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Table 3 Comparison of the emergent key concepts and number of quotations across different ED staff roles

From: Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective

Theme Key concepts Number and % of respondent for each concept by ED staff roles Number and mean number of quotations by ED staff roles
All (n=119) Physician (n=43) Admin (n=11) Nursing (n=44) Director (n=21) All Physician Admin Nursing Director
No No % No % No % No % No No Mean No Mean No Mean No Mean
Personal experiences of stress and morale 4HR/NEAT increased stress and decreased morale 109 39 91% 10 91% 42 95% 18 86% 1146 458 11.7 42 4.2 519 12.4 127 7.1
4HR/NEAT increased workload 81 32 74% 6 55% 31 70% 12 57% 419 180 5.6 16 2.7 179 5.8 44 3.7
4HR/NEAT improved morale in ED staff 18 10 23% 0 0% 3 7% 5 24% 52 27 2.7 0 0.0 6 2.0 19 3.8
4HR/NEAT improved the clinical role performance 8 4 9% 1 9% 3 7% 0   11 7 1.8 1 1.0 3 1.0 0 0.0
4HR/NEAT decreased stress 4 4 9% 0   0   0   5 5 1.3 0 0.0 0 0.0 0 0.0
Intergroup dynamics 4HR/NEAT necessitated the Whole of Hospital Approach (WoHA) 87 34 79% 4 36% 31 70% 18 86% 334 133 3.9 21 5.3 135 4.4 45 2.5
4HR/NEAT impaired relationships with rest of the hospital 77 30 70% 4 36% 27 61% 16 76% 257 108 3.6 10 2.5 90 3.3 49 3.1
Hospital failed to employ the WoHA 54 19 44% 4 36% 17 39% 14 67% 190 65 3.4 5 1.3 59 3.5 61 4.4
Suboptimal leadership and insufficient buy-in at hospital executive confounded 4HR/NEAT-related changes 47 17 40% 1 9% 20 45% 9 43% 128 66 3.9 1 1.0 34 1.7 27 3.0
4HR/NEAT undermined ED teams and teamwork 35 13 30% 2 18% 17 39% 3 14% 82 28 2.2 3 1.5 45 2.6 6 2.0
4HR/NEAT improved relationships with rest of the hospital 33 14 33% 2 18% 13 30% 4 19% 40 18 1.3 2 1.0 16 1.2 4 1.0
4HR/NEAT improved communications within ED staff 29 11 26% 5 45% 11 25% 2 10% 50 16 1.5 10 2.0 19 1.7 5 2.5
4HR/NEAT worsened communication within ED staff 26 9 21% 2 18% 12 27% 3 14% 43 12 1.3 3 1.5 22 1.8 6 2.0
4HR/NEAT improved ED teams and teamwork 25 8 19% 1 9% 13 30% 3 14% 39 14 1.8 1 1.0 20 1.5 4 1.3
4HR/NEAT signified the importance of hospital’s executive buy-in 21 10 23% 3 27% 7 16% 1 5% 59 22 2.2 6 2.0 25 3.6 6 6.0
4HR/NEAT increased autonomy of ED staff 16 8 19% 1 9% 5 11% 2 10% 25 16 2.0 1 1.0 5 1.0 3 1.5
4HR/NEAT shifted the flow of power from ED to hospital executives 6 4 9% 0   1 2% 1 5% 7 4 1.0 0 0.0 1 0.0 2 2.0
4HR/NEAT led to overwhelming pressure from department of health 4 2 5% 0   1 2% 1 5% 5 3 1.5 0 0.0 1 1.0 1 1.0
Interaction with patients 4HR/NEAT decreased staff-patient communication 43 21 49% 2 18% 17 39% 3 14% 140 67 3.2 6 3.0 57 3.4 10 3.3
4HR/NEAT improved staff-patient communication 26 14 33% 1 9% 8 18% 3 14% 56 36 2.6 2 2.0 13 1.6 5 1.7
4HR/NEAT had no change on staff-patient relationships 17 6 14% 2 18% 5 11% 4 19% 20 7 1.2 2 1.0 6 1.2 5 1.3
Non-4HR/NEAT factors influencing staff-patient communication 6 1 2% 1 9% 3 7% 1 5% 6 1 1.0 1 1.0 3 1.0 1 1.0