Effects of the Levels of Awareness on Healthcare Staff Morale in Emergency Departments - Term Paper Example

EFFECTS OF THE LEVELS OF AWARENESS OF THE FOUR-HOUR WAIT PERIOD ON HEALTHCARE STAFF MORALE IN ACCIDENT AND EMERGENCY DEPARTMENTS By Presented to Introduction The accident and emergency (E&A) departments are undoubtedly some of the busiest and highly sensitive sections of any health unit. Hospitals need to equip the E&A to a level that is practically capable of handling the forecasted number of emergencies arising from within regions it directly serves. The country has recently seen a rise in the number of people seeking emergency treatment, estimated at 47% by the National Audit Office (2013). The same office further estimates that in 2012, 67% of hospital admissions emanated from the emergency department. These figures suggest just how important the A&E is. As a policy guideline, the government started the four-hour wait target to overcome the long-standing problem of delayed attendance to casualties at the A&E (Forero, McCarthy and Hillman, 2011). The policy directive was meant to achieve a 98% success rate by 2004 (Parry, 2015). Immediate mechanisms put in place to ensure success of the program were instantly effective, and the country achieved the highest rate of attendance to A&E patients in 2004 (98.2%). The high levels of success saw the model’s introduction to other countries, including New Zealand and Australia, sometimes in slightly altered forms (Hibbert et al, 2013). However, population growth against increasing demand for A&E services sooner forced the revision of the 98% target to 95% due to repeated failures to hit the target and the consequential feeling that the target was unrealistic in the face of trending changes and needs (Watt and Siddique, 2015). The 2012 to 2014 estimates show a consistent failure to meet the revised target of 95%, with the national average plummeting to as low as 92.6% (Parry, 2015; Press Association, 2015). According to the Royal College of Nursing (2015), healthcare staff are constantly calling for review of the four-hour waiting period, so it can be extended to accommodate more time. However, the Department of Health has adamantly refused a review, indicating that it is improper to allow medical staff to watch patients suffer at the reception due to irregularly adjusted guidelines. Mortimore and Cooper (2007) documented the views of nurses involved in A&E. They found out that besides reported increase in the rate of medical attention and care extended to patients, the nurses were overwhelmingly worries about several factors, including the imposed nature of the target, increased workload and pressure at work, the quality of care dispensed, and the level of support extended from primary and secondary care providers. These points were highlighted as a source of reduced morale among nurses (Vezyridis and Timmons, 2014). Inevitably, nurses undergo these experiences alongside their counterparts in other professions who all attend to patients in A&E. By extension, we can safely assume that the healthcare staff have looming grievances against the way the four-hour target policy is being implemented. Such grievances have inevitably demoralised them (The King’s Fund, 2015; Letham and Gray, 2012). The healthcare staff feel they should not have such policies forced upon them. On the other hand, the government (acting through the Department of Health) feels obligated and pressurized to come up with policies that are more sympathetic to the people (Mortimore and Cooper, 2007). This conflict is what begets the demoralising working atmosphere among the healthcare workers. The conflict highlighted above has been attributed to the falling levels of morale among healthcare workers. The awareness that failing to meet the attendance limits provided by the Department of Health insinuates underperformance can be translated into a demoralising catastrophe. For the purposes of this research, the researcher assumes that the higher the levels of awareness, the higher the loss of morale; perhaps due to increased feeling of pressure and reduced independence in decision making. Based on this hypothetical relationship between staff morale and levels of awareness of the four-hour waiting period, the researcher aims to explore the stated research question: Do higher levels of awareness of the four-hour waiting period lead to lower levels of morale among healthcare employees? Methods Use of Questionnaire The use of questionnaire has become standard practice of data and information collection across all disciplines of study. Questionnaires comprise a set of questions outlined for a respondent to provide guided or unguided replies. The present study will also employ questionnaires as the primary method of data collection. The general aim is to be able to measure how differing levels of awareness affect the level of morale among healthcare staffs. In this case, it is important to gather information on how much each potential respondent thinks or can be thought to be aware of the four-hour waiting policy. Therefore, scores on respondents’ acknowledged awareness levels will be reported on a scale that is sensitive to the levels of acknowledgement. Again, the morale of healthcare staff will be assessed on a numerical scale that they will individually be responsible of reporting. The need to get quantitatively valuable information for each of these measures underlines why questionnaire is the best tool for data collection. Questionnaires are modelled in such a way that the respondent is left adequate room to express their thoughts to guided questions