Table 4.

Staff survey undertaken 6 months after implementation of the new medical pathway

Question topic	Responses to multi-choice questions using a 5 option ‘graded’ scale. Specific options are indicated by inverted commas. The percentage of staff selecting specific options is reported for all respondents and differences between staff groups are in parenthesis.
The need for change	Before implementation of the new medical pathway, 73% of all staff (63% of doctors, 79% of nurses) had believed that either a ‘major change’ or a ‘new medical pathway’ was required.
Quality of care after change	After pathway implementation, 71% of all staff (76% of doctors, 62% of nurses, 83% of managers) believed QoC had improved either ‘significantly’ or ‘moderately’. In contrast, 2% felt it was ‘worse’.
Patient safety after change	After pathway implementation, 64% of all staff (64% of doctors, 55% of nurses, 100% of managers) reported that safety had improved either ‘significantly’ or ‘moderately’ and 3% felt it was ‘worse’.
Value of the new AEC	64% of all staff (70% of doctors, 45% of nurses) felt that the new AEC unit was either a ‘major’ or ‘transformational’ improvement in the medical pathway. In addition, 84% of all staff (88% of doctors, 76% of nurses) believed ‘the effort required (to implement AEC) had been worthwhile’.
Value of the new AAW	30% of all staff (34% of doctors, 24% of nurses) rated the new AAWs as either a ‘major improvement’ or ‘transformational improvement’ and 32% of staff (25% of doctors, 28% of nurses) a ‘moderate improvement’. Overall, 79% of staff (93% of doctors, 49% of nurses) felt ‘the effort required (to introduce the new AAWs) had been worthwhile’. Free text comments suggested that the AEC had been a more successful change than the AAWs initially. However, AAW subsequently improved with better continuity of care, doctor rotas and staffing levels.
Staff well-being and stress during the change process	29% of all staff (48% of nurses, 20% of doctors) reported that the changes required to introduce the new pathway had been either ‘very stressful’ or ‘unbearable’ and 29% as ‘moderately stressful’. Most of these staff were based on the AAW. In contrast, 42% of all staff (49% of doctors, 31% of nurses) reported that the change process was ‘not stressful’ or ‘mildly stressful. Most of these staff were based on AEC. Nursing staff found the change more difficult with 48% of all nursing staff (55% ward sisters, 33% staff nurses, 57% CSWs) reporting the change as ‘very stressful’ or ‘unbearable’ compared to 20% of all doctors (18% consultants, 43% SpRs, 12% junior doctors).
Effect of changes on workload	32% of all staff (19% of doctors, 52% of nurses) reported workload had ‘increased a lot’, whereas 45% of all staff (51% of doctors, 41% of nurses) reported ‘no change’ or a ‘reduction’ in workload.
Communication before and during the implementation of the pathway	39% of all staff rated communication as either ‘quite good’ or ‘good’ and 34% as either ‘quite poor’ or ‘poor’. Ward clerks, nurses and SpR/junior doctors were more likely to report either ‘quite poor’ or ‘poor’ communication. Managers, matrons and consultants tended to report ‘quite good’ or ‘good’ communication.
Involvement in planning before implementation	34% of all staff felt either ‘inadequately’ or ‘not involved as much as preferred’ and 49% reported they were involved ‘to some extent’ or ‘a lot’. Managers and consultants felt most involved and ward sisters and CSW least involved.
The overall value of buddying support	43% of all staff reported that buddying was ‘definitely beneficial’ and 27% ‘probably beneficial’ whilst 5% of all staff reported ‘probably not beneficial’ and 7% ‘definitely not beneficial’. 64% of doctors (and 92% consultants) rated buddying support as ‘beneficial’, whereas 35% of nurses (and 72% CSW) rated it as ‘not beneficial’.

AAW = acute admission wards; AEC = ambulatory emergency care unit; CSW = clinical support workers; QoC = quality of care; SpR = specialist registrar.