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Table 1 Action plan of ED providers’ identified issues for improvement, respective measures, and implementation status at follow-up

From: Effects of work conditions on provider mental well-being and quality of care: a mixed-methods intervention study in the emergency department

Work system factor (SEIPS) Identified problems and issues for improvement Solutions and respective improvement measures #HCM / #SCM Implementation status at follow-up
Organization Lack of personal breaks during work time (i.e., limited opportunities to take breaks while on duty; short duration of breaks; multiple short breaks instead of longer pauses) Schedule additional nursing staff for short-term replacement of nurses taking breaks HCM#2 / SCM#2, SCM#4 Not feasible and declined after discussion in steering committee
Short-term rotation across ED units to replace nursing staff in breaks HCM#2/ SCM#2, SCM#4 Partially completed
Supervising physicians coordinate residents’ breaks HCM#2/ SCM#2 Fully completed
Shift supervisor coordinates temporary replacement of nursing staff in breaks on a daily basis HCM#2/ SCM#2, SCM#4 Declined after discussion in steering committee
Task Unclear work agreements (i.e., lack of mutual agreement between ED units concerning patient transfers and admissions; unclear agreements with ICU and adjacent care units concerning specific care obligations, e.g., timing of transfusions) Revise agreements for interdisciplinary occupancy of ED observation unit HCM#3 / SCM#2, SCM#4 Discussed with consulting physicians and head nurses; not implemented
Agreement on transfusion process in ED observation unit HCM#3 / SCM#2 Discussed among attending physicians; completed
Organization Meeting with ICU representatives and revision of patient transfer agreements from ED observation unit HCM#3 / SCM#2 Not implemented
Organization High pressure environment - point of triage (i.e., poor and narrow design of triage area; understaffing; lack of qualified personnel for triage; ongoing project on redesign of triage process and assisting technology) Repeated discussion of various solutions for point of triage in ED management meeting (with the objective to manage exceeding work load during triage) HCM#4, HCM#5, HCM#7 / SCM#3, SCM#4 Few completed (e.g., blocking of external phone calls); but most solutions considered not feasible (e.g., separate room, free of distractions, permanent staffing of two qualified nurses at triage)
Leadership (e.g., staff’s need for enhanced participation in meetings and ongoing reorganization) External moderator for ED nursing staff meetings to allow for enhanced discussion and opportunities to ask questions HCM#6 / SCM#3, SCM#4 Agreed, but not implemented at follow-up
Ad hoc meeting for ED providers concerning reorganization of triage process HCM#6 / SCM#3, SCM#4 Completed
Lack of staff information (i.e., lack of status information concerning ongoing projects and reorganization activities in the ED) Provision of Q&A sheet on reorganization of triage process for nurses in intranet HCM#6 / SCM#3, SCM#4 Completed
Staff shortages (i.e., permanent understaffing, particularly during times of high patient load) Schedule additional nursing and medical providers in shifts HCM#8 / SCM#4 Not implemented
Realistic HR planning of ED personnel and shift staffing levels of ED nurses and physicians HCM#8 / SCM#4 Not started at follow-up
  1. Legend. ED emergency department, SEIPS Systems Engineering Initiative for Patient Safety model, ICU intensive care unit. #HCM / #SCM: Number of health circle meeting (HCM) or steering committee meeting (SCM), issue being discussed, analyzed, or reconsidered (HCM#1: feedback session of baseline results and development of action plan; SCM#1: feedback session of baseline results)