Table 2 Examples of coding process during analysis of narrative and interview data
Meaning units from narrative (Project 7) that indicate performance variability | Factors influencing performance variability | Adaptations made in response to variation | Stakeholders involved in adaptations | Stakeholder relationships |
Considerable variations were identified in the time (hour of day) the patient was determined medically fit for discharge; discharge process was found to be more rushed when the patients were declared medically fit after noon. This was because of the reduced possibility to prepare the discharge requirements for care transfer if the transfer was to take place the same day. The healthcare personnel stated that time pressure affected precision in their work. When decisions are made later in the day, this also creates time pressure for local municipality personnel who have to initiate processes related to care planning and post-care transfer on their end. This time pressure was exacerbated by financial penalties for delayed discharge; these encourage municipal staff to rush care planning to avoid paying the daily fee. The next of kin played an important role as advocates in the decision making regarding post-discharge arrangements. In some cases, the next of kin questioned whether their involvement and persistence had an impact on the level of post-discharge care offered. | Patient characteristics Degree of familiarity with patient Time of discharge Time pressure to complete task Competing task demands Availability of information Availability of resources External financial demands | Involvement of patients’ next-of-kin in decision-making (at discharge). Family members actively advocate for patients. | Patients Family members Healthcare professionals | Patients and family: fully linked Family and healthcare professionals: collaboration Healthcare professionals from different provider organisations: communication and collaboration |
Meaning units from interview (Project 15) that indicate performance variability | Factors influencing performance variability | Adaptations made in response to variation | Stakeholders involved in adaptations | Stakeholder relationships |
[Patient participation and shared decision-making] is easier to achieve in practice with those [patients] who are motivated and have resources behind them and within their network, then it is much easier to succeed. … For those who seek treatment and believe in it, who are motivated and want it, it is easy to make it happen. For those [patients] who have a more complex picture and who are more unwell, and perhaps have less support, et cetera, then it is far more demanding and … the healthcare personnel and therapists must use their clinical competence and make a discretionary assessment as a provider. You cannot standardise it [patient care] 100%, you have to offer different menus to different people. Some people get a simpler menu, while others get one with many options … or where multiple steps … is what is required to be able to establish collaboration or create a secure environment [for the patient]. Whereas if you were to do that with every single young person who comes into mental health care, then you would not have managed to help more than the tip of the iceberg of those who need it. So an assessment is required along the way by the staff. Family members often have an important role in … the follow-up of measures put in place [for the young person] but will depend on their capacity for cooperation and engagement in follow-up over time. | Patient characteristics Patient needs Patient capacity Degree of family support Family capacity for involvement Staff / team competency Staff / team experience Staff / team capacity Unit / ward capacity | Extra or special efforts to engage patients by healthcare professionals. Involvement and engagement of family by healthcare professionals. Family involvement in follow-up of care. | Patients Family members Healthcare professionals | Patients and family: fully linked Patients and family: not linked Family and healthcare professionals: collaboration Family and healthcare professionals: not linked |