International Journal of Health Policy and Management

International Journal of Health Policy and Management

Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study

Document Type : Original Article

Authors
John Rihari-Thomas 1
Michelle DiGiacomo 1
Jane Phillips 1
Phillip Newton 1
Patricia M. Davidson 1, 2
1 Faculty of Health, University of Technology Sydney, Ultimo, Australia
2 School of Nursing, Johns Hopkins University, Baltimore, MD, USA
10.15171/ijhpm.2016.156
Abstract
Background
Systemic and structural issues of rapid response system (RRS) models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses) experience and negotiate care for deteriorating patients within the RRS.
 
Methods
Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis.
 
Results
Thirty-four participants (21 physicians and 13 registered nurses [RNs]) participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1) responsibility is inversely proportional to clinical experience; (2) actions around system flexibility contribute to deviation from protocol; (3) misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4) poor communication and documentation of RRS increases clinician workloads.
 
Conclusion
Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.
Keywords
Medical Emergency Team (MET)
Qualitative Research
Healthcare Quality Improvement
Subjects
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International Journal of Health Policy and Management
Volume 6, Issue 8
2017
Pages 447-456

  • Received Date 21 June 2016
  • Revised Date 24 December 2016
  • Accepted Date 25 December 2016
  • First Published Date 01 August 2017
  • Published Date 01 August 2017