The hospital patient service in transition : a study of the development of totality of care
A concept of "total patient care" was developed in Hong Kong to enhance public hospital services. The development of this concept aimed to resolve two major concerns about patient care delivery. First, for historical reasons, there were differences among public hospitals in their emphases on the scientific medicine and social aspects of caring. Secondly, the health care system was under pressure to change due to rising expectations, in particular to an increasing number of patients requiring complex care in the community. The purposes of this study were (1) to investigate the historical influence on the development of patient services and (2) to examine the determinants affecting the development of new initiatives. The path-finding process to shift care practice from a traditional institutional orientation to a person-centred approach was studied through a focal point of study in all 38 public hospitals, serving a population of 6.3 millions. An analysis of the "successful" examples of the implementation of the concept of total patient care was initially conducted. The subsequent development of a variety of hospital patient care models was traced back to the different origins of patient care orientations through collecting views of hospital stakeholders and the support provided for patients outside the hospitals. A pluralistic approach, which involved site visits, interviews, focus group discussion and survey, was chosen to understand the complexity of historical influence and contemporary determinants in the development of the totality of patient care. A "mapping" method was adopted to analyse the data reflected different levels of concerns. The findings in this study indicated that, technological and financial factors often identified as the more important determinants in development of health care system, might have ignored the historical development of the hospitals and health traditions in the community in the development of totality of patient care. This study suggested that influences of these informal factors, as experienced in a Chinese community, would likely to continue and diffuse the goal of a planned policy. Formalisation of the informal and community involvement in formal hospital settings, through a concept of total patient care, had resulted in the consolidation of some diversified experience in the support of a diversified range of patient needs. The strengthening of a hospital-community linkage was highlighted as a possible solution to bring a full transformation of patient care into a model of totality.