Emptying the Corridors of Shame: Organizational Lessons From England's 4-Hour Emergency Throughput Target

摘要: Study objective Since 2005, 98% of patients treated in England's emergency departments (EDs) must be discharged or placed a hospital bed within 4 hours arrival. Using qualitative approach, we describe lessons learned from implementing the 4-hour throughput target. Methods This was study EDs England, purposively sampled for range size and performance on Leadership at 9 Acute Trusts (hospitals) were interviewed between June August 2008. content analysis, analyzed semistructured interviews to identify salient themes. Results Twenty-seven coded. Respondents agreed following (1) Interdependency: Even with extensive ED process re-engineering, widespread Trust involvement essential meeting Additionally, lack recognition that it "Trust target" contributed conflicts staff, concerns patient safety, lost opportunity organizational improvement. (2) Contrasting change management strategies: leadership used collaborative strategies, whereas rest required top-down approach. (3) Burden benefit staff: Nursing perceived greatest burden target but also acquired enhanced authority, skills, roles. (4) Costs: Although most are now target, consistent while balancing safety remains tenuous. Conclusion Achieving requires hospital-wide support. Lack ownership contributes negative effects incomplete improvement, risk patients. These have implications all targets may help explain why some health care fail achieve their aims.