Continuity of care in home health-care practice: two management paradoxes

Aim To explore continuity of care from a managers perspective: How do managers understand the concept of continuity of care and how do they assess continuity of care in home health-care? How do managers work to ensure continuity of care when managing care provision for patients in their homes? Background Continuity of care is considered a prerequisite for service quality. Managers can influence continuity of care through managing day-to-day work. Methods Semi-structured interviews of a purposive sample of 16 managers from 12 municipal units. Theory-driven and data-driven analysis was applied. Results Ideally, to promote continuity of care, the number of carers should be limited. Yet, in practice, discontinuity of care was accepted as a working compromise. The managers faced two paradoxes: the continuity ideal vs. the practicalities of home health-care, and caring for patients vs. caring for staff. Conclusions The managers were forced to prioritize, in conflict with ideals or professional standards, patients wellbeing or the wellbeing of the staff. Ensuring continuity of care for all patients did not seem feasible. Implications for nursing management The study highlights management paradoxes: possible unintended consequences of prioritizing needs for continuity of care should be objects of reflection in care management.