Table 4.
Problems identified by stakeholder groups and the numbers of group that identified each.
| Problem | Number of groups that identified | |
|---|---|---|
| 1 | Lack of resources (human/organizational finance to enable better inter-agency working) | 4 |
| 2 | Fear (including risk aversion, fear of repercussions for wrong decisions made about discharge and adverse outcomes) | 3 |
| 3 | Lack of clarity about expectations of each group (including patients and carers) | 2 |
| 4 | Blame culture (including fear of blame) | 2 |
| 5 | SILO working (lack of information sharing) | 2 |
| 6 | Ineffective communication and interagency working | 2 |
| 7 | No multiagency/disciplinary processes | 2 |
| 8 | No one taking responsibility for coordinating the transition (Lack of admission/discharge co-ordinator) | 2 |
| 9 | Not planning discharge from admission | 2 |
| 10 | Target driven culture | 1 |
| 11 | Excess paperwork | 1 |
| 12 | Ticking boxes | 1 |
| 13 | Law of unintended consequences (not learning from it and reviewing and adapting) | 1 |
| 14 | Missing opportunities to create therapeutic environment | 1 |
| 15 | Expectations of regulatory bodies | 1 |
| 16 | No flexibility within referral pathways | 1 |
| 17 | Micro-managing staff | 1 |
| 18 | Patient blaming (positive risk management) | 1 |
| 19 | Internal/external/partner agency communication | 1 |
| 20 | Duplication | 1 |
| 21 | Lack of involvement of patient, family/carers in information sharing | 1 |
| 22 | Patient/carer/other not being communicated what/who/why | 1 |
| 23 | Lack of multiagency/disciplinary strategy | 1 |
| 24 | Lack of multiagency/disciplinary meetings | 1 |
| 25 | Few interagency links | 1 |
| 26 | Lack of right care at the right time in the right time | 1 |
| 27 | Inappropriate admissions | 1 |
| 28 | Lack of educational/community resources | 1 |
| 29 | Insufficient beds | 1 |
| 30 | Pressure to discharge | 1 |
| 31 | Inappropriate cluster 7 and 8 provision | 1 |
| 32 | Austerity | 1 |
| 33 | Hierarchical Healthcare (top-down structure) | 1 |
| 34 | Defensive practice | 1 |
| 35 | Choice of wording—discharge | 1 |
| 36 | Information from MHA not being relayed to hospital, social worker etc. | 1 |
| 37 | No list of agencies that need to be contacted | 1 |
| 38 | Agencies working on different systems | 1 |
| 39 | Information not being relayed to ward staff at admission (from community agencies) | 1 |
| 40 | Revolving door | 1 |
| 41 | A and E breach reporting | 1 |
| 42 | Tension between teams (crisis, inpatient, CMHT) | 1 |
| 43 | Lack of alternative to inpatient admission | 1 |
| 44 | Insufficient early discharge planning meetings | 1 |
| 45 | Insufficient care planning in community (advanced statements etc.) | 1 |
| 46 | No ethics committees or complex case panels | 1 |
| 47 | Care pathways unclear | 1 |