Shizar Nahidi1,2, Roberto Forero1,2, Sally McCarthy3,4, Nicola Man1,2, Nick Gibson5, Mohammed Mohsin6,7, David Mountain8,9, Daniel Fatovich9,10,11, Gerard Fitzgerald12, Ghasem Sam Toloo12. 1. Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia. 2. Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia. 3. Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia. 4. Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia. 5. School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia. 6. Psychiatry Research and Teaching Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia. 7. School of Psychiatry, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. 8. Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 9. Division of Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia. 10. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia. 11. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia. 12. School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
Abstract
OBJECTIVE: The implementation of the time target policy (Four-Hour Rule/National Emergency Access Target [4HR/NEAT]) constituted a major change for ED, and potentially on quality of care. The present study aimed to understand perceptions and experiences of ED staff during 4HR/NEAT implementation. METHODS: A semi-structured interview was used to explore views and perceptions of 119 ED staff from 16 EDs in New South Wales, Australian Capital Territory, Queensland and Western Australia. The interviews covered aspects such as perceived changes in quality of clinical care, whether the capacity to deliver education was diminished or enhanced and whether the policy affected access to care. Interviews were transcribed, imported to NVivo 11 and analysed using content and thematic analysis. RESULTS: Three themes were identified: quality and safety of care; access block and overcrowding; and medical education and training. Participants described both positive and negative aspects of the policy. Although some reported negative impacts on care quality and access block, more cited overall improvements in these areas. The majority perceived that medical education and training was negatively affected, mainly because of restricted training opportunities and reduced time for procedural skills. CONCLUSIONS: ED staff perceived important effects on quality and safety of care; access block and overcrowding; and medical education and training. In relation to an optimised ED role, quality of care and access block were overall felt to be improved, while education and training deteriorated. Our study increases understanding of the complexity of policy implementation processes and its impact on staff. Staff perceptions are a valuable measure of system performance and should be incorporated into system change evaluations.
OBJECTIVE: The implementation of the time target policy (Four-Hour Rule/National Emergency Access Target [4HR/NEAT]) constituted a major change for ED, and potentially on quality of care. The present study aimed to understand perceptions and experiences of ED staff during 4HR/NEAT implementation. METHODS: A semi-structured interview was used to explore views and perceptions of 119 ED staff from 16 EDs in New South Wales, Australian Capital Territory, Queensland and Western Australia. The interviews covered aspects such as perceived changes in quality of clinical care, whether the capacity to deliver education was diminished or enhanced and whether the policy affected access to care. Interviews were transcribed, imported to NVivo 11 and analysed using content and thematic analysis. RESULTS: Three themes were identified: quality and safety of care; access block and overcrowding; and medical education and training. Participants described both positive and negative aspects of the policy. Although some reported negative impacts on care quality and access block, more cited overall improvements in these areas. The majority perceived that medical education and training was negatively affected, mainly because of restricted training opportunities and reduced time for procedural skills. CONCLUSIONS: ED staff perceived important effects on quality and safety of care; access block and overcrowding; and medical education and training. In relation to an optimised ED role, quality of care and access block were overall felt to be improved, while education and training deteriorated. Our study increases understanding of the complexity of policy implementation processes and its impact on staff. Staff perceptions are a valuable measure of system performance and should be incorporated into system change evaluations.
Authors: Roberto Forero; Shizar Nahidi; Josephine de Costa; Daniel Fatovich; Gerry FitzGerald; Sam Toloo; Sally McCarthy; David Mountain; Nick Gibson; Mohammed Mohsin; Wing Nicola Man Journal: BMC Health Serv Res Date: 2019-01-30 Impact factor: 2.655