Ashbaugh J W, Bradley V J
Hosp Community Psychiatry. 1979 Feb;30(2):105-10. doi: 10.1176/ps.30.2.105.
Deinstitutionalization of patients is an inevitable forerunner of hospital phase-down or closure, but if the two processes are carried out at the same time, they will be counterproductive. An evaluation of the combined deinstitutionalization and phasing down of a state hospital in Pennsylvania indicated conflicts in the areas of case management, community and political support, and administrative flexibility. A substantial problem was that deinstitutionalization is time-consuming and must be flexible enough to allow for the development of essential community supports and for largely unpredictable reactions from patients, families, communities, and service providers. Conversely, hospital consolidation must be relatively quick and inflexible to permit the orderly redisposition of staff and patients, reduce unnecessary staff resistance and anxiety, and withstand changing political pressures.
患者非机构化是医院逐步缩减或关闭的必然前奏，但如果这两个过程同时进行，将会适得其反。对宾夕法尼亚州一家州立医院的非机构化和逐步缩减相结合的情况进行评估后发现，在病例管理、社区和政治支持以及行政灵活性等方面存在冲突。一个重大问题是，非机构化耗时且必须足够灵活，以便能够发展必要的社区支持，并应对患者、家庭、社区和服务提供者在很大程度上不可预测的反应。相反，医院整合必须相对迅速且缺乏灵活性，以便有序地重新安置工作人员和患者，减少工作人员不必要的抵触和焦虑，并承受不断变化的政治压力。
