When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance

on behalf of the 4HR/NEAT Partnership Grant

Research output: Contribution to journalArticle

Abstract

Objective: To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. Methods: A mixed-methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Results: Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff–patient communication and staff shortages; significant changes in ED management and effective use of the whole-of-hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole-of-hospital approach. ED staff also reported a reduction in communication with patients. Conclusions: There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.

Original languageEnglish
JournalEMA - Emergency Medicine Australasia
DOIs
Publication statusE-pub ahead of print - 8 Oct 2019

Fingerprint

Health Policy
Hospital Emergency Service
Emergencies
Morale
Communication
Compliance
Motivation
Safety
Education

Cite this

@article{51ddeda913c14ef6ac4bea5c2abacfc6,
title = "When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance",
abstract = "Objective: To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. Methods: A mixed-methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Results: Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff–patient communication and staff shortages; significant changes in ED management and effective use of the whole-of-hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole-of-hospital approach. ED staff also reported a reduction in communication with patients. Conclusions: There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.",
keywords = "ED performance, Four Hour Rule, mixed methods research, National Emergency Access Target, staff perception",
author = "{on behalf of the 4HR/NEAT Partnership Grant} and Roberto Forero and Nicola Man and Shizar Nahidi and Gerard Fitzgerald and Daniel Fatovich and Mohammed Mohsin and Hanh Ngo and Ghasem Toloo and Nick Gibson and Sally McCarthy and David Mountain and Ken Hillman",
year = "2019",
month = "10",
day = "8",
doi = "10.1111/1742-6723.13395",
language = "English",
journal = "Emergency Medicine",
issn = "1742-6723",
publisher = "John Wiley & Sons",

}

When a health policy cuts both ways : Impact of the National Emergency Access Target policy on staff and emergency department performance. / on behalf of the 4HR/NEAT Partnership Grant.

In: EMA - Emergency Medicine Australasia, 08.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - When a health policy cuts both ways

T2 - Impact of the National Emergency Access Target policy on staff and emergency department performance

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

AU - Forero, Roberto

AU - Man, Nicola

AU - Nahidi, Shizar

AU - Fitzgerald, Gerard

AU - Fatovich, Daniel

AU - Mohsin, Mohammed

AU - Ngo, Hanh

AU - Toloo, Ghasem

AU - Gibson, Nick

AU - McCarthy, Sally

AU - Mountain, David

AU - Hillman, Ken

PY - 2019/10/8

Y1 - 2019/10/8

N2 - Objective: To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. Methods: A mixed-methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Results: Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff–patient communication and staff shortages; significant changes in ED management and effective use of the whole-of-hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole-of-hospital approach. ED staff also reported a reduction in communication with patients. Conclusions: There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.

AB - Objective: To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. Methods: A mixed-methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Results: Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff–patient communication and staff shortages; significant changes in ED management and effective use of the whole-of-hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole-of-hospital approach. ED staff also reported a reduction in communication with patients. Conclusions: There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.

KW - ED performance

KW - Four Hour Rule

KW - mixed methods research

KW - National Emergency Access Target

KW - staff perception

UR - http://www.scopus.com/inward/record.url?scp=85073971000&partnerID=8YFLogxK

U2 - 10.1111/1742-6723.13395

DO - 10.1111/1742-6723.13395

M3 - Article

JO - Emergency Medicine

JF - Emergency Medicine

SN - 1742-6723

ER -