ED healthcare professionals and their notions of productivity

Role of emotions in change and change management in an emergency department: a qualitative study

BACKGROUND

Changes in emergency departments are frequently implemented to improve efficiency and reduce costs. However, staff acceptance and adoption are crucial for the intended success of changes.

OBJECTIVES

This study explored staff perceptions of factors influencing the implementation of changes and any common themes linking changes and factors influencing changes in an emergency department at a university teaching hospital in the UK.

METHODS

We used constructivist grounded theory methodology to perform a secondary analysis of 41 interview transcripts of physicians, nurses, support workers and managers involved in paediatric emergency care.

RESULTS

Participants identified leadership, communication and education as factors impacting change management. They described many emotions associated with changes and with communication, leadership and education or the lack of any of them during changes. Both positive and negative emotions sometimes coexisted at individual, team or organisational levels. Negative emotions were due to real-life challenges and concern over compromised patient care. Professional values dictated the actions or inactions that transpired either because of these emotions or despite these emotions in health professionals.

CONCLUSIONS

Emotions to change should be acknowledged and addressed by credible leadership clear communication and education to improve the change process, its success and ultimately, patient care.

Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review

INTRODUCTION

Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address.

METHODS

A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses.

RESULTS

We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted.

CONCLUSION

Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.

Health professionals' perspectives of patients' and family members' needs in emergency departments and patient pathway improvement: a qualitative study in Denmark

OBJECTIVE

Besides working in a fast-paced environment, healthcare professionals (HCPs) in the emergency department (ED) are required to promptly respond to patients' needs and simultaneously achieve their organisational goals, which can be challenging. This study investigates how HCPs perceive and support the needs of patients discharged after a brief ED stay, as well as their family members.

DESIGN

The study used focus group discussions. The text material was analysed using systematic text condensation.

SETTING

Data were collected from two large EDs in Denmark.

PARTICIPANTS

Sixteen HCPs were sampled purposively to participate in three focus group discussions.

RESULTS

Three main themes were condensed: (1) creating a trustful and reassuring relationship; (2) responding to family members: a bother or a benefit; and (3) working as an interdisciplinary team. The study indicated the need for increased interdisciplinary collaboration to reduce discrepancies in information dissemination, to meet patient and family needs and to deliver a holistic approach. A technical solution was suggested to facilitate collaborative teamwork.

CONCLUSION

The study highlighted an existing gap between emergency HCPs' perceptions of patients' and family members' needs and the provision of the current patient and family support. Suggestions for future interventions include focusing on interdisciplinary teamwork, facilitated by a technical solution to support a person-centred and family-centred informative approach.

Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation

BACKGROUND

Primary care faces unprecedented challenges. A move towards a more comprehensive, multi-disciplinary service delivery model has been proposed as a means with which to secure more sustainable services for the future. One seemingly promising response has been the implementation of physiotherapy self-referral schemes, however there is a significant gap in the literature regarding implementation. Aim This evaluation aimed to explore how the professionals and practice staff involved in the delivery of an in-practice physiotherapy self-referral scheme understood the service, with a focus on perceptions of value, barriers and impact. Design and setting A qualitative evaluation was conducted across two UK city centre practices that had elected to participate in a pilot self-referral scheme offering 'physiotherapy-as-a-first-point-of-contact' for patients presenting with a musculoskeletal complaint.

METHODS

Individual and focus group interviews were conducted amongst participating physiotherapists, administration/reception staff, general practitioners (GPs) and one practice nurse (in their capacity as practice partner). Interview data were collected from a total of 14 individuals. Data were analysed using thematic analysis.

RESULTS

Three key themes were highlighted by this evaluation. First, the imperative of effecting a cultural change - including management of patient expectation with particular reference to the belief that GPs represented the 'legitimate choice', re-visioning contemporary primary care as a genuine team approach, and the physiotherapists' reconceptualisation of their role and practices. Second, the impact of the service on working practice across all stakeholders - specifically re-distribution of work to 'unburden' the GP, and the critical role of administration staff. Finally, beliefs regarding the nature and benefits of physiotherapeutic musculoskeletal expertise - fears regarding physiotherapists' ability to work autonomously or identify 'red flags' were unfounded.

CONCLUSION

This qualitative evaluation draws on the themes to propose five key lessons which may be significant in predicting the success of implementing physiotherapy self-referral schemes.

Slow or swift, your patients’ experience won’t drift: absence of correlation between physician productivity and the patient experience

Objectives

To evaluate the relationship between Emergency Physician (EP) productivity and patient satisfaction with Emergency Department (ED) care.

Methods

This retrospective observational study linked administrative and patient experience databases to measure correlations between the patient experience and EP productivity. The study was performed across three Calgary EDs (from June 2010 to July 2013). Patients>16 years old with completed Health Quality Council of Alberta (HQCA) ED Patient Experience Surveys were included. EP productivity was measured at the individual physician level and defined as the average number of patients seen per hour. The association between physician productivity and patient experience scores from six composite domains of the HQCA ED Patient Experience Survey were examined using Pearson correlation coefficients, linear regression modelling, and a path analysis.

Results

We correlated 3,794 patient experience surveys with productivity data for 130 EPs. Very weak non-significant negative correlations existed between productivity and survey composites: “Staff Care and Communication” (r=-0.057, p=0.521), “Discharge Communication” (r=-0.144, p=0.102), and “Respect” (r=-0.027, p=0.760). Very weak, non-significant positive correlations existed between productivity and the composite domains: “Medication Communication” (r=0.003, p=0.974) and “Pain management” (r=0.020, p=0.824). A univariate general linear model yielded no statistically significant correlations between EP productivity and patient experience, and the path analysis failed to show a relationship between the variables.

Conclusion

We found no correlation between EP productivity and the patient experience.