Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study

Jo Daniels; Emilia Robinson; Elizabeth Jenkinson; Edward Carlton

doi:10.1136/emermed-2023-213189

Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study

Emerg Med J. 2024 Mar 21;41(4):257-265. doi: 10.1136/emermed-2023-213189.

Authors

Jo Daniels^{1

2}, Emilia Robinson³, Elizabeth Jenkinson⁴, Edward Carlton^{5

6}

Affiliations

¹ Department of Psychology, University of Bath, Bath, UK j.daniels@bath.ac.uk.
² Psychology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
³ Department of Psychology, University of Bath, Bath, UK.
⁴ Department of Health and Social Sciences, University of the West of England, Bristol, UK.
⁵ Emergency Department, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, UK.
⁶ Bristol Medical School, University of Bristol, Bristol, UK.

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.

Keywords: qualitative research; staff support.

MeSH terms

Delivery of Health Care
Emergency Service, Hospital*
Female
Humans
Leadership
Qualitative Research
Working Conditions
Workplace*