I can't get no satisfaction: Building occupational wellbeing into patient care improvement in the Emergency Department

Abstract
Emergency Departments (EDs) are a crucial component of the healthcare system, but ED staff are experiencing high levels of ‘burnout’. We sought understanding of the institutional work of ED staff and its impact on individual psychological wellbeing to prioritise improvement initiatives likely to promote autonomous motivation and staff experience. Abductive reasoning was adopted to analyse 44 ED interviews with staff from three EDs; negative and positive sentiment expressed by participants about their work was extracted from interviews and coded to Self-Determination Theory’s basic psychological needs - for autonomy, competence and relatedness. Negative sentiment was thematically analysed. Staff experienced most distress when they felt threatened physically or professionally, when they perceived patient wrong-doing or harm, where there was tension between their professional obligation and their work, and when they felt unvalued. Urgent attention is required to mitigate staff burnout in an environment of overcapacity. Priorities include making the work environment safe, embracing collaborative governance and collective practices to address complex care needs particularly for older adults and mental health cohorts, affirmative resourcing to build capacity and capability of the workforce, and re-engineering quality management to empower clinical decision-making and outcomes-based measures, de-implement low-value practices, and retract punitive policy.

Key words: Workforce; resilience; burnout; autonomy; overcapacity; wrong-doing; self-determination