Resilience practices of healthcare professionals during the hospital discharge process: a qualitative study

Efficient hospital discharge is critical for improving patient experience and post-discharge safety. This study aimed to understand the daily hospital discharge process and explore healthcare professionals' experiences with the challenges, adjustments, and outcomes from a Safety-II perspective.

This qualitative study was conducted with 30 healthcare professionals from two general hospitals using semi-structured interviews and focused ethnography observations. Each interview lasted an average of one hour, and the total observation time was 99.6 h over 41 observation sessions. Data were analysed using the Functional Resonance Analysis Method and the Concepts for Applying Resilience Engineering model 2.0, along with thematic analysis.

Functions with high variability impact were 'to interview patient/family for discharge' and 'to share patient/family requests' in terms of endogenous and cross variability. Healthcare professionals frequently encountered challenges related to 'process' and 'communication', mainly owing to patient/family requests and conditions. The emergent theme was 'ameliorating variabilities due to couplings between healthcare professionals' behaviours and unpredicted patient/family requests under time pressure'. Most adjustments to cope with challenges were made in the 'process-how' and 'process-when' categories. The theme was 'meeting discharge time expected by patient/family by utilizing internal and external resources and performing additional work'. While these adjustments frequently led to positive outcomes, participants sometimes experienced dissatisfaction and concerns about potential errors. The main themes of post-discharge contact from patients and families included managing medications, wounds, and symptoms.

During the time-constrained discharge process, healthcare professionals primarily adjusted their work processes to adapt to the challenges they faced, which resulted in both positive and negative outcomes. The discharge process should focus on strengthening functions to enhance the post-discharge care management of individual patient/family by reducing unnecessary variability in communicating patient/family requests. Implementing support systems to promote adaptive practices among healthcare professionals is recommended.