The organisation of internal medicine services - literature review
Illawarra Shoalhaven Local Health District
Duration: February 2012 - March 2012
The Director of the Division of Internal Medicine within the Illawarra Shoalhaven Local Health District requested a targeted literature review focused on the organisation of internal medicine services in acute hospitals.
This review of the literature sought to answer the question: what is known in the literature about the optimal way to organise, manage and deliver internal medicine services in the acute hospital setting? This work aimed to provide best practice evidence to inform future planning, quality improvement and change management initiatives within the organisation. The audience for the report included executive personnel and senior clinicians working within the organisation.
What we did
The literature review focused on evidence-based material and encompassed both the academic and practice literature, particularly literature published in the UK, Canada and New Zealand. Accepted academic search methods were used with almost 3000 titles/abstracts resulting in only 24 papers of potential relevance to the literature review. Selected professional websites were considered to identify relevant practice literature for example: the Royal College of Physicians of London.
The Medical Staff Capability Framework developed in Tasmania by Shannon et al* was used to structure our findings. Identifying high quality papers of relevance to the research question for this review was difficult. Studies often elicited mixed findings of questionable relevance to internal medicine in Australia. Many of the interventions covered in this review (e.g. clinical practice guidelines, clinical indicators) are a means to an end, with success or failure probably more dependent on how and why a particular intervention is implemented than the intervention itself. In conclusion, the optimal way to organise, manage and deliver internal medicine services in the acute hospital setting cannot be achieved through a simple remedy. It will be facilitated through an inclusive approach addressing all aspects of the capability framework provided by Shannon et al (2007). Success will rely on combining available evidence with expert opinion; working within each organisation's unique context, harnessing the good will of clinicians and accepting that change is likely to be incremental.
* Shannon EA, Brand BA, et al. (2007) Developing metrics for hospital medical workforce allocation. Australian Health Review 31(3): 411-421.