Perceptions of workload in emergency care in the Netherlands and how to influence this: a qualitative study

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BACKGROUND: Adequate staffing and manageable workloads are crucial for high-quality emergency care. However, high perceived workloads in the emergency department (ED) threaten both. Increased demand and staff shortages intensify these issues and cause crowding. Understanding healthcare workers' perspectives on workload is essential for effective policymaking and maintaining a durable workforce. The objective of this study was to explore the current perceived workload of ED professionals, and their vision on how to influence it and to understand the healthcare worker's perspective on proposed healthcare reforms in the Netherlands. METHODS: Qualitive study using semi-structured interviews with 33 healthcare professionals (ED physicians, physician assistants and nurses) working in a university medical center, and three general hospitals from March-July 2023. The interviews were audio-recorded and transcribed verbatim. The interview transcripts were coded. An inductive content analysis was performed, where codes were assigned to the transcripts and adjusted. Codes were then sorted into themes on causes of workload, consequences and proposed solutions for reducing the workload. RESULTS: Emergency department professionals identified increasing patient inflow, barriers to patient throughput and output, and staff shortages as key workload causes. Consequences included increased time, mental and psychological demands, leading to stress and reduced job satisfaction. A well-coordinated team and having social interaction with colleagues is seen as a key part of the profession by ED-professionals. Next to that, training and development opportunities contribute to job satisfaction. Proposed solutions involved public education, improved care coordination, technological innovations, and enhanced collaboration within and among hospitals to improve efficiency and job satisfaction, and to reduce perceived workload pressure. CONCLUSIONS: Addressing perceived workload is crucial for maintaining quality and accessibility of care. Dutch ED professionals face a high workload leading to stress and lower job satisfaction. To ensure successful changes, adequate preconditions and engaging healthcare professionals in decision-making are crucial. In future research, a stronger focus on effective work habits and processes, including provider satisfaction and workplace well-being, is necessary.

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