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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study

Authors: Kim Manley, Anne Martin, Carolyn Jackson, Toni Wright

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery.

Methods

A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included 14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n = 48); and a review of literature and analysis of policy documents including care pathways and protocols.

Results

The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning.

Conclusions

In this study, participants agreed that whole systems urgent and emergency care allows for the design and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication and waste and improve healthcare outcomes and patients’ experiences. For this to be achieved emphasis needs to be placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and retention and the overall effectiveness of the organization. These also need to be attended to for transformational change to be achieved and sustained. Research to refine and validate a single integrated career and competence framework and to develop standards for an integrated approach to workplace facilitation to grow the capacity of facilitators that can use the workplace as a resource for learning is needed.
Appendix
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Literature
1.
Weissman JS, Rothschild JM, Bendavid E, Sprivulis P, Cook EF, Evans RS, et al. Hospital workload and adverse events. Med Care. 2007;45(5):448–55.PubMed
2.
Jayaprakash N, O’Sullivan R, Bey T, Ahmed SS, Lotfipour S. Crowding and delivery of healthcare in emergency departments: the European perspective. West J Emerg Med. 2009;10(4):233–9.PubMedPubMedCentral
3.
Lowthian JA, Curtis AJ, Cameron PA, Stoelwinder JU, Cooke MW, McNeil JJ. Systematic review of trends in emergency department attendances: an Australian perspective. Emerg Med J. 2011;28(5):373–7.PubMed
4.
Harris P, Whitty JA, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, et al. The Australian public’s preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment. BMJ Open. 2015;5(4):e006820.PubMedPubMedCentral
5.
Cunningham PJ. What accounts for differences in the use of hospital emergency departments across US communities? Health Aff. 2006;25(5):W324–36.
6.
7.
Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20(5):402–5.PubMedPubMedCentral
8.
9.
Scott T, Mannion R, Davies H, Marshall M. The quantitative measurement of organizational culture in health care: a review of the available instruments. Health Serv Res. 2003;38(3):923–45.PubMedPubMedCentral
10.
11.
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human resources for health: overcoming the crisis. Lancet. 2004;364(9449):1984–90.PubMed
12.
13.
O’Cathain A, Knowles E, Munro J, Nicholl J. Exploring the effect of changes to service provision on the use of unscheduled care in England: population surveys. BMC Health Serv Res. 2007;7(1):61.PubMedPubMedCentral
14.
Turner J, O’Cathain A, Knowles E, Nicholl J. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study. Bmj Open. 2013;3(11):e003451.PubMedPubMedCentral
15.
16.
Charters S, Knight S, Currie J, Davies-Gray M, Ainsworth-Smith M, Smith S, Crouch R. Learning from the past to inform the future–a survey of consultant nurses in emergency care. Accid Emerg Nurs. 2005;13(3):186–93.PubMed
17.
Weinick RM, Bristol SJ, DesRoches CM. Urgent care centers in the US: findings from a national survey. BMC Health Serv Res. 2009;9(1):79.PubMedPubMedCentral
18.
19.
Centre for Workforce Intelligence. Starting the debate on the future consultant workforce. 2012. file://stafs-nhr-03.ccad.canterbury.ac.uk/am626/Downloads/Shape%20of%20the%20medical%20workforce%20-%20starting%20the%20debate%20(1).pdf. Accessed 16 April 2014.
20.
21.
22.
23.
Attwood M, Pedler M, Pritchard S, Wilkinson D. Leading change: a guide to whole systems working. Bristol: Policy Press; 2003.
24.
Pratt J, Gordon P, Plamping D. Working whole systems: putting theory into practice in organisations. 2nd ed. London: Radcliffe Publishing; 2005.
25.
Yin RK. Case study research: Design and methods. 5th ed. California: Sage publications; 2014.
26.
Checkland P. Systems thinking. In: Currie W, Galliers R, editors. Rethinking management information systems: an interdisciplinary perspective. New York: Oxford University Press; 1999. p. 45–56.
27.
Von Bertalanffy L. The role of systems theory in present day science technology and philosophy. In: Schaefer KE, Hensel H, Brady R, editors. A New Image of Man in Medicine, Vol 1 toward a Man-Centered Medical Science Symposium Herdecke, West Germany Sept 24–28, 1973 Xxv + 203p Illus. Mt Kisco: Futura Publishing Co; 1977. p. 11–5. ISBN 0-87793-069-1.
28.
Guba EG, Lincoln YS. Fourth generation evaluation. California: Sage; 1989.
29.
30.
Manley K, Sanders K, Cardiff S, Webster J. Effective workplace culture: the attributes, enabling factors and consequences of a new concept. Int Prac Dev J. 2011;1:2.
31.
Roach MS, Canadian Hospital A. The human act of caring: a blueprint for the health professions: Canadian Hospital Association. 1987.
32.
Jong PD, Berg IK. Interviewing for solutions. Belmont: Thomson Brooks/Cole; 2002.
33.
Cornish F, Gillespie A, Zittoun T. Collaborative analysis of qualitative data. In: Flick U, editor. The sage handbook of qualitative data analysis. London: Sage Publications Ltd; 2013. p. 79–93.
34.
Cooperrider DL, Whitney D. A positive revolution in change: appreciative inquiry. Public Adm Public Policy. 2001;87:611–30.
35.
Wilber ST, Gerson LW, Terrell KM, Carpenter CR, Shah MN, Heard K, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the committee on the future of emergency care in the US health system. Acad Emerg Med. 2006;13(12):1345–51.PubMed
36.
37.
38.
39.
Frich JC, Brewster AL, Cherlin EJ, Bradley EH. Leadership development programs for physicians: a systematic review. J Gen Intern Med. 2015;30(5):656–74.PubMed
40.
41.
Manley K, Crisp J, Moss C. Advancing the practice development outcomes agenda within multiple contexts. Int Pract Dev J. 2011;1:1.
42.
Watling T. Factors enabling and inhibiting facilitator development: lessons learned from Essentials of Care in South Eastern Sydney Local Health District. Int Pract Dev J. 2015;5:2.
Metadata
Title
Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study
Authors
Kim Manley
Anne Martin
Carolyn Jackson
Toni Wright
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1616-y

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