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AGSM research study improves hospital work process

AUTHOR: Lachlan Colquhoun   DATE: 26.11.06   ISSUE 2, 2006

As trainee doctors they have to deal with a multitude of patients with varying injuries and conditions and regularly work up to six hours of overtime on any shift.

And although they have access to the knowledge and experience of more senior registrar doctors, often they are too reticent to reach out for that support and advice, for fear it may reflect poorly on how they are perceived.

"Our aim is to evaluate the effects of emotional demands and proactive behaviours on staff well-being and performance," says Dr Markus Groth.

Illustration: Gregory Baldwin

Sydney’s Prince of Wales Hospital, in partnership with AGSM, is attempting to decrease the pressure on JMO’s through an innovative research project.

An AGSM team, originally initiated by former Professor Sharon Parker – now at the University of Sheffield in the UK – is monitoring the impact of having a senior Advanced Practice Nurse (APN) present on the overtime shift as an added support resource, a model which is significantly different from the hospital’s usual practice.

The team, which is now headed by AGSM’s Dr. Markus Groth, includes research associates Anya Johnson and Helena Hong and former AGSM Ph.D student Catherine Collins. They have surveyed JMO’s across 200 shifts since September 2005 to discover how the presence of an APN impacts on their work in terms of confidence levels and initiative, their workload and the type of work they perform.

The project is one of several the AGSM team is undertaking with the Prince of Wales Hospital to evaluate the impact of work design (e.g. in terms of leadership and staff development) on staff effectiveness, patient outcomes and organisational performance.

As well as the JMO project, the team is also working with the emergency department from a holistic viewpoint, on how staff engagement is driven and influenced.

The performance of the JMOs 'changed for the better' on shifts where an APN was present.

After more than a year of working with the hospital, the AGSM team has now applied for an Australian Research Council grant which, if successful, will see the project continue to 2010.

“Our aim is to evaluate the effects of emotional demands and proactive behaviours on staff well-being and performance, as well as on patient satisfaction and organisational performance,” says Dr. Groth.

“By conducting longitudinal research, we are able to track how these things effect staff behaviour in terms of absenteeism and also how it affects turnover.

“Our main theme is employee engagement and how these professionals cope emotionally with situations that they must internalise.”

Ultimately, he says, the project could then begin to look at how these issues impact on customer satisfaction, or the patient experience.

“That will give us a complete picture but we are still at the earliest stages,” says Dr. Groth. "That is one of the avenues we are heading down as the study matures.”

Dr. Markus Groth is leading the JMO research project.

Even in its early stages, the JMO project analysing the impact of the APNs on overtime shifts has yielded results, despite the fact that there is only one APN on duty for five JMOs.

Researcher Anya Johnson says one of the most significant findings was that JMOs gained their “voice,” or a confidence to speak out, through the shifts where an APN was present.

“When we did interviews with the JMOs they would tell us that it was much easier to discuss what was happening openly and frankly and ask for reassurance or get another opinion with the APN than it was with a registrar, because they felt less vulnerable,” says Johnson.

“They had greater ‘voice’ and more confidence about discussions with the APN than within the hierarchy of doctors.”

The role of the APN changed over the 12-month survey period, she says. Initially, the APN was asked to do many things which were well below his level of expertise, such as inserting cannulas – or drips – into patients, one of the least favourite tasks for many JMOs.

This evolved over time, however, and soon the APN was taking a much more proactive role, which corresponded in a changing perception of the APN from the JMOs, a lift in their level of confidence and an improvement in teamwork across the medical disciplines.

JMOs gained their confidence to speak out through the shifts where an APN was present.

“The change also had an impact on the type of work the JMOs were doing,” says Anya Johnson.

“With time, they were doing a lot less of the more routine work which was partly done by the APN, but also facilitated by the APN who could also work with the nurses and help them do it as well.

“We also found a difference in how proactive the JMOs could be, so they were thinking ahead about patient needs and were able to share information with patients' families and also think about what happened to patients after their shift was finished.”

With increased levels of confidence, the performance of the JMOs “changed for the better” on shifts where an APN was present.

The results have been so positive that the hospital has developed a viable business case for the new model, and the Prince of Wales Hospital has now taken it up full time in a new service where 2.5 APN positions will be dedicated to overtime shifts.

"As we continued the project we saw how hospitals might be able to develop and think about how they use resources within a hospital that are in short supply, which is good doctors and good nurses,” says Johnson.

“So it was a way of trying to bridge some of the traditional gaps between those two groups as well as to improve the services they are providing.”