Background: To maintain patient independence and reduce healthcare costs, more individuals are being discharged to a housing support scheme as an alternative to community hospitals across the United Kingdom. However, little is known regarding the decision-making processes and impact of enacted health reforms, particularly, housing support and hospital staff located in Wales. Therefore, this research contributes to an under-researched area to strengthen our understanding.
Aim: To explicate how the ruling relations (those who organise work from afar) and social processes within housing and hospital institutions organise the everyday practices of housing and nursing staff and to make visible discharge and housing work.
Methods: Qualitative methods using fieldwork and semi-structured interviews using an Institutional Ethnography and co-design workshops using both an Institutional Ethnography and Participatory Action Research lens were used.
Data collection: Non-participant observation, semi-structured interviews with healthcare and housing professionals were conducted. A series of co-design workshops were conducted involving healthcare professionals, housing professionals and tenants from housing support schemes across the four data collection sites. Conclusions: Current ruling relations such as delayed transfer of care meetings and other auditing processes throughout the two hospital sites were discovered as resulting in problems for those on the ground, particularly nursing staff. Due to ongoing pressures to maintain patient flow, nursing staff found themselves being encouraged to discharge patients as quickly as
possible, often creating problems for those in community sites and patients. Discharge interventions to promote patient flow meant that patients were viewed as figures or a piece of furniture. Housing professionals also found themselves struggling with the promotion of tenant independence as tenants rejected the use of telecare and professionals were often unable to Page 2 of 554 provide client-facing issues as governed by ruling relations which enforced time constraints and auditing processes