Udvikling af akutfunktioner på tværs af sektorerne i sundhedsvæsnet

Abstract

How can the healthcare system be administrated in Denmark? How do we ensure the prevention of unnecessary hospitalizations of patients, thus only patients who are in absolute need of hospitalization will get transferred into the hospitals for treatment, and that the treatments at the hospitals will be executed in the shortest amount of time? These are all questions that are relevant to ask, when I as a leader of the home health care and the home nursing in Albertslund municipality, also has the responsibility of the forthcoming emergency function.

In the spring of 2017, the Danish Health and Medicines Authority established a new quality standard regarding the emergency function, which the municipalities has to follow. It prescribes that all the municipalities in Denmark from the beginning of 2018, are required to have emergency functions. The quality standard regarding the emergency functions prescribes, that we need to have fewer hospital admissions, and more citizens who gets treated at home. This was decided, despite all the prognoses shows, that there in the future will be more elderly people over 65 years old, there will be more people with chronical deceases, and there will be more people with simultaneous deceases. It is these categories of patients who greatly take up the beds at the hospitals. When we shut down the bed capacity at the hospitals, it means that these patients henceforward needs to be treated at home.

The healthcare system exists of three main components; the municipal health system, the general practitioners and the hospitals. In order for the emergency functions purpose to be fulfilled, there needs to be a different interdisciplinary cooperation between the sectors than we have today. In this assignment, I am describing bureaucracy and professional management as a perspective on reflections that could have made the government choose to compose a quality standard for the collaboration in the healthcare system. This can help me to understand this development in the society in terms of management. I am using New Public Management, Neo Weberian State and New Public Governance to discover, what these management logics can offer as a setting of the organizations in the healthcare system, and how these can advance or impede the development towards the patients being treated at home. I am using the theory of ralational coordination to learn, what it requires from the cooperation, for the citizens to be treated at home when possible.

My examination shows, that the way the healthcare system is organized today, and the way the employees are understanding their roles and collaborates together, do not support the development towards the citizens being treated at home.

From my interviews it seems, that there is a mutual goal towards the patients being treated at home when possible. There however is not a common agreement in terms of what patients this concerns, nor the symptoms and issues the patients can be treated for at home. There is not an agreement in terms of the roles and assignments the general practitioners and the hospitals each have. The cooperation is characterized with a lack of a common understanding regarding the patients and at lack of knowledge regarding the roles and the tasks the general 5 practitioners and the hospitals have. The cooperation is also embossed by the absent of common knowledge regarding the patients and each other’s competences. Likewise there is a lack of coordinating of tasks regarding the patient care.

There is an agreement amongst the people I have interviewed, that the communication between the defended parties is embossed by a lack of precision, frequency and rights.

When all comes to all, my thoughts are, that we need to see this quality standard regarding the emergency function as a version one as related to at different and much closer cooperation between the employees on the hospitals, the general practitioners and the nurses at the municipalities. A collaboration which will be very beneficial for the patients, and which in ten to fifteen years will seem rather necessary and obvious.