Article Text

Download PDFPDF
Staff perceptions of how changes occur in an emergency department: a qualitative study
  1. Savithiri Ratnapalan1,2,
  2. Daniel Lang3
  1. 1 Paediatrics, University of Toronto, Toronto, Ontario, Canada
  2. 2 Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3 Leadership in Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Savithiri Ratnapalan, Paediatrics, University of Toronto, Ontario M5G 1X8, Canada; savithiri.ratnapalan{at}


Introduction Changes in healthcare organisations often incur significant financial costs and disrupt of normal operations. The objective of this research was to explore staff perceptions of changes at a university teaching hospital in the UK.

Methods Grounded theory methodology was used to perform a secondary analysis of 41 interview transcripts from participants consisting of 20 physicians, 13 nurses, 2 support workers and 6 managers involved in paediatric emergency care at the hospital.

Results Four major themes identified from the analysis were types of changes, change readiness, change triggers and challenges to implementing changes. Both planned and emergent changes can occur simultaneously, and emergency department staff are ready to manage them although external pressures seem to be the main trigger for changes, emergent changes appear to occur as initiatives to improve performance or improve services. Emergent changes at a systemic level have an inclusive planning, implementation and evaluation process. They have to be implemented at minimal cost and show the value of changes.

Discussion and conclusion These results suggest that emergent changes that were to be implemented at a system level had higher scrutiny of their value and to occur with zero or minimum financial cost. Planned changes implemented by senior management as top–down process should have similar procedures and scrutiny to emergent changes arising from staff, to ensure value for cost. Policy makers and senior managers should encourage and evaluate group or system level changes that arise as a bottom–up process and assess associated financial cost.

  • health system
  • research
  • management

Statistics from


  • Contributors SR was involved in study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. DL was involved in study design, analysis and interpretation of the data and critical revision of the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by institutional research ethics boards for secondary analysis of interview transcripts from 20 physicians, 13 nurses, 2 support workers and 6 managers.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data is not shared publicly for reuse.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.