Modelling a typical patient journey through the geriatric evaluation and management ward to better understand discharge planning processes

Our study sought to identify the variability inherent in everyday practice during discharge processes, to assist us in understanding how clinicians ‘muddle through’ to meet organisational and patient needs. The study utilised the Functional Resonance Analysis Method to develop a model to describe Work-as-Done in a Geriatric Evaluation and Management Ward at a regional hospital in Australia. The model was based on interviews with 14 ward staff. We describe four instantiations where uncontrolled performance variability could lead to unwanted outcomes, such as extended length of stay and inadequate post-discharge treatment and care. Three key features were identified to dampen variability. The need to trade-off thoroughness for efficiency drives staff to adopt a muddling through process, whereby objectives are agreed, but the actual process varies to meet patient needs and the demands of the work.