SPECIALIZED VERSUS GENERAL UNIT SYSTEMS IN PSYCHIATRIC HOSPITALS
Abstract
An evaluation research project was designed to compare the effectiveness of the general unit system to specialized treatment wards and to assess the effectiveness of a hospital administrative change. The project made use of an August 1977 reorganization from the general unit system to a system of specialized treatment units at one large V. A. psychiatric hospital. It also made use of a similarly sized and located V. A. hospital which had not undergone a reorganization as a control for the effects of history and long-term trends in psychiatric care. Outcome measures included length of hospital stay and length or community stay or recidivism rate obtained from 23,341 hospital records. Also included were patient post-hospital community adjustment assessed by patient and relative questionnaires. Results were analyzed through two-way analyses of variance. Statistics based upon hospital records were also put into month by month time-series covering five years. Staff interviews were conducted to describe the many aspects of the reorganization. Overall findings indicated that ward specialization per se had little effect upon any of the outcome measures. However, certain specific aspects of this particular reorganization had measurable effects: (1) The reorganization was implemented without line staff input. Staff on wards which became acute psychiatric admission wards and chronic continued treatment wards opposed the reorganizaton and felt that many plan oversights resulted in temporary disorganization and lowered staff morale. Immediately after the reorganization length of hospital stay substantially increased on these wards but then returned to usual levels six months later. (2) Staff on substance abuse wards came to favor the reorganization and mentioned increased staff morale and cohesiveness. They also spoke of increasing pressure to discharge substance abusers quickly. This was reflected in an apparent halving of the median length of hospital stay for substance abusers. (3) There was also a significant decrease in the length of hospitalization of frequently readmitted patients. The hospital policy of increasing the turnover rate was apparently implemented on this population but not implemented on first admissions and infrequently readmitted patients. (4) The reorganization resulted in the transfer of many chronic psychiatric patients from Psychiatry Service to Intermediate Medicine Service where staff claimed that nursing and foster home placement were more aggressively pursued. This policy change may be responsible for an observed increase in the discharge rate of patients who had been in the hospital continuously for at least two years. In conclusion, changes in administrative discharge policies, staff morale, and the means of implementing hospital reorganization appeared to affect patient length of hospital stay. Ward specialization did not seem to affect this or any other variable. Recommendations were made regarding the implementation of hospital reorganization, particularly concerning the involvement of line staff.
Degree
Ph.D.
Subject Area
Psychotherapy
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