Shifting stroke care from the hospital to the nursing home: explaining the outcomes of a Dutch case

Arno van Raak*, Siebren Groothuis, Robert van der Aa, Martien Limburg, Leti Vos

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Rationale, aims and objectives Supply chains can contribute to better care for stroke patients and more efficiency. However, such outcomes are hampered when links in the chain are weak. The article aims to further the knowledge about the causes and possible improvements of weak links thereby using theory about rules for action and routines (action patterns). Method We executed a single case study of a chain of service delivery to stroke patients by a university hospital and a nursing home in the city of Maastricht, the Netherlands. Methods included document study, interviews, observations, process mapping, use of data matrices and performance of t-tests. Results In the case, the care delivery process in the chain was redesigned to improve the flow of patients and to reduce the length of hospital stay. Length of stay was reduced. However, transfer of patients from the hospital to the nursing home was hampered. At this weak link in the chain, the redesign clashed with the routines of hospital paramedics who did not want to work according to the redesign. Conclusions The applied theory is useful to understand why a link in a supply chain is weak. Negotiations can be used to strengthen a link.
Original languageEnglish
Pages (from-to)1203-1208
JournalJournal of Evaluation in Clinical Practice
Issue number6
Publication statusPublished - Dec 2010


  • case study
  • patients flow
  • process redesign
  • routines
  • stroke care
  • supply chain

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