Case Study “Strategic Management of Clinical Emergency Departments”
In the last ten years, the centralization of the discipline-specific emergency departments into a central emergency department (CED) has led to enhanced patient-safety and more quality-oriented emergency care in hospitals. The flow of patients in CEDs is very heterogeneous due to different characteristics such as age, severity and urgency of treatment, which makes the working environment very dynamic and unpredictable for staff. Thus, patient safety is a crucial issue in emergency care in hospitals, which can only be guaranteed in the long term if mistakes are communicated so that lessons can be learnt from them.
For a transparent handling of mistakes and learning from these mistakes, a safety culture is required. This is an essential element of the High Reliability Organization (HRO) theory. When linking the HRO, the safety culture and the CED, the competencies and competency development of the employees are taken up.
The study “Strategic Management of Clinical Emergency Departments” is part of the main project “Gestaltungskompetenz as an Innovator for Highly Reliable Organisations in the Healthcare System”. Aim of the study is to identify the competencies of employees to create a safety culture in a clinical emergency department in the sense of high reliability.
Based on the identified competencies of the employees, an interactive learning environment will be developed. Consequently, the research question of this study is:
“Which competencies do the professionals need to design a safety culture in a central emergency department in terms of high reliability and how can these be developed?”
The first step was the identification of possible problem areas and thus potential competency needs of employees within the CED. Therefore, a CIRS data analysis with the CIRSmedical database was carried out first.
Then the identification of the competencies was carried out on the basis of the literature, whereupon a separate catalogue of competencies for the CED was developed. After that, the competencies were validated within the framework of an empirical method mix (expert interviews, management interviews and employee surveys in the cooperating hospital).
An essential result of these surveys is the adapted basic competency catalogue “Highly reliable patient safety”, enriched by the emergency-specific competencies from the competency catalogue “Patient safety in the central emergency department”. On the basis of the findings of these surveys, a concept for the competency development of staff will be developed.
Expert interviews: Ten experts of international and national professional associations and organisations were interviewed. The topic was classified as very relevant for German hospitals. Furthermore, the competencies and their descriptions were highly relevant.
Concept for competency development: The first draft of the concept for competency development contains two blended learning units (e-learning and attendance phases) on the topics: Interprofessional and interdisciplinary/multidisciplinary cooperation and decision-making and flexibility in critical situations in emergency care.
In a next project step, managers of the cooperating hospital are interviewed. The adapted basic competency catalogue will then be finalised and the employee survey will be carried out. Based on the findings of the empirical surveys, the concept for competency development is finalised.