Disentangling the impact of multiple innovations to reduce delayed hospital discharges

Delayed hospital discharges are often blamed for interrupting the smooth operation of hospitals. In England, the Community Care Act in 2003 introduced fines to social services departments to resolve this issue. Evaluations of this policy reported success in the reduction of delays. However, this policy was an amalgam of several innovations, not just the introduction of fines. This simultaneity makes attribution of impact of fines a difficult task because of the potential impact of those other measures. All the other designed organizational changes contain as much mechanisms of change as the more advertised fines. The exploration of how all these elements are connected unravels the inner workings of the programme as a whole, and by default, of the fines. This theoretical analysis also demonstrates how the reduction of some delays is based on the re-definition of key concepts for delayed discharges such as 'safe to transfer', team decision-making and causes for delays.