ED Assembly: Introducing a Simple Method of Bringing Emergency Department Staff Together to Facilitate Improvement; A Report of a Real Experience (2024)

Abstract

Keywords: Assembly, Emergency Department, Overcrowding, Quality Improvement, Team Work

Introduction

Emergency department (ED) serve as the front line of care for the injured and severely ill. The pressure on the UK’s EDs has been described by the Royal College of Emergency Medicine as the “biggest operational challenge facing the national health system (NHS)” as more and more people are attending, and it is stretching the ability of departments to cope (1).

Working in a busy department is both challenging and demanding; communication can be particularly difficult, and risks arise directly from the unique contextual demands of the ED environment. Shortage of staff at every level across the NHS is hitting every hospital and the effects are being felt more severe in EDs where recruitment and retention can be difficult, due to the demanding nature of the role. A steady increase in attendances, a falling number of doctors and nurses, waiting time target pressure and poor work/life balance is resulting in bottlenecks throughout the hospital system that back up into the ED; “With bed occupancy high, staff under strain and resources tight, there is no doubt that the system is near breaking point” (2).

The ED at St Peter’s Hospital is a medium size department, seeing around 260–300 patients per day. As a result of sustained demand, meeting the 4-hour waiting target continues to be a struggle so is there anything we can do to try to alleviate this problem and improve staff morale in ED?

At ASPH, there is excellent setup with a dedicated quality improvement (QI) team working under the umbrella of ‘Be the Change’; the trust-wide program and mechanism for identifying, supporting and affecting staff-led improvement projects. The QI team supports individuals and teams to be creative and innovative, providing help to continue to find ways, in which services and care can be improved, their work is supported by the executive team and hierarchy.

One of the biggest challenges in any ED is communication, hence we set out to find a way to provide a platform for the team that would allow them to directly input into decisions that influence the department and given them the freedom to raise ideas for improvement, regardless of their position within the team hierarchy.

We searched the options available; concept of daily clinical huddles, daily meetings as seen in motor industry, possibility of monthly debrief sessions outside work environment, frequent quality and safety day type events, offer platform for anonymous feedback, but it was felt that none of the above fit the purpose in a busy ED.

In September 2015, some members of the QI team and Dr Nayeem visited Sheffield Teaching Hospitals NHS Foundation Trust where there is a Microsystems Coaching Academy program, which supports staff to carry out QI work, through training and team coaching. As part of the visit, the team attended a ward improvement meeting and witnessed an example of structured, well-led, non-hierarchical meeting. We decided to use the model seen in Sheffield with changes needed to implement the model in a busy ED. Aim being to improve the productivity of the ED team and find a mechanism to create a more supportive and enjoyable working environment within the department.

Methods

With the support of the ASPH QI team, ED took the core concept of what they saw at Sheffield and created an effective meeting with the aim to provide staff with a platform of no hierarchy, an opportunity to lead improvement projects, to support and provide tools to lead changes with the aim to have a huge amount of work completed within a short (30 minutes) time via an effective ED meeting called ‘ED assembly’.

ED assembly is a simple method of bringing staff together to facilitate improvement and better team working. It is a platform for effective communication, in which there is no hierarchy and everyone is encouraged to contribute. The whole ED team is invited; in fact, anyone from across the Trust is invited. The assembly creates time and space for the whole team (doctors, nurses, porters, housekeepers, administrative staff and managers) to come together. It runs to a routine, every other Wednesday at 11^am for half an hour.

The agenda is set by the team in advance and everyone is encouraged to contribute their ideas and any items they wish to communicate to others. There is a timekeeper and note taker allocated for each meeting and short term actions are agreed. It is important that progress is made from one meeting to another in order to generate the rapid improvement cycles that create the energy to fuel the continued desire for staff to improve and find better ways of working. Since the inception of ED assembly, there has been multiple improvement projects completed resulting in improved quality of care and safety for patients attending the ASPH ED.

Results

Here are some examples of the quality improvement initiatives that have been born out of ED Assembly

Discussion

At ASPH, we aim to empower all staff to identify quality improvement opportunities in their own areas and support them to make these improvements themselves. The ED assembly has not only enabled all ED staff to come forward with ideas, but has actively encouraged the team to work together to make improvements and to develop new skills in doing so. As well as making improvements to individual processes and pathways, ED assembly aims to improve the environment for staff and patients alike. There is a well-established relationship between staff experience and patient experience (4). ED assembly is one way that the staff are improving the teamwork and culture in the department. Facilitating teamwork, improvement and respect means staff are more likely to raise concerns or ask, which helps to improve safety.

Our chief executive at ASPH, said that “we are embracing QI, not only because it is the right thing to do, but because it will help us achieve the culture of curiosity and creativity where we all feel empowered and confident in looking for improvements for the benefits of our patients.” ED assembly is testament to this developing culture of curiosity and creativity and demonstrates what can be achieved by well supported and well led staff in a short space of time.

Conclusions

ED assembly has supported many small but effective QI initiatives and regular communications support timely feedback on progress and update on plan-do-study-act (PDSA) cycles, resulting in changes in the everyday practice and improved pathways of patient care.

Acknowledgements

None.

Footnotes

References