Analysis of the profile, characteristics, patient experience and community value of community hospitals : a multimethod study

Davidson, D; Paine, AE; Glasby, J; Williams, I; Tucker, H; Crilly, T; Crilly, J; Le Mesurier, N; Mohan, J; Kamerāde, D; Seamark, D; Marriott, J

Abstract

Background: Community hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.
Aim: To provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.
Design: A multimethod study with three phases. Phase one involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase two involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase three
involved analysis of Charity Commission data on voluntary support.
Setting: Community hospitals in England.
Results: The study identified 296 community hospitals with beds in England. Typically, the hospitals were small
(<30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site
medical cover, providing step-down and step-up inpatient care, with an average length of stay of <30 days
and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community
hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the
relationships that they support; their provision of personalised, holistic care; and their role in supporting
patients through difficult psychological transitions. Communities engage with and support their hospitals
through giving time (average = 24 volunteers), raising money (median voluntary income = £15,632),
providing services (voluntary and community groups) and giving voice (e.g. communication and consultation).
This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer
well-being. Engagement varies between and within communities and over time. Community hospitals
are important community assets, representing direct and indirect value: instrumental (e.g. health care),
economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity
and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time.
Limitations: There were limitations to the secondary data available for mapping community hospitals and
tracking charitable funds and to our sample of case study respondents, which concentrated on people
with a connection to the hospitals.
Conclusions: Community hospitals are diverse but are united by a set of common characteristics. Patients
and carers experience community hospitals as qualitatively different from other settings. Their accounts
highlight the importance of considering the functional, interpersonal, social and psychological dimensions
of experience. Community hospitals are highly valued by their local communities, as demonstrated through
their active involvement as volunteers and donors. Community hospitals enable the provision of local
intermediate care services, delivered through an embedded, relational model of care, which generates
deep feelings of reassurance. However, current developments, including the withdrawal of GPs, shifts
towards step-down care for non-local patients and changing configurations of services, providers and
ownership may undermine this.
Future work: Comparative studies of patient experience in different settings, longitudinal studies
of community support and value, studies into the implications of changes in community hospital
function, GP involvement, provider-mix and ownership and international comparative studies could all
be undertaken.

Citation

Davidson, D., Paine, A., Glasby, J., Williams, I., Tucker, H., Crilly, T., …Marriott, J. (2019). Analysis of the profile, characteristics, patient experience and community value of community hospitals : a multimethod study. Health Services and Delivery Research, 7(1), https://doi.org/10.3310/hsdr07010

• Journal Article Type: Article
• Online Publication Date: Jan 23, 2019
• Publication Date: Jan 23, 2019
• Deposit Date: Jan 16, 2019
• Publicly Available Date: Jan 24, 2019
• Journal: Health Services and Delivery Research
• Print ISSN: 2050-4349
• Electronic ISSN: 2050-4357
• Publisher: NIHR Journals Library
• Volume: 7
• Issue: 1
• DOI: https://doi.org/10.3310/hsdr07010
• Publisher URL: https://doi.org/10.3310/hsdr07010
• Related Public URLs: https://www.journalslibrary.nihr.ac.uk/hsdr/#/
• Additional Information: Projects : A comprehensive profile and comparative analysis of the characteristics, patient experience and community value of the 'classic' community hospital situated in contrasting contexts and communities