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

Journal article


Manley, K., Martin, A., Jackson, C. and Wright, T. 2016. Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study. BMC Health Services Research. https://doi.org/10.1186/s12913-016-1616-y
AuthorsManley, K., Martin, A., Jackson, C. and Wright, T.
Abstract

Background: Overcrowding in emergency departments is a global issue, which places pressure on the shrinking
workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this
crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality
and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent
and emergency care delivery.

Methods: A multiple case study design framed around systems thinking was conducted in South East England across
one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included
14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and
rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n=48); and a review of literature
and analysis of policy documents including care pathways and protocols.

Results: The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical
systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning.
Conclusions: In this study, participants agreed that whole systems urgent and emergency care allows for the design
and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication
and waste and improve healthcare outcomes and patients’ experiences. For this to be achieved emphasis needs to be
placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often
overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and
retention and the overall effectiveness of the organization. These also need to be attended to for transformational
change to be achieved and sustained. Research to refine and validate a single integrated career and competence
framework and to develop standards for an integrated approach to workplace facilitation to grow the capacity of
facilitators that can use the workplace as a resource for learning is needed.

Keywords: Urgent and emergency care, Whole systems working, Leadership, Workforce development, Multiple case
study, Facilitation, Work based learning, Integrated competence framework

KeywordsUrgent and emergency care, Whole systems working, Leadership, Workforce development, Multiple case study, Facilitation, Work based learning, Integrated competence framework
Year2016
JournalBMC Health Services Research
PublisherBioMed Central
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/s12913-016-1616-y
FunderHealth Education Kent Surrey Sussex
Publication dates
Online09 Aug 2016
Publication process dates
Deposited25 Aug 2016
Submitted23 Mar 2016
Accepted01 Aug 2016
Output statusPublished
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Jackson, C. 2014. A snapshot culture assessment undertaken for Kent and Medway Partnership NHS Trust. Canterbury Canterbury Christ Church University.
Action learning: maximizing learning in the workplace
Jackson, C. and Thurgate, C. 2011. Action learning: maximizing learning in the workplace. British Journal of Healthcare Assistants. 5 (9), pp. 454-456.
Developing the role of the Assistant Practitioner
Jackson, C. 2010. Developing the role of the Assistant Practitioner.
Preparing for the new graduate workforce across health provider organisations
Manley, K. and Jackson, C. 2011. Preparing for the new graduate workforce across health provider organisations.
Navigating contested terrain - AP stories from the frontline
Jackson, C. and Thurgate, C. 2011. Navigating contested terrain - AP stories from the frontline. British Journal of Healthcare Assistants. 5 (7), pp. 346-349.
Career planning for the future - where to from here?
Jackson, C. 2011. Career planning for the future - where to from here? in: Jackson, C. and Thurgate, C. (ed.) Workplace Learning in Health and Social Care: A Student's Guide Maidenhead Open University Press. pp. 112-126
How does learning happen in the workplace?
Jackson, C. 2011. How does learning happen in the workplace? in: Jackson, C. and Thurgate, C. (ed.) Workplace Learning in Health and Social Care: A Student's Guide Maidenhead Open University Press. pp. 12-21
First do no harm: reflections on setting up a fitness to practice panel at Canterbury Christ Church University
Jackson, C., Biela, C. and Levine, A. 2008. First do no harm: reflections on setting up a fitness to practice panel at Canterbury Christ Church University.
Becoming a learning community: a transformative journey towards a sustainable model to support student learning in practice
Jackson, C. and West, S. 2008. Becoming a learning community: a transformative journey towards a sustainable model to support student learning in practice.
Personal development plans and workplace learning
Jackson, C. and Thurgate, C. 2011. Personal development plans and workplace learning. British Journal of Healthcare Assistants. 5 (6), pp. 292-296.
Transforming professional development for an era of interagency leadership
Hryniewicz, L. and Jackson, C. 2010. Transforming professional development for an era of interagency leadership.
The importance of partnership working in the design and implementation of band A assistant practitioner roles - a case example
Thurgate, C. and Jackson, C. 2010. The importance of partnership working in the design and implementation of band A assistant practitioner roles - a case example. British Journal of Healthcare Assistants. 4 (12), pp. 603-604.
Learning leaders, new professional identities and the implications for children’s centres and early years
Jackson, C. and Hryniewicz, L. 2011. Learning leaders, new professional identities and the implications for children’s centres and early years.
Understanding the importance of career planning
Thurgate, C. and Jackson, C. 2011. Understanding the importance of career planning. British Journal of Healthcare Assistants. 5 (1), pp. 35-37.
Partnership working and the assistant practitioner
Thurgate, C. and Jackson, C. 2010. Partnership working and the assistant practitioner. British Journal of Healthcare Assistants. 4 (12), pp. 603-604.
Facing the challenge: the development of assistant practitioners
Thurgate, C. and Jackson, C. 2010. Facing the challenge: the development of assistant practitioners. British Journal of Healthcare Assistants. 4 (11), pp. 546-547.
Developing foundation degrees in adult health services
Thurgate, C. and Jackson, C. 2010. Developing foundation degrees in adult health services. British Journal of Healthcare Assistants. 4 (8), pp. 382-383.
Creative thinking for whole systems working
Jackson, C. and Ellis, P. 2010. Creative thinking for whole systems working. in: Standing, M. (ed.) Clinical Judgement and Decision-Making in Nursing and Interprofessional Healthcare Maidenhead Open University Press.
An overview of the national challenges of embedding an assistant practitioner workforce in health and social care
Thurgate, C. and Jackson, C. 2010. An overview of the national challenges of embedding an assistant practitioner workforce in health and social care. British Journal of Healthcare Assistants. 4 (11), pp. 546-547.