title: Understanding the occupational and organizational boundaries to safe hospital discharge.
abstract: OBJECTIVE
  Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge.
  
  
  METHODS
  An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers.
  
  
  RESULTS
  Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge.
  
  
  CONCLUSIONS
  Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety.
authors.affiliation: Professor of Organizational Sociology, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK justin.waring@nottingham.ac.uk.
authors.forename: Justin
authors.initials: J
authors.lastname: Waring
authors.affiliation: Research Fellow, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Marshall
authors.affiliation: Lecturer, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bishop
mesh_terms: D000884:Anthropology, Cultural; D017028:Caregivers; D003142:Communication; D003299:Cooperative Behavior; D004739:England; D006282:Health Personnel; D006302:Health Services Research; D006620:Hip Fractures / Q000534:rehabilitation; D006739:Hospital Administration; D006801:Humans; D007400:Interprofessional Relations; D015279:Organizational Culture; D010351:Patient Discharge; D061214:Patient Safety; D012947:Social Work / Q000458:organization & administration*; D000068217:Social Workers; D000071939:Stroke Rehabilitation
keywords: boundaries; communication; coordination; hospital discharge; patient safety