I read this article with interest and there is much to commend it. Firstly, it represents a sound and well-intentioned study that investigates a topical issue with an important client group.
Highlighting a general culture of poor practice, as Dunnion and Kelly’s (2005) article does, and putting forward tangible solutions will always be a good reason for conducting research. Focusing on specific practices, such as discharge- planning, is also certainly one way of addressing the dilemmas that many emergency departments face – in effect ‘chipping away’ to produce eventual reform. My comments, however, are more concerned with a different approach to departmental or organizational reform (emergency depart- ment or otherwise) and namely those approaches that require a different ‘leap of faith’. In this age of health service reform that alludes to and advocates the notion of ‘seamless services’, it is right and correct that departments and organizations implement and evaluate effective discharge services that cut across hospital and community-based settings. For me this is a given. Dunnion and Kelly’s (2005) article is particularly useful in highlighting that this is clearly not the case and an area of concern. However, what might the effects of implementing effective discharge planning be in terms of initiating and maintaining seamless service provision? Very little I would argue in terms of overall organizational quality reform.
For me, departmental and organizational-wide reform is the only feasible mechanism by which seamless services, between hospital and community-based services can be measured. For those that know my work they will probably know what’s coming next. I will always advocate wide- reaching health promotion strategies as the means by which to drive such reform – particularly from a settings-based perspective (Whitehead 2003, 2004, 2005). Specifically, from an emergency department perspective, I highlight Bensberg and her colleague’s seminal work on health-promoting emergency departments (i.e. Bensberg & Kennedy 2002, Bensberg et al. 2003), as a case in point. Other works further validate my claims (Dunlop 1999, Williams et al. 2000). Therefore, from this position, I argue that discharge planning constitutes an important, yet nevertheless fractional, component of a drive for seamless services within and outside of departments. Where such activities are occurring, it would be helpful to measure these against a framework of overall organizational capacity. Dunnion and Kelly (2005) do already allude to this, in that they recommend ‘action research’ as a tool for improvement. As I and colleagues of mine have already stated, action research is a particularly effective tool for both departmental and organizational capacity and reform (Whitehead et al. 2003, 2004a,b). I would like to see more studies, that have the intention of Dunnion and Kelly’s, but that are set against a broader organizational-change context.
Bensberg M & Kennedy M (2002) A framework for health promoting emergency departments. Health Promotion International 17, 179–188.
Bensberg M, Kennedy M & Bennetts S (2003) Identifying the opportunities for health promoting emergency departments. Acci- dent and Emergency Nursing 11, 173–181.
Dunlop M (1999) Health promotion as an ENP: is it possible? Emergency Nurse 7, 24–27.
Dunnion ME & Kelly B (2005) From the emergency department to home. Journal of Clinical Nursing, 14, 776–785.
Whitehead D (2003) Incorporating socio-political health promotion activities in nursing practice. Journal of Clinical Nursing 12, 668– 677.
Whitehead D (2004) The European Health Promoting Hospitals (HPH) project: How far on? Health Promotion International 19, 259–267.
Whitehead D, Taket A & Smith P (2003) Action research in health promotion. Health Education Journal 62, 5–22.
Whitehead D, Keast J, Montgomery V & Hayman S (2004a) A preventative health education programme for osteoporosis. Journal of Advanced Nursing 47, 15–24.
Whitehead D, Keast J, Montgomery V & Hayman S (2004b) A multidisciplinary osteoporosis service-based action research study. Health Education Journal 63, 347–361.
Whitehead D (2005) Health Promoting Hospitals (HPH): the role and function of nursing. Journal of Clinical Nursing 14, 20–27.
Williams JM, Chinnis AC & Gutman D (2000) Health promotion practices of emergency physicians. American Journal of Emergency Medicine 18, 17–21.