Did not answer the question
24 (39.34%) participants did not answer the question.
Information
3 (4.9 1 %) participants made reference to information:
I think a multidisciplinary system with the patient at the centre and linking that with IT is absolutely crucial [ 1 0]
With every new system there comes a new set of information and reporting requirements [3 1 ]
One of the problems we have struck going into the new system is that we don 't have any baseline data [49]
Finance
1 1 ( 1 8 .03%) participants referred to financial matters.
Limited or no financial return
5 (8. 19%) participants answered in terms of a financial return:
It will be slightly more expensive [2]
It's costly [ 1 6]
It 's certainly no cheaper [40]
We 're not going to save a lot of money on this [49]
Very costly when faced with facilities redesign and multi-skilling [4 1 ]
Effect of structure
2 (3 .27%) participants answered in terms of structure
The funding structure fragments the service . . . I don 't want to start something unless
I know I have the funding for it [8]
It 's the cost they [medical staff] drive in terms of drugs and technology [ 1 0]
Other
The logical conclusion is that it does require sophisticated financial systems we haven 't got the ability to meet [9]
We 're not going to save a lot of money out of this. I don 't believe in the next 2-3
years, but down the track it will be massive [49]
Plant and equipment
Except for reference to facilities redesign [4 1 ] and technology [ 10] there is not a specific reference to plant and/or equipment
Staff
1 3 (2 1 . 1 3%) participants made staff related comments
As the service reduces in size it may be an opportune time to shift people [2] A lot of the wards are too busy for the nurses to leave the wards for meals [5]
Within the business units staff stay working in one area. There isn 't the crossover between units so it 's not so easy to manage [6]
A lot of health resource has been put in place to report to the RHA and to the health authorities. We have to pull people out from actual delivery of services to spend time in meetings and formulating quite detailed reports [7]
The present system is very resource heavy especially in terms of senior medical staff
[ 1 0]
It 's a sadfact that we have to use more resources for few people [patients] because they [health professionals] want to be territorial [ 1 1 ]
We don 't use a lot of support o r health care assistant staff [ 1 4]
The next thing that is being looked at is multiskilling .. . breaking down some occupational boundaries [ 1 8]
By assigning a person, one person to manage care they get a better quality of care and consistency [22]
Previously nurses with management qualifications have moved into management positions which adds a degree of tension [25]
There seem to be four times the amount of work with the same people [38] Accessing consultancy input from other specialties can be a problem [45]
There is tremendous amount of pressure out there and the acuteness of the place is coinciding with a lack of manpower-of skilled manpower [60]
Geography and demography
Demographics and geography pose particular problems [9]
Geography and demography strongly affect resource use [33]
Remaining
I think it 's quite indulgent, certainly indulgent in lengths of stay [4]
The educational preparation of nurses in particular roles isn 't necessarily understood [25]
Probably the utilisation of staff could be improved with a better system [46]
There are major barriers to changing the structure and systems because of professional education needs. It seems to me that the tail is wagging the dog [57]
Only 5 (8. 1 9%) participants appeared to recognise the importance of factors external to the organisation namely patient acuity, the availability of a skilled workforce, geography and demography and education.
Seedhouse's comment on health systems is equally pertinent to the PCDS and the NCDS .
Given that there is so much confusion about the extent, nature and purpose of health systems it may seem pointless to address this . . . . But it is not, for in doing so the magnitude of the problem facing health reformers becomes clearer still. (Seedhouse, 1 990, p.3)
The central purpose of a CHE and its successors is the delivery of safe, effective care to patients. Patient need and to some extent patient demand are met through the PCDS. The largest and usually the most expensive subsystem of the patient care delivery system is the nursing care delivery system. Executives' and senior nurses' knowledge and understanding of these systems is essential to the delivery and
evaluation of patient care. That this not the case is evident from answers to this question.
The following themes emerge from participants' answers to questions about the patient care delivery system.
Chapter themes
The delivery of safe, effective patient care was not the primary focus of e RE executives and senior nurses.
The majority of participants (95.08%) did not describe a system of patient care delivery.
The organisation was not the primary frame of reference for 22.95% of senior staff.
Systematic and ongoing evaluation of the patient care was not a priority.
There w as not a systematic and comprehensive approach to assessing resource implications.