Process evaluation of discharge planning implementation in healthcare using normalization process theory.
BACKGROUND
Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers.


METHODS
The study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff.


RESULTS
Using the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice.


CONCLUSIONS
The result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.
Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden. sofi.nordmark@ltu.se.|Department of Healthcare Administration, Norrbotten County Council, Luleå, Sweden. sofi.nordmark@ltu.se.
Sofi
S
Nordmark
Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.|Department of Research and Development, Norrbotten County Council, Luleå, Sweden.
Karin
K
Zingmark
Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.|Department of Healthcare Administration, Norrbotten County Council, Luleå, Sweden.
Inger
I
Lindberg
D000328:Adult; D001291:Attitude of Health Personnel; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D009936:Organizational Innovation; D010351:Patient Discharge / Q000592:standards*; D017064:Process Assessment, Health Care / Q000379:methods*; D036301:Qualitative Research
Discharge planning process; Implementation; Normalization Process Theory; Qualitative research