Intermediate care in Denmark–a qualitative study of healthcare without healthcare mandate and diverging practices in temporary stays

Abstract

Introduction: Intermediate care has expanded across Europe to support early discharge and continuity for complex patient populations. Temporary Stays (TSs) constitute a large, decentralized intermediate care structure without a healthcare mandate. Limited knowledge exists on how this organization shapes practice. This study explores the functioning of TSs and the implications of local divergence on continuity, safety, and equity. Theory: We draw on Lipsky’s concept of street-level bureaucracy to analyse how underspecified mandates lead frontline staff to shape practice through discretion. Method: Across 12 TSs, we conducted 22 semi-structured interviews with leaders and eight focus groups with healthcare employees. Data were analysed using Malterud’s Systematic Text Condensation to identify cross-case patterns related to organization, competence, resources, and coordination. Results: TSs primarily function as step-down intermediate care, managing medically complex patients despite lacking access to physicians, medication, and patient records. Local variations in staffing, competencies, and facilities result in inconsistent service levels. Discussion: Communication gaps and limited cross-sector knowledge undermine continuity, while organizational instability and infrastructural differences condition daily practice. Decentralized development generates divergence with implications for equity, safety, and coordination. Strengthening intermediate care requires clearer task definitions, improved medical support, aligned governance, and shared data monitoring. Interdisciplinary research is needed.