Aims: To explore heads of department (HOD) views on current and future services, barriers, challenges and strategies to develop services.
Methods: Public hospital HODs across Australia and New Zealand (n = 84) were invited to participate in an online quantitative survey (published). Of these, 41 took part in qualitative semi-structured online interviews conducted by a single interviewer. Two investigators independently coded the transcripts, meeting regularly to discuss emerging themes. Framework analysis was used to identify key themes, with final framework validation by all investigators pending.
Results: HODs described well-developed models of care and those that needed development. Gaps included community services, dementia/delirium units, perioperative medicine, nursing home outreach and telehealth. An acute geriatric medicine service was desirable for many though not all. Barriers to service development include lack of funding, insufficient junior medical staff, poor understanding of the role of geriatric medicine by hospital management/other specialties and for some, a difficult relationship with the hospital executive. Strategies for successful development included providing evidence to support service development, proactively obtaining multiple sources of funding and working constructively with executive. Most HODs wanted a service that covered the full breadth of health care from acute care to out-of-hospital care.
Conclusions: HODs described well-developed hospital and out-of-hospital models of care, but also areas of deficiency. The future challenge is for a larger proportion of departments to be able to provide the breadth of care that is possible. Our findings could inform further discussion between departments as well as government policy.