AN EXPLORATION OF EMERGENCY STAFF PERCEPTIONS AND EXPERIENCES OF TEAMWORK IN AN EMERGENCY DEPARTMENT IN THE KINGDOM OF SAUDI ARABIA

Abstract

Background: Teamwork practices have been recognised as a significant strategy to improve patient safety, quality of care, and staff and patient satisfaction in healthcare settings, particularly within the emergency department (ED). The ED depends heavily on teams of interdisciplinary healthcare staff to carry out their operational goals and the core business of providing care to the seriously ill and injured. The ED is also recognised as a high-risk area concerning service demand and the potential for human error. Few studies have considered the perceptions and experiences of ED staff (physicians, nurses, allied health professionals, and administration staff) regarding the practice of teamwork, especially in the Kingdom of Saudi Arabia (KSA), and few studies have been conducted in KSA to explore the teamwork practices in EDs. Aim: To explore teamwork practices from the perspectives and experiences of staff (physicians, nurses, allied health professionals, and administration staff) when interacting with each other in the admission areas of the ED in a public hospital in the Northern Borders region of the KSA. Method: This research used a qualitative case study design, drawing on three data collection methods: documentary review, semi-structured interviews (n=22) with physicians (n=6), nurses (n=10), allied health professionals (n=3), and administrative staff (n=3) and six non- participant direct observations. All data were analysed using Braun and Clarke's thematic analysis. Findings: The thematic analysis of the data yielded ten prominent themes, which were integral to understanding the staff's views and experiences with teamwork in the ED's admission areas. These themes revealed the barriers and the enablers experienced by the ED teams. The findings demonstrated that interdisciplinary teamwork is encouraged by a shared goal of patient care, reduced employee stress, and improved job satisfaction. In the ED, interdisciplinary collaboration was critical and functioned under a hierarchical structure, with a clear leader guiding decisions to achieve the best outcomes. However, barriers such as negative staff behaviours, staff shortages, and inadequate management support often hindered teamwork. Moreover, the study found that gender interactions and the high number of expatriates in the ED posed challenges such as discrimination and language barriers. In addition, the triage process, such as admitting non-urgent patients, contributed to overcrowding and overwhelmed the teams. The findings revealed that effective teamwork depends on effective communication, multitasking, stress management, and leadership skills. Finally, these findings were examined and compared with the four domains (relational, processual, organisational, and contextual) of Reeves et al.'s (2010) conceptual framework for understanding interprofessional teamwork. However, individual factors emerged as a new fifth domain that is not a part of the framework also played a critical role in interdisciplinary teamwork in the ED. Conclusion: Effective interdisciplinary teamwork is crucial in the ED in KSA due to the diverse cultural issues staff experience. Gender, language, social, and organisational issues can sometimes impose barriers to collaboration. Consequently, continuous teamwork training and support are necessary to improve the teamwork practices of the ED staff and ensure the provision of high-quality care to patients. The study’s findings provide practical insights for healthcare policymakers, hospital administrators, the KSA Vision 2030, and other countries seeking to optimise patient safety and quality of care by implementing effective teamwork practices in an ED setting.