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Background
The introduction of targets within emergency medicine has led to numerous changes in the way care is delivered in the UK. These changes are largely based on local priorities and demands rather than evidence. However, staff within emergency departments (ED) do not operate in silos, but depend on strong relationships across organisational and professional boundaries to achieve their goals. This study aimed to identify key factors in the context of EDs which may influence performance.
Methods
As part of a multicentre study identifying organisational factors associated with waiting times in UK EDs, an in-depth mixed methods study in eight EDs was undertaken using interviews, focus groups, ethnographic observations and staff questionnaire. While these departments were selected on the basis of a range of performance and situational variables, the research team was blind to the performance information.
Results
Qualitative analyses revealed that better performing EDs were proactive in managing working relationships with the hospital, primary and secondary care. Poor performing departments were reactive in their overall approach. Examination of team working indicated that higher performing departments are more proactive, prioritise work and demonstrate co-operative leadership strategies. Developmental activities take place in high performing departments to increase staff skill and competence. A questionnaire survey of seven of the eight EDs revealed strong relationships between waiting time and stress (psychological strain) and autonomy and control. This indicated that departments with longer waiting times are more likely to report higher than average levels of strain and higher than average levels of autonomy and control over work.
Conclusions
A participative management style is a broad term suggesting proactive leadership, boundary spanning and developmental behaviour that will reduce role conflict and increase co-operation and collaboration within the department along with other associated agencies. These activities may reduce individuals’ autonomy and control, requiring people to work together in a co-operative way to reduce waiting times.