Through the latest years, the discourse related to preventive hospitalization of citizens older than 65 years, has affected the debate about the health care system. We, as leaders of a municipal acute team, a medical helpline 1813/1-1-2 and a medical ward respectively, have the impression that a lot of initiatives have been identified and initiated to prevent hospitalization within the group of citizens older than 65 years. Despite the vast number of initiated activities to address this issue, it still seems to be an unsolved problem, which puzzles us.
Based on this the present master thesis aims at clarifying the construction of the discourse related to preventive hospitalization and analyse how the discourse affects the hospitalization of citizens older than 65 years.
In addition to focusing on hospitalization of citizens older than 65 years, scope of the research for this master thesis has been further limited by only including procedures involving the following three public organizations within the Capital Region of Denmark: a municipality, a hospital and the emergency medical service.
Norman Faircloughs theory of critical discourse analysis and Tor Hernes process of sensemaking applies as the theoretical framework for the analysis. The theoretical frame is used to analyse collected empirical data, consisting of semi structured interviews of three leaders within the investigated organizations and in addition case studies of actual hospitalization cases. The thesis includes 23 case studies, based on observations and interviews with citizens, relatives and members of the staff.
Faircloughs theory of critical discourse analysis addresses the topic of understanding and talking in and about a specific context. Using this theory, it is analysed through three interviews how the discourse of preventive hospitalization is constructed and interrelations to other discourses and their respective position and discourse order within the discourse of preventive hospitalization. Through this knowledge about the reality the discourse of preventive hospitalization constructs is derived. Hernes’ process of sensemaking addresses how organisations create a common purpose but can also be used to explain the absence of a common purpose. Within the thesis the process of sensemaking is applied as analytical tool in the case study analysis to derive knowledge about how the discourse affects hospitalization of citizens older than 65 years.
Conclusions from the research for this master thesis shows that the discourse about preventive hospitalization constructs a reality about preventive hospitalization which can be recognized in the case studies observations and interviews of staff members, but not in the individual hospitalization processes themselves. Furthermore, it is concluded that the discourse lacks ambiguity and that no common “we” can be identified in relation to solving the problem preventive hospitalization is said to be. Whereas the discourse gets a significant function in bringing hope to staff and leaders for a solution to challenges related to lack of resources. Finally, it is concluded that within the discourse of preventive hospitalization lies a field of stress between the discourse’s construction of a reality and the reality staff members experience during the individual hospitalization processes.
Overall there is a need to approach the field of preventive hospitalization on multiple levels. First the need for a reform of the field is identified in order to create a common understanding of problem, roles and responsibility. Implemented solutions have so far had an internal organisational focus and been based on a cross functional perspective due to a normative frame related to lack of resources and finance. Validity and reliability of this master thesis shows that conclusions from the case studies can be generalized to include the complete health care system.
In a larger perspective, conclusions from this master thesis can contribute to a unified understanding within in the health care system of the field “preventive hospitalization” and based on this unified understanding contribute to further develop the field.
|Uddannelser||Master of Public Governance , (Masteruddannelse) Afsluttende afhandling|