through provision of hierarchically sensitive options for replies to questions/ statements (Office of Planning and Institutional Assessment, 2006; Mathers, Fox and Hunn, 2009). The questionnaire is designed to effectively provide sufficient data to respond to the research question. Key Concepts and Operational Definition The assessment criteria is built upon the concept that both levels of awareness and levels of morale among healthcare employees provide quantitative insight into how individual respondents express their feelings towards each question. In order to achieve a level of quantification desirable for answering the question, the possible replies are ranked; such that responses indicating low or lack of a specified quality are systematically denoted by lower scores while indications of higher ranking imply rising agreeability. This way, consistency will be maintained and interpretation of results will be easier. The operationalization procedure just described is best accommodated by the likert scale; a scale that ranks potential responses to a survey question based on an established criteria for ranking (Mathers, Fox and Hunn, 2009). Justification for Inclusion of the Questions in the Questionnaire Form The first section explores the healthcare workers perceptions of their workload. Apparently, workload has been cited by Royal College of Nursing (2015) as one of the factors that lead to apathy towards work. The first question explores whether workload is shared fairly among departmental staff members. Unequal treatment when sharing workload could potentially lead to low morale among the officers assigned more workload. The second question explores whether the amount of work handled in the A&E department is reasonable. In situations where the workload is unbearable, lack of administrative support in such ways as failure to recruit enough staffs could be cited. If too much work is assigned without implementing a reasonable methodology of achieving desired targets, then it would be unreasonable to assess the particular staff members against the national standard of four hours. This unreasonable assigning of workload could also lead to reduced morale, besides some other obvious situations such as burnout, psychological and physical harm. The second set of questions contains two questions and explores the relations between the employees and their managers. The first asks whether the employee is provided a platform to engage the manager regarding ways they can attain the work targets. If such an avenue is unavailable, the employee will be perpetually frustrated, a simple path towards explaining their loss of morale. On the other hand, if the avenue is availed, the employee will be more likely to report higher levels of morale. Change in targets is supposed to be discussed with employees, as much as they should take part in formulating the incoming ones. Failure to observe this could lead to a feeling that the targets are unreasonably imposed on employees, besides highlighting the role of management in reinforcing the levels of morale among junior employees. As noted above, quality of care plays a significant role in enhancing the morale of healthcare workers. Several aspects can be used to assess the maximum level of quality provided or available. In the first question, the researcher aims at investigating whether setting targets leads to improved quality of service. If it does, employees will more likely feel comfortable working to meet the targets even when they have not originated from within the general cadres in the workforce. Similarly, lack of adequate resources to handle the incoming patients could hamper employees’ ability to offer quality care, thereby dampening their morale. The next question investigates whether the employees feel the four-hour limit is adequate to adequately assist patients requiring emergency attention. As indicated above, this is the main point of contention between nurses and could help to assess how it affects employee morale. Similarly, if the time limit is unreasonable, the quality of care would be compromised. That is why the last question in this section asks whether quality of care is affected by setting of the target. The segment on professional development starts with a question on whether the training offered stresses awareness on the four-hour wait target. This question measures participants’ awareness levels as a sub-segment of professional development. The next question investigates whether the participants are allowed to perform what tasks they are best in. Allowing employees to specialize in what they are best in means they give their best on what they have the greatest awareness. Next, the questionnaire investigates whether participants are allowed to contribute to the programme. In the event they are not allowed, it indicates that they are denied the level of awareness that would enable them contribute to policy implementation. The last question in the segment focuses on how working towards the target makes the whole experience interesting. The researcher assumes that when the level of awareness is high, the worker understands the policy better and will be thrilled to work to a standard recommended by the thereof. Participation in decision making is another morale boosting undertaking. The question on whether a participant is involved in decision making on achieving the target is used to hint the analyst on how the worker draws the morale boost that comes with being involved in decision making. Equally intended to investigate the role of involvement in decision making to morale boosting is the question