Whole system approach: from pilot to practice

Authors: Castleton, Beverly1; Dunstan, Chris2; Mattocks, Rea3; Cpsychol, Colin Rowett4

Source: Quality in Primary Care, Volume 11, Number 2, 1 June 2003 , pp. 91-95(5)

Publisher: Radcliffe Publishing Ltd.

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Background The term 'whole system approach' (WSA) has entered common parlance to describe the analysis of interdependent elements of a complex system in order to deliver benefits to the whole system. Aim In this study we investigated whether taking a whole system approach to care of the elderly could improve efficiency and patient care. Methods Using a predefined protocol, a researcher identified and tracked all over-75s who entered the health/social care system during a 14-week period. A standardised questionnaire was used to determine the decisions made, who made the decisions, and views of the outcome from healthcare professionals, social care staff, patients and carers. Results Twenty-nine patients (18 female, 11 male) were included in this study, with 42 care episodes being recorded. The 42 care episodes involved 51 separate decision processes and 66 staff. Overall 33/ 51 decisions had a social care component, but social services were only involved in 10 decisions. There was little evidence of joint agency working, particularly in initial assessment and decision making. In 75% of cases, undesired outcomes were thought to be preventable. In 50% of the care episodes, although a decision was taken, the decision maker did not have confidence that the outcome would be achieved. Patients and carers usually expressed general satisfaction with the services provided, although they showed little understanding of the relationship between health and social services and often felt a lack of involvement in the decision-making process. Discussion In isolation, all the components of the health and social care system were operating with efficiency according to individual standards. However, from a patient, carer and healthcare professional perspective, efficiency across the whole system was not evident, with decisions resulting in increased use of hospital and residential homes when, with relatively small changes, it would have been possible to manage some of these people in the community.


Document Type: Research Article

Affiliations: 1: Specialist Services, North Surrey PCT and Woking Area PCT, and Consultant Physician, Ashford and St Peter's Hospital, Surrey, UK 2: West Byfleet Health Centre, Surrey, UK 3: London Borough of Merton (formerly of Surrey Social Services, Thames Ditton, Surrey), UK 4: Adults and Community Care Service, Surrey County Council, Surrey, UK

Publication date: June 1, 2003

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