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A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent

Gadsby, Erica Wirrmann, Wistow, Gerald and Billings, Jenny (2022) A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent. Critical Social Policy, 42 (4). 671 - 694. ISSN 0261-0183

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Identification Number: 10.1177/02610183211065028


Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.

Item Type: Article
Official URL:
Additional Information: © 2022 The Authors
Divisions: Personal Social Services Research Unit
Subjects: R Medicine > RA Public aspects of medicine
Date Deposited: 20 Jan 2022 15:03
Last Modified: 07 Jun 2024 05:12

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