asking whether the employee gets the opportunity to take a leadership role for the achievement of the four-hour target. Being able to make personal decisions is motivating and impacts the morale of employees positively. They feel encouraged and not unnecessarily supervised. Getting enough opportunities to discuss staff awareness on why meeting the target is important and the specific details of the target policy further reinforces the morale of employees. The section on the environment is also associated with how a conducive environment positively contributes to the morale of employees. For instance, working as a team, which is inquired in the first question, makes every member feel appreciated and offer what they are best in. There is hardly any opportunity that individual employees will be overburdened unnecessarily, which in itself is a morale breaker. Similarly, a working environment that encourages feedback to employees makes them learn in time when they are performing optimally and helps them maintain the commendable standards. On the other hand, poor performance at any specific moment is pointed out in time, enabling the involved worker to review their performance in time. Availability of internal and external support also boosts morale since the employee is always guaranteed of understanding and support when facing difficulties. Equally important are physical and mental support to achieve the target. A feeling of achievement when successfully meeting the target parameters boosts employee morale. The personal aspect of the questionnaire investigates how the employee’s individual; perceptions and how they affect morale. Individual’s commitment to achieving the set target is a direct measure of their willingness to work as a team, and implied persuasion to abide by the set standards. The feeling that a member of the healthcare team is being pressured to meet certain objectives is another measure of how much morale can be lost through employment of methods that do not respond to individuals’ needs. Similarly, a sense of belonging (to the workforce) drawn from knowing that the team is working towards meeting set targets which one is a part of serves to boost employees’ morale. Possessing enough information about the four-hour wait target program serves as another morale boost, mainly due to the feeling of confidence that comes with a sense of adequate awareness. A system that allows employees to feel as achievers and gives recognition for meeting objectives is necessary to raise morale levels among employees. Additionally, proving that the target is set for a positive reason serves to persuade the employees to aim towards specific goals by diligently playing their individual parts. In essence, the question on whether the employee understands what purpose the target plays raises the morale to work diligently and in a focused way. The final section of the questionnaire investigates the aspect of respect for employees and how it affects their morale at work. For instance, the ability to influence decisions on targets is regarded as a way to raise employees’ morale through giving them enough space to decide what best suits healthcare-centre-specific needs. Consulting employees when changes in working conditions are to be implemented also raises their morale since they feel that their presence and input is appropriately acknowledged. Another sign of respect that raises employees’ morale is passing informal appreciation and praise to individuals when they meet the set targets. The feeling of appreciation shows that individuals are free to interact with each other, thereby boosting interpersonal relations at the healthcare centre. Finally, a situation where the management listens to the voices and opinions of junior employees regarding the targets sets a precedent of respect and a feeling of recognition, which proportionately promotes employees’ morale. Sampling Strategy Apparently, the method of sampling must initially involve a degree of subjectivity since the researcher must identify employees working in A&E. Therefore, the initial sampling would be biased and non-random. After the employees working in the desired department have been identified, the researcher can then select a few from each category; for instance, medical doctors, nurses, paramedics and so on. Random sampling will in this case help to allocate questionnaire forms to just few of identified workers. This can be replicated across several healthcare centres/ hospitals in order to obtain a sizeable and representative sample. Potential respondents will be issued with questionnaire forms, educated on the importance of the study and its scope, and guided on the process of returning completed forms to the researcher. Only forms with complete data and non-confidential information will be admitted for analysis. This aspect will also be communicated clearly to the participants. Recruitment for the Pilot Study During the pilot study, the researcher sought to establish rapport with A&E employees from two healthcare centres. The initial survey form that had been designed for data collection was issued to my university department for approval. The amended form was issued to employees at the A&E department and the scope and aim of the study explained to them. The hospital staff were requested to join the study voluntarily, after assurances that their information would remain anonymous for the study were provided. The process highlighted the need to include staff members from all professions participating in A&E. As a result, subjective sampling was recommended to replace the initially intended random sampling (that would have been used exclusively throughout the entire study). The initial form used for data collection was amended for use in the final study. Ethical Issues One of the main ethical issues covered was getting approval from my university department. I approached the department and defended the choice of proposal. Once allowed, I sought the department’s consent to issue questionnaires so I could collect data from potential participants. I notified the medical institutions about my intention to interview their staffs, and presented the consent forms signed by my university department. I was finally given access to the A&E department, from where I appealed to members to join the programme after explaining the topic I wished to explore and convincing them about the safety of information they provided to me during the survey period. Lessons Learnt The experience presented unique insights into what high-level research encompasses – a high level of ethical involvement should be maintained at high level. The use of quantitative methods highlights important statistics that are easy to understand and could help shed light into the situation at hand. However, review of literature shows that in situations like the one exploring the role of awareness to employees’ morale, qualitative methods could enhance the quality of responses obtained. One more lesson lies in establishing a good rapport with potential respondents, and making them understand the importance of the study being undertaken and how their privacy is maintained at all times. Strengths and Limitations of the Research Method Quantitative analysis presents an understandable interpretation to data and captures the attention of the reader in a simple and easily legible manner. However, it is unable to capture feelings and opinions that cannot be expressed quantitatively (Mathers, Fox and Hunn, 2009). Furthermore, the questionnaire presented does not explore views beyond what the researcher asks (Office of Planning and Institutional Assessment, 2009). The Likert scale is the best known method for arranging opinion-based data into realistic quantitative schemes. However, it also poses challenges of unequal ranking of similar aspects of the personal experience (Mathers, Fox and Hunn, 2009); for instance, an individual whose level of awareness of the four-hour wait target is good may feel morally unobligated to indicate a score as high as they should, while another whose understanding is much lesser could indicate a higher score than they deserve. Therefore, it is prone to personal misjudgements. Summary The research outlined presented the researcher with a unique procedure to enhance preparation for high-level research. The pilot survey presented insights into the real process of engaging potential respondents in a healthcare situation in data collection. Furthermore, despite the high expectations put in place for the A&E, it is apparent that achieving the target is not always easy, and requires the engagement and training of all levels of staffs to enhance understanding and quality service that is key to achieving the four-hour wait target. References Forero, R., McCarthy, S. and Hillman, K. 2011. Access block and emergency department overcrowding. Critical Care. 15(2):216-221. Hibbert, P., Hannaford, N., Long, J., Plumb, J. and Braithwaite, J. 2013. Final report: Performance indicators used internationally to report publicly on healthcare organisations and local health systems. Australian Institute of Health Innovation, University of New South Wales. Letham, K. and Gray, A. 2012. The four-hour target in the NHS emergency departments: A critical comment. Emergencias. 24: 69-72. Mathers, N., Fox, N. and Hunn, A. 2009. Surveys and questionnaires. The NIHR RDS for the East Midlands/ Yorkshire and the Humber. Mortimore, A. and Cooper, S. 2007. The “4-hour target”: Emergency nurses’ views. Emergency Medicine Journal. 24(6): 402-404. National Audit Office. 2013. Emergency admissions to hospital: Managing the demand. London: The Stationery Office. Office of Planning and Institutional Assessment. 2006. Using surveys for data collection in continuous improvement. The Pennsylvania State University. Parry, L. 2015. A&E waiting times in England are worst for a decade as hospitals strain under the pressure of ‘exceptional demand’. Mail Online: Associated Newspapers Ltd. [Online]. http://www.dailymail.co.uk/health/article-2898495/A-E-waiting-times-England-worst-decade-hospitals-strain-pressure-exceptional-demand.html. Press Association. 2015. NHS fails to meet four-hour waiting target every week this winter. The Guardian: Guardian News and Media Ltd. http://www.theguardian.com/society/2015/mar/13/nhs-fails-to-meet-four-hour-waiting-target-every-week-this-winter. Royal College of Nursing. 2015. 8 stop-watch care: Matter for discussion submitted by the RCN Lothian Branch. [Online]. http://www.rcn.org.uk/newsevents/congress/2009/rcn_councils_report_of_progress_on_agenda_items_at_congress_2008/8_stop-watch_care. The King’s Fund. 2015. What is going on in A&E? The key questions answered. [Online]. http://www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters. Watt, N. and Siddique, H. 2015. NHS four-hour wait time target in A&E met in 90% of cases – Jeremy Hunt. The Guardian: Guardian News and Media Ltd. [Online]. http://www.theguardian.com/society/2015/jan/06/nhs-failing-to-meet-targets-health-minister-norman-lamb. Vezyridis, P. and Timmons, S. 2014. National targets, process transformation and local consequences in an NHS emergency department (ED): A qualitative study. BMC Emergency Medicine. 14(12): 1-11. Read More