From Patient-Centered Care to Patient-Oriented Management: Exploring the Decision-Making Process in Hospital Patient Flow

OBJECTIVES: In the complex healthcare system, the challenge of personalizing treatments is transitioning from patient-centered care to the management of the entire healthcare service. Despite recognizing leadership's importance in adopting patient-centered policies, literature lacks clarity on factors influencing managerial decisions for patient-oriented care amid resource scarcity and time-dependent pressure. The study aims to identify crucial decision-making factors and defining characteristics of patient-oriented decisions. The reported results focus on the first exploratory phase, examining the decision-making process in patient flow management.

METHODS: In November 2023, a qualitative descriptive study was conducted through semi-structured interviews with Nursing Coordinators and Bed Managers at a 400-bed private Italian hospital, including a Level 1 Emergency Department. The interview structure, informed by the Westberg model, was developed and discussed by the researchers. The transcribed interviews were analyzed using the content analysis approach suggested by Forman and Damschroder. The study data were reported following the guidelines of the Consolidated Criteria for Reporting Qualitative Research - COREQ checklist.

RESULTS: Seven Nursing Coordinators and three Bed Managers were recruited through convenience sampling. Six main themes emerged from the analysis results: clinical and care needs as priorities, patient and staff safety, bed availability, external influences not patient-oriented, experience as a guide, and the difficulty of making choices.

CONCLUSIONS: Despite the sample limitations, the research serves as an initial step towards defining a broader study to deepen insights into the decision-making process in a dynamic context where risk is associated with the individual for whom one is responsible, not just the loss of their assets. From a practical standpoint, the research results can aid in developing a managerial decision-making model to guide healthcare managers in creating patient-centered organizations within resource constraints. This model could be developed in the field and serve as a reference for training future healthcare system managers.