Clarifying workforce flexibility from a division of labor perspective : A mixed methods study of an emergency department team

Journal article


Wise, Sarah, Duffield, Christine, Fry, Margaret and Roche, Michael. (2020). Clarifying workforce flexibility from a division of labor perspective : A mixed methods study of an emergency department team. Human Resources for Health. 18(1), p. 17. https://doi.org/10.1186/s12960-020-0460-7
AuthorsWise, Sarah, Duffield, Christine, Fry, Margaret and Roche, Michael
Abstract

Background
The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, “flexibility” is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team’s division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly.

Methods
The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically.

Results
The roles were occupationally specialized: “Assessment and Diagnosis” tasks consumed the largest proportion of doctors’ (51.1%) and NPs’ (38.1%) time, and “Organization of Care” tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients’ needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses.

Conclusion
Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to “be flexible” (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients’ needs within its organizational context. The study’s findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.

Keywordsworkforce flexibility; functional flexibility; division of labor; mixed methods research; time study; emergency department; healthcare workforce; workforce reform
Year2020
JournalHuman Resources for Health
Journal citation18 (1), p. 17
PublisherBiomed Central Ltd
ISSN1478-4491
Digital Object Identifier (DOI)https://doi.org/10.1186/s12960-020-0460-7
Scopus EID2-s2.0-85081220302
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-9
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online06 Mar 2020
Publication process dates
Accepted24 Feb 2020
Deposited29 Jun 2021
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