The process of setting main objectives and care standards for a new rehabilitation hospital for the elderly

Abstract

[...] The aim of this research is to examine the process of setting main objectives and care standards in a rehabilitation hospital for the elderly. The work concentrates on elaborating the management process under the following questions: (i) How can objectives be set and formulated? (ii) How are relevant standards of care derived? Much of the practical insights gained in the analysis of such processes is obtained through reviewing literature on organisational and managerial methods. This had to be supplemented by ancillary reading from the care of the elderly field, to create a complete framework wherein a comprehensive analysis of the management process in a rehabilitation hospital for the elderly could be conducted. On the basis of this analysis a Maltese model is defined. Data for the reference framework were collected from secondary sources. Strengths and weaknesses of the method are based on the strength of such borrowed data. This approach was enhanced by visits to four Care of the Elderly Units, to get acquainted with the present situation in Britain. In the case of Malta data were collected from two sources. Secondary data gleaned from the scanty ancillary reading were supplemented by primary data. An unstructured questionnaire was undertaken with the elderly themselves. Various officers presently undertaking planning and provision of care of the elderly were interviewed, formally and informally. Relevant institutions were also visited. Use of these two methods of data collection was mutually beneficial in that information could be verified, enhancing the validity of the recommended model for Malta. The author's first-hand knowledge of the Maltese situation and long years of experience in the health service would obviously bear upon all comments and recommendations made, though they are entirely her own views. The author embarks on expounding the management process in a rehabilitation hospital through an exposition of organisation theory. Broad consideration of the objective setting process and the possibility of its application to the health field are explored in Chapter 2. The setting of long run objectives, which can even be implemented through incremental ones and include relevant values, is proposed under a rational model. The objective setting process in an organisation is delineated in a grid including rational! incremental, official and unofficial operative goals. A normative model whereby goals should be determined primarily by the elderly clients' needs is highlighted in Chapter 3. The better the hospital service caters for their individual special needs, the better the quality of care. Clients' needs should also dominate policy making issues at the wider contextual organisational and social level. Such a model could be the catalyst to an integrated and coherent service for care of the elderly. In Chapter 4 various possible styles of practice are outlined. On the basis of secondary data and findings, an acute/rehabilitation model is proposed. In this context, the process of deriving standards of care is elaborated. Requirements at both the management level and substantive levels for specific delivery of care are explained. Finally in the context of the preceding review, the management process for a Maltese model is recommended in Chapter 5. Management systems cannot translate literally from one culture to another, but an effective model can be developed if the possibility of building on existing work is explored.