Table 1

Phase 1 themes and subthemes

ThemeSubthemeExample quotes
Perceptions of the planA behaviour contract… it is meant to provide agreement across disciplines …’ (Doctor 1)
… everyone works within this policy …’ (Manager 4)
‘… there was almost like rules of engagement and people knew how decisions were made’. (Manager 1)
Provides consistency, predictability and transparency… provide[s] guidance that’s consistent so that our response is consistent …’ (Doctor 1)
… so it’s completely clarified our entire process …’ (Manager 4)
‘… we wanted it to be more transparent how beds get allocated … if we suddenly had a bus crash … then we couldn’t do our cardiac surgery that wasn’t because we were badly organised it’s just because we don’t have that many beds’. (Doctor 2)
Gesture of goodwillI think [the Escalation Plan is] a good attempt at policy for (the) ICU…’ (Manager 3)
‘[on GREEN] there are [ED, ward] patients that … might not usually come to ICU that we may admit with a lower threshold’. (Doctor 1)
An authority to say ‘NO’… if we say RED is RED, and we have a ventilated patient down in the ED, and you’ve got the med super saying you need to take it … well let’s see if this escalation policy actually works’. (AH/nurse 3)
… it’s kind of solidified. You’ve got it in writing …’ (AH/nurse 1)
… to have some concrete way of explaining to surgeons and surgical institute that we actually provide a service to the whole community not just post-op patients’. (Doctor 2)
Not a fix, but provides visibility of the problem‘… flow doesn’t always happen just because of the escalation plan. Unfortunately, there are still bed blocked patients because the wards are so full’. (AH/nurse 1)
It provides me with evidence if we’re at capacity’. (Manager 4)
We say we’re at RED or AMBER but I don’t know if [those outside ICU know exactly what that means] …’ (AH/nurse 1)
A canary in the coalmine to identify system pressure ‘ … [the plan] identifies a way of being able to describe the level of capacity pressure within the ICU … in terms of how it manages the system and assesses the level of distress the system is under, I think that, ultimately, what you’ve got there is a safer system’. (Manager 1)
Benefits of the planImproved teamwork and communicationI definitely enjoy working in the ICU and I think it’s nice to see a bit more … multidisciplinary involvement’. (AH/nurse 4)
The only difference [with the plan] is the [improved] communication’. (AH/nurse 1)
… everyone knows where we stand’. (AH/nurse 3)
New ways of thinkingI think the success of this … it was able to give clinicians a different way of looking at things … the ability to think about your system, and the safety of your system, I think is a real benefit… What I saw was a shift in terms of the … problem solving and some of the solution finding’. (Manager 1)
The idea itself is beautiful. It had to happen’. (Manager 4)
Meeting processesNo subthemes ‘…the nurses would go to the bed management meeting and the doctors would not know what they’d asked for, how many beds they had, how many nursing staff were available or how many people we could admit. …’ (Doctor 2)