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Workforce shortages can have a negative impact on quality patient care. The emergency department in particular requires an efficient, collaborative and patient-care-centric workforce in order to streamline the patient journey and strengthen models of care.
What are the key staff management challenges facing your hospital/service and do you have any strategies around increasing staff satisfaction, training, recruitment and retention?
Ambulance services are undergoing significant change. In Victoria our workforce demographic is shifting rapidly from a male dominated vocationally trained workforce to an increasingly urbanised female, university trained workforce. Whilst attrition remains stable (3-4% per annum), there are increasing challenges in recruiting to more rural areas.
To address this we have introduced an innovative Rural Sponsored Degree Program which allows ambulance volunteers from rural locations to become degree qualified paramedics. Following completion of a Certificate IV level qualification and bioscience bridging program they receive 1st year credit into a Bachelor of Paramedic Science program at Flinders University and are employed full-time by Ambulance Victoria whilst completing their degree part-time over the next 4 years. To date 6 paramedics have graduated from the program with a further 12 currently completing it. We are now in the fifth year of the program, which is proving popular and providing a pathway for people with life experience, commitment and a strong interest to pursue a career as a paramedic whilst enabling us to staff difficult to fill rural locations. Mr Tony Walker, General Manager Regional Services, Ambulance Victoria, VIC
The key staff challenges for me for medical staff in our ED are always going to be recruitment and retention. This encompasses all levels from interns, TMO’s, RMO’s and consultants. Issues around this include appropriate funding for to enable adequate staffing numbers, enticing people to a smallish regional hospital where there are limited opportunities for ongoing specialist training (GP training excepted) and the time commitment and resources involved in the recruitment process.
Strategies for staff satisfaction include better communication with the staff through various means, securing more senior consultant level supervision in the ED across a broad range of hours, trying to have ED accredited for specialist training (e.g. ED registrar training) as well as the current GP training that we provide and, in general, improving the experiences of the medical staff both in and out of work. This year we have recruited our RMO’s from the UK and this has been a great step forward and they are all very skilled and work as a highly cohesive team.
Most importantly is the ability for us to all work well together in an efficient multidisciplinary team to support each other as we are a small environment that does lack resources but, on the other hand, has a wealth of multidisciplinary experience that should be tapped. Dr Trevor Burchall, Director of Emergency Medicine, Mount Gambier and District Health Service
The key threat to staff satisfaction in an ED is uncertainty. Issues such as workload, lack of resources, inadequate admin support, lack of respect from inpatient departments, and so on, are common to all ED’s, and are a constant. Staff are willing to put up with all of those things provided there is a sense of stability within the ED. Because by nature the ED is a place of relentless and fast paced change (new policy, temporary staff, evolving models of care, political expectations…), maintaining stability is the chief challenge to keep staff happy and engaged.
Caboolture Hospital ED closed temporarily in 2006 due to a lack of registrar staff, in turn due to poor planning. The morale could not have been lower. The department was filled with a sense of being powerless victims of a health system that didn’t care. the relationship with our administration was toxic, and all consultants resigned in despair. A series of strategic interventions restored the dept to function, and it is now blossoming with 16 training registrars. The key factor in recovery was the development of a culture of hope, because when there is hope there is stability. This hope was generated by things like:
Building a strong collaborative relationship with admin, so that we have an influential voice in the hospital, and goodwill to call on when needed
Teambuilding through combined education, multidisciplinary leadership group, social activities within and external to the ED. A genuine family atmosphere
Involvement of staff in key decision making, and portfolios for senior nurses, registrars and consultants to foster ownership of problems/solutions
Frequent communication of changes, plans, activities
Strong focus on education programmes for all levels to build a sense of long term commitment to staff development
Long term vision and annual goals to demonstrate progress year by year
Regular meetings with all inpatient departments to problem solve – removes long term gripes and mistrust
All of this gives a sense of self determination, forward thinking, and belonging to a caring team. This in turn brings resilience to all of the chaos outside the ED. Dr. Chris Johnstone, Director Department of Emergency Medicine, Caboolture Hospital
In relation to the primary contact musculoskeletal physiotherapy ED service challenges are:
The absence of an available pool of qualified staff requires us to train our own
The absence of dedicated training time (and funding for this) to allow such development and training
The afterhours and weekend staffing requirements required in the ED and staff wanting to maintaining a good work-life balance (family friendly rostering)
Various barriers, some legislative barriers preventing the full implementation of an effective, efficient role – for example regarding prescribing, imaging, writing Work cover certificate.
Strategies around increasing staff satisfaction, training, recruitment and retention are:
Utilising a team-based approach to service delivery ie. not one sole physiotherapist in the ED providing the primary contact musculoskeletal physiotherapy ED service. Several experienced physiotherapists who work in other advanced practice musculoskeletal services, such as orthopaedic outpatient screening clinics, also work in the ED setting
Training is conducted on-the-job with a work-based competency assessment to be completed once self-directed learning and trainee program is completed
Additional strategies for the future include: working towards changing legislative barriers for physiotherapists’ to allow limited prescribing (E.g. analgesia for back pain patients) and access to imaging other than plain film when indicated. This will result in improved productivity and patient flow in the ED whilst also improving staff satisfaction, recruitment and retention
Paula Harding, Musculoskeletal Physiotherapist, The Alfred
Key management challenge – achieving more with less.
NEAT target – 50% increase in departmental efficiency required, in the background of reduced staffing numbers and reduced overall funding.
Management in time of uncertainty – Queensland Health has recently undergone a significant restructure – with loss of many top level executives – in Critical Care division – the Executive Director is gone, as is her boss, the hospital CEO, as is his boss, the District CEO – so much corporate knowledge has left with them.
Communication with staff of the changes happening and explanation of why changes have to be made.
Frequent publication of positive results ( eg improvements to NEAT targets), maintenance of what is valued by staff (eg education and training time)
Ongoing performance management and support.
Remember: your priorities are not necessarily those of your staff! Adjunct Prof Alan O’Connor, Director of Emergency Medicine, Royal Brisbane & Women’s Hospital