The ihub’s Evidence and Evaluation for Improvement Team (EEvIT) undertook a mixed-method research approach to build a rich picture of how this success was achieved. By doing so, we identified five initiatives that contributed the most to getting people home promptly.

Why delayed discharge matters

Delayed discharge, when a patient remains in hospital despite no further need for hospital care, poses an unnecessary risk to the health and welfare of the patient.

Hospital is not always the best place to be and the risks are particularly concerning for older or frailer people, whose independence may be threatened.

As well as being inappropriate care, it is an inefficient use of scarce healthcare resources.

East Ayrshire HSCP has successfully reduced both the numbers and lengths of delayed discharges.

We wanted to understand how they achieved this success in order to share learning from their approach with other HSCPs across Scotland.

Approach

Our evaluation consisted of:

• semi-structured interviews with a range of stakeholders from the health, social care and third sectors
• a review of documents
• observation of hospital work, and
• analysis of data from the Information Services Division (ISD) of NHS National Services Scotland.

Identifying improvement initiatives

Interviewees reported five main improvement initiatives, which they thought contributed most to getting people who no longer needed hospital treatment home - or to a homely environment - in a prompt, safe and legal manner.

Although the success of these initiatives is considered key, they cannot be seen separately from one another nor from the whole organisation.

Indeed, our key finding is that East Ayrshire’s whole system approach driven by strong, consistent and caring leadership across all levels of the HSCP, with a relentless person-centred focus, is central to their overall success.

The improvement initiatives reported are:

1. early referral to hospital-based social work team (SWT) and presumption of return home
2. dedicated Mental Health Officer (MHO) for adults with incapacity (AWI)
3. discharge to Assess (D2A)
4. intermediate care and enablement, and
5. British Red Cross 'Home from Hospital' services.

We also identified system-wide enabling factors that underpin the improvement work. These include:

• leadership and person-centred ethos
• ownership of the delayed discharge target as a priority across the partnership
• flexibility of finance/budgeting to support priorities
• whole system preventative approach
• integrated working values and practice
• openness to improvement ideas from all parts of the partnership, and
• constructive party politics with political groupings in the council working constructively together.

Comments from staff summarise the collective ownership of the improvement work. A widespread sentiment among the interviewees was:

“do right by people and the money will look after itself”

“Delayed discharge? Not on my watch”

Sharing good practice

It is our intent with this story to share some of the ideas that worked for East Ayrshire HSCP.

We believe that our approach of combining qualitative and quantitative data analysis was helpful in capturing the key learning important to spreading the approach taken by East Ayrshire elsewhere.

The Director of Quality Innovation and People at the Golden Jubilee National Hospital, Gareth Adkins, said this was “valuable learning shared”.

We hope that other health and social care organisations in Scotland find this overview useful when further developing your own practical ideas for change in reducing both delayed discharge and the risks to patients from unnecessary time spent in hospital.

Further information

There is more information on the EEvIT web pages, including the full case study report about East Ayrshire’s work.