Expanding our understanding of factors impacting delayed hospital discharge: Insights from patients, caregivers, providers and organizational leaders in Ontario, Canada

Abstract

INTRODUCTION: The purpose of this paper was to understand the nature of delayed hospital discharge through the lens of a policy framework (ideas, institutions and interests; 3-I framework). MATERIALS AND METHODS: One-to-one in-depth interviews were conducted with 57 participants, including 18 patients, 18 caregivers, 11 providers and 10 organizational leaders across two hospital networks in urban and rural regions of Ontario, Canada. RESULTS: Delayed discharge was a product of spill-over effects (due to rules and eligibility in other health sectors) and variable implementation of policies and guidelines (institutions); competing priorities and tensions among patients, caregivers, providers and organizational leaders (interests); as well as a number of perceived root causes including patient complexity, caregiver burnout, lack of system infrastructure, and an imbalance of system and personal responsibility to support aging adults (ideas). CONCLUSIONS: The 3-I framework allowed us to examine the contributing factors to delayed discharge in a comprehensive way. Based on our findings we suggest that cross-sectoral collaboration and strengthening of relationships among stakeholders is required to address this complex policy problem.