Context factors
| Domain | Context | Exemplar quotes |
| Capacity | Lack of outflow sites/access block | ‘[So] then the patient should go… to the next phase of care. Well, that never happens. So, all these programs come and they go, “[the patient] doesn’t meet my program. Ask him. Ask that one. Ask this one.” And the patient stays.’ (10132) |
| Inadequate resources |
‘Exactly, like the RAU (Rapid Assessment Unit), the idea was that this was successful, it could be something that could be modeled at other sites, but I have yet to see any funding or discussion. But we know it works but it’s very expensive.’ (5228) ‘I think fast tracks have lots of value but you also have to have the staff to do it. The other piece that we’re running into is PTA (Physician in Triage Area). We’re moving more patients through quickly but we’ve outstripped our housekeeping ability to keep up and we’ve outstripped our unit support workers ability to keep up… …what the nurses are doing in PTA is non-nursing: it is washing stretchers; making [up] stretchers and physicians too, I’ve got pictures of physicians washing stretchers somewhere; stocking equipment; moving patients around the department; porter entry; a lot of that stuff.’ (9106) | |
| Population and capacity | Demand Outstrips Capacity | ‘Actually the metrics improved for a short while. We are at a point now where the metrics actually returned to where they were initially. Which is very discouraging but …could [reflect] the fact that our numbers increased dramatically. …our patient numbers are about 10% higher than they were last year and last year they were 10% higher than the year before. So that’s a lot of people when you see 100,000 people over the course of two emergency rooms in a year. So we’re a little discouraged.’ (9108) |
| Population, capacity and process | Inadequate demand for designated streams (carve-out effect) | ‘…the whole thing about assigning a physician to the back area was an epic fail, because sometimes it wasn’t busy enough and sometimes the doctors didn’t take it serious[ly]. So they’d be like oh, we’re not that busy and I’m just going to step out and go get a haircut….’ (7225) |