A critical systems evaluation of the introduction of a 'discharge to assess' service in Kent



Gadsby EW, Wistow G & Billings J (2022) A critical systems evaluation of the introduction of a 'discharge to assess' service in Kent. Critical Social Policy.

Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.

critical systems heuristics; discharge to assess; hospital discharge; implementation process; integrated care

Output Status: Forthcoming/Available Online

Critical Social Policy

StatusIn Press
FundersUniversity of Kent
Publication date online31/01/2022
Date accepted by journal06/01/2022

People (1)


Dr Erica Gadsby
Dr Erica Gadsby

Senior Lecturer, Health Sciences Stirling