Beverly Castleton
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 standardized 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
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