Background Changes in emergency departments are frequently implemented to improve efficiency and reduce costs. However, staff acceptance and adoption are crucial for the intended success of changes.

Objectives This study explored staff perceptions of factors influencing the implementation of changes and any common themes linking changes and factors influencing changes in an emergency department at a university teaching hospital in the UK.

Methods We used constructivist grounded theory methodology to perform a secondary analysis of 41 interview transcripts of physicians, nurses, support workers and managers involved in paediatric emergency care.

Results Participants identified leadership, communication and education as factors impacting change management. They described many emotions associated with changes and with communication, leadership and education or the lack of any of them during changes. Both positive and negative emotions sometimes coexisted at individual, team or organisational levels. Negative emotions were due to real-life challenges and concern over compromised patient care. Professional values dictated the actions or inactions that transpired either because of these emotions or despite these emotions in health professionals.

Conclusions Emotions to change should be acknowledged and addressed by credible leadership clear communication and education to improve the change process, its success and ultimately, patient care.