Original research
Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study Jo Daniels , 1,2 Emilia Robinson , 1 Elizabeth Jenkinson , 3 Edward Carlton 4,5
Abstract Background Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating to working conditions and working practices in Emergency Departments (EDs). Methods A qualitative approach was taken, using focus groups with ED staff (doctors, nurses, advanced care practitioners) of all grades, seniority and professional backgrounds from across the UK. Snowball recruitment was undertaken using social media and Royal College of Emergency Medicine communication channels. Focus group interviews were conducted online and organised by profession. A semi-structured topic guide was used to explore difficulties in the work environment, impact of these difficulties, barriers and priorities for change. Data were analysed using a directive content analysis to identify common themes. Results Of the 116 clinical staff who completed the eligibility and consent forms, 46 met criteria and consented, of those, 33 participants took part. Participants were predominantly white British (85%), females (73%) and doctors (61%). Four key themes were generated: ’culture of blame and negativity’, ’untenable working environments’, ’compromised leadership’ and ’striving for support’. Data pertaining to barriers and opportunities for change were identified as sub-themes. In particular, strong leadership emerged as a key driver of change across all aspects of working practices. Conclusion This study identified four key themes related to workplace concerns and their associated barriers and opportunities for change. Culture, working environment and need for support echoed current narratives across healthcare settings. Leadership emerged more prominently than in prior studies as both a barrier and opportunity for well-being and retention in the EM workplace. Further work is needed to develop leadership skills early on in clinical training, ensure protected time to deliver the role, ongoing opportunities to refine leadership skills and a clear pathway to address higher levels of management. Introduction Emergency Medicine (EM) is facing a global staffing crisis. 1 Record numbers of staff continue to leave the UK NHS with EM the most affected specialty. 2 EM reports the highest work intensity of all medical specialties, 3 with ‘intensity’ recognised as one of the leading factors in job dissatisfaction, attrition and
Handling editor Caroline Leech ► ► Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi. org/1 0.1136/e mermed-2023- 213189). 1 Department of Psychology, University of Bath, Bath, UK 2 Psychology, North Bristol NHS Trust, Westbury on Trym, UK 3 Department of Health and Social Sciences, University of the West of England, Bristol, UK 4 Emergency Department, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, UK 5 Bristol Medical School, University of Bristol, Bristol, UK Correspondence to Dr Jo Daniels, Department of Psychology, University of Bath, Bath, UK; j.daniels@b ath.ac.u k Received 28 February 2023 Accepted 11 December 2023 Published Online First 9 January 2024
career burnout. 3–5 These factors are amplified in an already stretched workforce. 2 Psychological well-being of the EM workforce is compromised, with working conditions recognised as playing a key role. 6 7 Staff attrition has a systemic impact: lower staff ratios lead to higher workloads, reduced quality of care, 8 higher levels of medical errors 9 and poorer staff well-being, 10 all factors associated with staff absence and intention to leave. 11 The landscape of EM has also changed; increased prevalence of high patient acuity, multimor- bidity and an ageing population all bear considerable impact. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ ⇒ This study identifies leadership as a key opportunity for change and as a result makes specific recommendations for policy and practice regarding leadership in emergency medicine. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ ⇒ Retention of staff in emergency medicine is at crisis level and has been a high priority area for over a decade. ⇒ ⇒ Multiple guidelines have been published to outline improvements that need to be made to retain staff; however, little improvement has been seen on the ground in EDs. ⇒ ⇒ Key factors such as staff burnout and poor working conditions are known to influence intention to leave; however, it is unclear why change has not taken place despite knowledge of these problems and existing guidelines seeking to address these issues. WHAT THIS STUDY ADDS ⇒ ⇒ This qualitative study assessed perceived barriers that may be inhibiting the implementation to working conditions and working practices in EDs. ⇒ ⇒ Leadership is identified as an important driver of change in working practices and can play an important role in workplace well-being and retention. ⇒ ⇒ Key recommendations for avenues of improvement are made, identifying key actions at government, professional, organisational and personal level.
To cite: Daniels J, Robinson E, Jenkinson E, © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
et al . Emerg Med J 2024; 41 :257–265.
Daniels J, et al . Emerg Med J 2024; 41 :257–265. doi:10.1136/emermed-2023-213189
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