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Manley, Kim, Martin, Anne, Jackson, Carolyn 
ORCID: https://orcid.org/0000-0003-2046-0242 and Wright, Toni
(2016)
Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study.
BMC Health Services Research, 16.
ISSN 1472-6963
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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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | urgent and emergency care,whole systems working,leadership,workforce development,facilitation,work based learning,integrated competence framework,medicine(all),health professions(all),nursing(all),sdg 3 - good health and well-being,sdg 4 - quality education,sdg 8 - decent work and economic growth,sdg 10 - reduced inequalities,sdg 17 - partnerships for the goals ,/dk/atira/pure/subjectarea/asjc/2700 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > School of Health Sciences |
| UEA Research Groups: | Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre |
| Depositing User: | LivePure Connector |
| Date Deposited: | 01 Nov 2024 16:30 |
| Last Modified: | 03 Nov 2024 07:31 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/97439 |
| DOI: | 10.1186/s12913-016-1616-y |
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