Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective

Roberto Forero, Shizar Nahidi, Josephine de Costa, Daniel Fatovich, Gerry FitzGerald, Sam Toloo, Sally McCarthy, David Mountain, Nick Gibson, Mohammed Mohsin, Wing Nicola Man

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BackgroundThe Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project.MethodsThe methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis.ResultsThree key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels.ConclusionFindings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff's experiences.

Original languageEnglish
Article number82
Number of pages14
JournalBMC Health Services Research
Volume19
DOIs
Publication statusPublished - 30 Jan 2019

Cite this

Forero, Roberto ; Nahidi, Shizar ; de Costa, Josephine ; Fatovich, Daniel ; FitzGerald, Gerry ; Toloo, Sam ; McCarthy, Sally ; Mountain, David ; Gibson, Nick ; Mohsin, Mohammed ; Man, Wing Nicola. / Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia : a qualitative social dynamic perspective. In: BMC Health Services Research. 2019 ; Vol. 19.
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title = "Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective",
abstract = "BackgroundThe Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project.MethodsThe methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis.ResultsThree key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels.ConclusionFindings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff's experiences.",
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Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia : a qualitative social dynamic perspective. / Forero, Roberto; Nahidi, Shizar; de Costa, Josephine; Fatovich, Daniel; FitzGerald, Gerry; Toloo, Sam; McCarthy, Sally; Mountain, David; Gibson, Nick; Mohsin, Mohammed; Man, Wing Nicola.

In: BMC Health Services Research, Vol. 19, 82, 30.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia

T2 - a qualitative social dynamic perspective

AU - Forero, Roberto

AU - Nahidi, Shizar

AU - de Costa, Josephine

AU - Fatovich, Daniel

AU - FitzGerald, Gerry

AU - Toloo, Sam

AU - McCarthy, Sally

AU - Mountain, David

AU - Gibson, Nick

AU - Mohsin, Mohammed

AU - Man, Wing Nicola

PY - 2019/1/30

Y1 - 2019/1/30

N2 - BackgroundThe Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project.MethodsThe methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis.ResultsThree key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels.ConclusionFindings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff's experiences.

AB - BackgroundThe Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project.MethodsThe methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis.ResultsThree key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels.ConclusionFindings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff's experiences.

KW - Four hour rule

KW - National Emergency Access Target

KW - Qualitative research

KW - Australia

KW - Emergency department

KW - Health policy

KW - Unintended consequences

KW - UNINTENDED CONSEQUENCES

KW - MORTALITY

KW - BLOCK

KW - CARE

KW - ASSOCIATION

KW - ADMISSIONS

KW - STANDARD

KW - ENGLAND

KW - LESSONS

KW - HEALTH

U2 - 10.1186/s12913-019-3877-8

DO - 10.1186/s12913-019-3877-8

M3 - Article

VL - 19

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

M1 - 82

ER -