Impact of the Four-Hour Rule/National Emergency Access Target policy implementation on emergency department staff: A qualitative perspective of emergency department management changes

on behalf of the 4HR/NEAT Partnership Grant

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: It has been 10 years since the ACEM Access Block Solutions Summit and 5 years since the introduction of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) policy. The impact of this policy on ED management and on ED staff has been poorly understood. The aim of the present study was to identify changes in ED management resulting from the policy based on ED staff experiences. Methods: Semi-structured interviews were conducted and transcribed, imported to NVivo 11 and analysed using a combination of content, thematic analysis and phenomenological focus within a theoretical framework known as the ‘logic model’. Results: One hundred and nineteen ED staff participated in 2015–2016 to assess the impact of the policy implementation. Participants were drawn from 16 EDs in New South Wales, Queensland, Western Australia and Australian Capital Territory. In relation to ED management, three themes were identified: changes in ED management; activities and changes driven by the hospital in relation to 4HR/NEAT; and participant experiences in relation to policy compliance by staff. Conclusions: Policy implementation is a complex process that had both positive and negative consequences on how ED staff managed the implementation of the 4HR/NEAT policy and how it changed their work environment. Understanding the perceptions of staff involved in policy implementation has significance for the design of future implementation strategies. The biggest insight from the present study is that ED management is very complex and the policy generated multiple positive and negative changes demonstrating the wide range of processes involved in this area of health services research.

Original languageEnglish
Pages (from-to)362-371
Number of pages10
JournalEMA - Emergency Medicine Australasia
Volume31
Issue number3
DOIs
Publication statusPublished - 1 Jun 2019

Fingerprint

Hospital Emergency Service
Emergencies
Australian Capital Territory
Guideline Adherence
Western Australia
New South Wales
Queensland
Health Services Research
Interviews

Cite this

@article{71b24f91eaae46ae9c6255a46fb2f94c,
title = "Impact of the Four-Hour Rule/National Emergency Access Target policy implementation on emergency department staff: A qualitative perspective of emergency department management changes",
abstract = "Objective: It has been 10 years since the ACEM Access Block Solutions Summit and 5 years since the introduction of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) policy. The impact of this policy on ED management and on ED staff has been poorly understood. The aim of the present study was to identify changes in ED management resulting from the policy based on ED staff experiences. Methods: Semi-structured interviews were conducted and transcribed, imported to NVivo 11 and analysed using a combination of content, thematic analysis and phenomenological focus within a theoretical framework known as the ‘logic model’. Results: One hundred and nineteen ED staff participated in 2015–2016 to assess the impact of the policy implementation. Participants were drawn from 16 EDs in New South Wales, Queensland, Western Australia and Australian Capital Territory. In relation to ED management, three themes were identified: changes in ED management; activities and changes driven by the hospital in relation to 4HR/NEAT; and participant experiences in relation to policy compliance by staff. Conclusions: Policy implementation is a complex process that had both positive and negative consequences on how ED staff managed the implementation of the 4HR/NEAT policy and how it changed their work environment. Understanding the perceptions of staff involved in policy implementation has significance for the design of future implementation strategies. The biggest insight from the present study is that ED management is very complex and the policy generated multiple positive and negative changes demonstrating the wide range of processes involved in this area of health services research.",
keywords = "emergency department management, Four-Hour Rule, National Emergency Access Target, qualitative research, staff perception and experience",
author = "{on behalf of the 4HR/NEAT Partnership Grant} and Shizar Nahidi and Roberto Forero and Nicola Man and Mohammed Mohsin and Gerard Fitzgerald and Toloo, {Ghasem (Sam)} and Sally McCarthy and Nick Gibson and Daniel Fatovich and David Mountain",
year = "2019",
month = "6",
day = "1",
doi = "10.1111/1742-6723.13164",
language = "English",
volume = "31",
pages = "362--371",
journal = "Emergency Medicine",
issn = "1742-6723",
publisher = "John Wiley & Sons",
number = "3",

}

TY - JOUR

T1 - Impact of the Four-Hour Rule/National Emergency Access Target policy implementation on emergency department staff

T2 - A qualitative perspective of emergency department management changes

AU - on behalf of the 4HR/NEAT Partnership Grant

AU - Nahidi, Shizar

AU - Forero, Roberto

AU - Man, Nicola

AU - Mohsin, Mohammed

AU - Fitzgerald, Gerard

AU - Toloo, Ghasem (Sam)

AU - McCarthy, Sally

AU - Gibson, Nick

AU - Fatovich, Daniel

AU - Mountain, David

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objective: It has been 10 years since the ACEM Access Block Solutions Summit and 5 years since the introduction of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) policy. The impact of this policy on ED management and on ED staff has been poorly understood. The aim of the present study was to identify changes in ED management resulting from the policy based on ED staff experiences. Methods: Semi-structured interviews were conducted and transcribed, imported to NVivo 11 and analysed using a combination of content, thematic analysis and phenomenological focus within a theoretical framework known as the ‘logic model’. Results: One hundred and nineteen ED staff participated in 2015–2016 to assess the impact of the policy implementation. Participants were drawn from 16 EDs in New South Wales, Queensland, Western Australia and Australian Capital Territory. In relation to ED management, three themes were identified: changes in ED management; activities and changes driven by the hospital in relation to 4HR/NEAT; and participant experiences in relation to policy compliance by staff. Conclusions: Policy implementation is a complex process that had both positive and negative consequences on how ED staff managed the implementation of the 4HR/NEAT policy and how it changed their work environment. Understanding the perceptions of staff involved in policy implementation has significance for the design of future implementation strategies. The biggest insight from the present study is that ED management is very complex and the policy generated multiple positive and negative changes demonstrating the wide range of processes involved in this area of health services research.

AB - Objective: It has been 10 years since the ACEM Access Block Solutions Summit and 5 years since the introduction of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) policy. The impact of this policy on ED management and on ED staff has been poorly understood. The aim of the present study was to identify changes in ED management resulting from the policy based on ED staff experiences. Methods: Semi-structured interviews were conducted and transcribed, imported to NVivo 11 and analysed using a combination of content, thematic analysis and phenomenological focus within a theoretical framework known as the ‘logic model’. Results: One hundred and nineteen ED staff participated in 2015–2016 to assess the impact of the policy implementation. Participants were drawn from 16 EDs in New South Wales, Queensland, Western Australia and Australian Capital Territory. In relation to ED management, three themes were identified: changes in ED management; activities and changes driven by the hospital in relation to 4HR/NEAT; and participant experiences in relation to policy compliance by staff. Conclusions: Policy implementation is a complex process that had both positive and negative consequences on how ED staff managed the implementation of the 4HR/NEAT policy and how it changed their work environment. Understanding the perceptions of staff involved in policy implementation has significance for the design of future implementation strategies. The biggest insight from the present study is that ED management is very complex and the policy generated multiple positive and negative changes demonstrating the wide range of processes involved in this area of health services research.

KW - emergency department management

KW - Four-Hour Rule

KW - National Emergency Access Target

KW - qualitative research

KW - staff perception and experience

UR - http://www.scopus.com/inward/record.url?scp=85052485231&partnerID=8YFLogxK

U2 - 10.1111/1742-6723.13164

DO - 10.1111/1742-6723.13164

M3 - Article

VL - 31

SP - 362

EP - 371

JO - Emergency Medicine

JF - Emergency Medicine

SN - 1742-6723

IS - 3

ER -