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Patient Turnover in a new Psychogeriatric Day Hospital: a Pluralistic Evaluation

Published online by Cambridge University Press:  14 November 2008

Gilbert Smith ,
Caroline Cantley  and
Valerie Ritman
Gilbert Smith
Affiliation:
Professor of Social Administration, University of Hull, England.
Caroline Cantley
Affiliation:
Research Assistant, Department of Community Medicine, University of Aberdeen, Scotland.
Valerie Ritman
Affiliation:
Research Student, Department of Social Administration and Social Work, University of Glasgow, Scotland.
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Abstract

Studies designed to evaluate the services of a health or welfare institution face the major difficulty of selecting evaluative criteria to serve as measures of successful performance. This paper explores that difficulty in the context of a study of a new psychogeriatric day hospital. The study and its methods of data collection are described. ‘Patient turnover’ features prominently as a measure of success within the hospital. Consultants, nurses, general practitioners, social workers, staff of a related hospital and patients’ relatives interpret this measure in different ways and adopt different strategies to pursue ‘success’ in their own interests. These differences are described. The paper concludes that a ‘pluralistic evaluation’ has several advantages as compared to other approaches.

Type
Research Article
Information
Ageing & Society , Volume 3 , Issue 3 , November 1983 , pp. 325 - 356
Copyright
Copyright © Cambridge University Press 1983

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References

NOTES

1 For the most recent overview of research on this theme in the context of services for the elderly see Goldberg, E. M. and Connelly, N.The Effectiveness of Social Care for the Elderly: An Overview of Recent and Current Evaluative Research, Heinemann, London, 1982.Google Scholar In spite of much work on the problems of evaluation, a difficulty – which is essentially some form of the difficulty that we describe here – constantly reappears. Goldberg, and Connelly, state in summary: ‘The evaluative process starts with the identification of aims, goes on to the definition and assessment of needs, the description and monitoring of input and moves on finally to the measurement of outcome’ (p. 37)Google Scholar [italics added]. In this article we describe how we are confronting the first stage of this process in research. (Although by the end of the paper we shall be led to concude that aims, assessed needs, inputs and outputs are by no means as separate or sequentially related as Goldberg and Connelly seem to suggest.)

2 Throughout the paper, such figures are drawn from the pilot study of the medical records, mentioned in the text. There may have been changes over time but we have no evidence to suggest that this would affect the general points that are made in this paper.

3 For comparative accounts of day hospital and other day services for the elderly and elderly mentally infirm, see Brocklehurst, J. C. and Tucker, J. S.Progress in Geriatric Day Care, King Edward's Hospital Fund for London, 1980Google Scholar; and Tibbitt, J. E. and Tombs, J.Day Services for the Elderly and Elderly with Mental Disability in Scotland, Scottish Office, Edinburgh, 1981.Google Scholar

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5 ‘Patient flow’ is not the only criterion of success used within this hospital. We are reporting upon other aspects of the work of the hospital elsewhere. See Smith, G., Cantley, C. with the assitance of Ritman, V.Pluralistic Evaluation: A Study in Day Care for the Elderly Mentally Infirm. End of Grant Report Submitted to the Scottish Home and Health Department (mimeo), Department of Social Administration, University of Hull, 1983.Google ScholarSmith, G., Cantley, C. with the assistance of Ritman, V., Day Care Made Simple. Health and Social Service Journal (9 06 1983).Google ScholarPubMedCantley, C. and Smith, G. Social work and a relatives support group in a psychogeriatric day hospital: a research note. British Journal of Social Work (forthcoming).Google Scholar

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7 Data on this project were collected under the usual conventions of research confidentiality and the protection of individual respondents. It is not possible in this paper to infer with certainty the identity of respondents (even though readers familiar with the research context may feel that they can). In ways which are not significant to the arguments of the paper some details have been deliberately falsified to ensure that this is so.

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16 This is not to imply that patients are discharged in a way that could be adjudged clinically premature. Such an assessment is not a part of our evaluation of the hospital.

17 Op. cit.

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27 Organisational strategies for achieving patient turnover are important, but we do not mean to imply that the Consultant's manoeuvres are purely tactical. He also exercises very considerable power rooted in his professional and legal position as consultant-in-charge of the hospital.

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46 Robertson, Unlikeop. cit.)Google Scholar who deliberately didnot interview patients because they expected their views to differ from staff, we do consider patients to be a significant constituent group of the day hospital. However, the collection and analysis of data generated by psychogeriatric patients themselves raises such substantial practical and methodological problems as to be beyond the scope of this paper.

47 For a recent study see Blaxter, M.The Meaning of Disability: A Sociological Study of Impairment. Heinemann, London, 1976.Google Scholar

48 Weiss, Carol H.Evaluation Research. Prentice-Hall, Englewood Cliffs, New Jersey, 1972, pp. 24–25.Google Scholar Amongst the problems she lists are the following. Goals are often hazy and ambiguous. In pursuing goals unexpected accomplishments are often achieved additionally and sometimes instead. Programmes consist of ‘congeries of activities, people and structures’. And in its simplest form the evaluative question neglects the issue of why, which is quite as important as the issues of how well.

49 Goldberg, E. M. and Connelly, W.Evaluative Research in Social Care. Heinemann, London, 1981, p. 313.Google Scholar

50 Kelman, H. R.The underdevelopment of evaluative research on health services for the elderly in the United States. International Journal of Health Services 10, 3 (1980), 501–511.CrossRefGoogle ScholarPubMed

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53 Ibid. pp. 127–129.

54 Strauss, A., Schatzman, L., Ehrlich, D., Booker, R. and Shabshin, M. The Hospital and Its Negotiated Order. In Salaman, J. and Thompson, K. (eds) People and Organisations. Longmans for the Open University Press, 1973, p. 318.Google Scholar

55 It could be argued that it is a mistake to link pluralistic evaluation methods to the pluralistic model of policy analysis. It may well be thought equally possible to use pluralistic methods within a ‘conflict’ model of policy analysis, or any other theoretical framework for that matter. Here we note only that in the course of our research we came to adopt pluralistic methods by viewing the Hospital as a pluralistic institution. We propose to discuss the general point at greater length elsewhere, for it involves issues which are beyond the scope of this paper. We are grateful to an anonymous referee for raising the matter.