Social work and complex care systems : The case of people hospitalised with a disability

Health and hospital system reforms prioritise efficiency. However, initiatives can impact on people with new or existing disabilities who require time to maximise functional independence. With greater demands for shorter hospital stays social workers face increasing pressure to facilitate discharge. This paper reports findings from research identifying factors contributing to extended stays for adults with disabilities. We sought to better understand patient characteristics and discharge planning challenges by analysing a clinical dataset of 80 patients and qualitative interviews with five experienced hospital social workers. Three key factors are identified: issues around rehabilitation services; assessment and planning for community care; and availability of and access to discharge options. Strategies to reduce length of stay are reported. We argue that building collaborative partnerships and working across multiple, complex systems and disciplines are vital to ensure these patients access appropriate community-based resources within the current health reform environment.

卫生医疗体系的改革是效率优先。有些动议会影响那些需要尽可能在功能上自立的残疾人。缩短住院时间的要求增大，社会工作者面临帮助病人出院的压力。本文旨在确定哪些因素有助于成年残疾人延长住院时间。笔者对包括80位病人的病案做了分析，并对5位资深驻院社会工作者做了访谈，以便更好了解病人的特点和出院计划遇到的问题。我们确定了三个关键因素：康复服务；社区看护的评估及计划；能得到哪些出院选项。本文记述了缩短住院时间的一些办法。作者认为，打造伙伴合作关系，进行横跨多重复杂系统及学科的运作，对于病人在现有卫生改革的环境中获得适当的社区资源至关重要。