The Emergency Department, Clinical Research Centre, Amager and Hvidovre Hospital, University of Copenhagen , Hvidovre, Denmark.
Department of Public Health, University of Copenhagen , Copehagen, Denmark.
J Health Organ Manag. 2019 Aug 8;33(5):547-562. doi: 10.1108/JHOM-10-2018-0284. Epub 2019 Jul 17.
Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools for preventing readmissions in emergency department (ED), where the primary focus is often the present-day flow of patients, is scant. The purpose of this paper is to explore whether a new screening tool for predicting readmissions and functional decline in medical patients>65 years of age could be implemented and its influence on cross-continuum collaborations between the primary and secondary sectors.
DESIGN/METHODOLOGY/APPROACH: The study took place in an ED in Denmark, in collaboration with the surrounding municipalities. An evaluation workshop with nurses and leaders from the ED and the surrounding municipalities took place with the aim of investigating the organizational changes that occurred in daily practice after the implementation of the screening tool. The workshop was designed and analyzed using cultural historical activity theory (CHAT).
The results showed that it was possible to develop collaboration between the two sectors during the test period. However, the screening tool created different transformations for the municipality employees and in the ED. The contradictions indicated that the screening tool did not mediate a general and sustained transformation in the cross-continuum collaboration.
RESEARCH LIMITATIONS/IMPLICATIONS: Screening tools are not objective, neutral or "acontexual" artifacts and must always be adapted to the local context and sectors. CHAT offers a perspective to understand the collective object when working with organizational transformations and implementation.
The study have shown that screening tools are not objective, neutral or "acontexual" artifacts and must always be adapted to the local context. This is called adaption process. This adaption requires time and resources that should be taken into consideration from the beginning of introduction of new screens.
ORIGINALITY/VALUE: This paper contributes with knowledge about CHAT which offers a way to understand the leading collective object when working with organizational transformations and implementation. CHAT focuses not only on the structural changes but also on the cultural aspects of organizational changes, which is important if we want to reach a sustained change and implement the new screening tool in different sectors.
老年患者住院再入院的风险较高，这导致了越来越多的筛查和干预计划。在急诊科（ED）中，由于主要关注点通常是当前患者的流程，因此对于用于预防再入院的筛查工具的知识相对较少。本文的目的是探讨是否可以实施一种新的用于预测 65 岁以上医疗患者再入院和功能下降的筛查工具，以及其对初级和二级保健部门之间的跨连续合作的影响。
设计/方法/方法：该研究在丹麦的一家急诊科进行，与周边市合作。与 ED 和周边市的护士和领导举行了一次评估研讨会，目的是调查在实施筛查工具后日常实践中发生的组织变化。研讨会的设计和分析采用了文化历史活动理论（CHAT）。
结果表明，在测试期间可以在两个部门之间发展合作。然而，筛查工具为市员工和 ED 带来了不同的转变。矛盾表明，筛查工具并没有在跨连续合作中促成普遍和持续的转变。
研究局限性/影响：筛查工具不是客观的、中立的或“无背景的”人工制品，必须始终适应当地的背景和部门。CHAT 提供了一个视角，用于理解在组织变革和实施过程中处理集体对象。
该研究表明，筛查工具不是客观的、中立的或“无背景的”人工制品，必须始终适应当地的背景。这被称为适应过程。这种适应需要时间和资源，从引入新的筛查开始就应该考虑到这些。
原创性/价值：本文为 CHAT 提供了知识贡献，CHAT 提供了一种理解在组织变革和实施过程中处理集体对象的方法。CHAT 不仅关注结构变化，还关注组织变革的文化方面，如果我们想要实现持续的变革并在不同部门实施新的筛查工具，这一点很重要。
