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

摘要

Background: Overcrowding in emergency departments is a global issue, which places pressure on the shrinkingudworkforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling thisudcrisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in qualityudand performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgentudand emergency care delivery.ududMethods: A multiple case study design framed around systems thinking was conducted in South East England acrossudone Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources includedud14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning andudrapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n=48); and a review of literatureudand analysis of policy documents including care pathways and protocols.ududResults: The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinicaludsystems leadership, a single integrated career and competence framework and skilled facilitation of work based learning.udConclusions: In this study, participants agreed that whole systems urgent and emergency care allows for the designudand implementation of care delivery models that meet complexity of population healthcare needs, reduce duplicationudand waste and improve healthcare outcomes and patients’ experiences. For this to be achieved emphasis needs to beudplaced on holistic changes in structures, processes and patterns of the urgent and emergency care system. Oftenudoverlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment andudretention and the overall effectiveness of the organization. These also need to be attended to for transformationaludchange to be achieved and sustained. Research to refine and validate a single integrated career and competenceudframework and to develop standards for an integrated approach to workplace facilitation to grow the capacity ofudfacilitators that can use the workplace as a resource for learning is needed.ududKeywords: Urgent and emergency care, Whole systems working, Leadership, Workforce development, Multiple caseudstudy, Facilitation, Work based learning, Integrated competence framework