
authors.lastname: Thomas
authors.forename: Susan
authors.initials: S
authors.lastname: Lambert
mesh_terms: D000368:Aged; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003152:Community Health Nursing / Q000458:organization & administration*; D017144:Focus Groups; D005851:Geriatric Nursing / Q000458:organization & administration*; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D016294:Models, Nursing; D009718:Nurse Administrators / Q000458:organization & administration; D024802:Nurse's Role / Q000523:psychology; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D013222:State Medicine / Q000458:organization & administration; D019467:Subacute Care / Q000458:organization & administration* / Q000523:psychology; D011795:Surveys and Questionnaires; D014852:Wales