Table 2

Phase 2 themes and subthemes

ThemeSubthemeExample quotes
Internal communicationImproved decision makingI think by reducing the ad hoc nature of the decisions that makes it clearer. I think any - you know the old good fences make good neighbours. I think it helps from that perspective. I think it probably has improved our workflow. Not so much the morning meeting but the people having an idea about our bed state has improved our workflow to some degree and that helps - then they can say yes we’re going to go ahead with all the surgery or we’re going to can all the surgery. …. We had in the past where individual surgeons would come marching up and say well, I want to do my case. That’s gone away, which is a very, very good thing’. (Doctor 2)
Increased team cohesion ‘I think bringing the whole team together and everyone hearing the same thing, and knowing what elective surgery are and knowing what our bed capacity is - I think is a very useful thing. I think it’s been good to incorporate nursing and allied health into that, as well. Just so everyone is on the same page, and in terms of a team building exercise’. (Doctor 1)
‘So we have lots of people - like the social worker comes, the speech pathologist - I think that’s great. Everyone’s on the same page. We never used to have that before’. (AH/nurse 3)
Inbuilt team building practiseI guess it’s more of a team environment, multi-disciplinary. I think that’s better for the patients we look after. So there’s more of a team approach. I think communication’s a lot better. Everyone seems to be on the same page more’. (AH/nurse 4)
In this unit alone, we have a joint morning meeting at 8 o’clock in the morning. That’s probably one of the biggest changes that’s come into effect in the last year I’d say within the unit, over the 15 years I’ve been here. Mainly because everyone’s involved, everyone knows what’s happening. I think by doing that everyone’s more confident with each other. That comes down then if things happen in the unit you can rely on people and you know who they are and you know what their skills and qualities and that are too’. (AH/nurse 5)
Team mental model… overall I’d say that the ICU is working well. I think they’re a really cohesive team. I think the steps they’ve taken to try and manage that uncertainty, that being a positive thing. I think the actual putting something in place that people can own has helped with the relationship in the team, that’s great. I think a lot of this is also around the difficulties of you could get the different decision depending on who was there. So having something they could all own and that people recognise this is how we manage and that the other services understand that, that helps. So I think that’s certainly, I’d say they were a cohesive, well functioning team. Yes there’s pressure but they manage it well’. (Manager 1)
General hospital context and patient flowImproved system understanding of ICU staffI guess it’s a lot of things. We have departments that have guidelines like ED will have a four hour guideline to get a patient to a ward. So then they want to push a patient to you because that’s their guideline. Rightly so, they’re trying to do their job’. (AH/nurse 5)
Need for improved system understanding from other departmentsThen I think the other thing is, not so much transparency because that’s what everybody talks about but, more visibility so that we can understand their challenges and constraints. We’re not there to fix them, but also so that they can understand ours. Because sometimes it feels like, when you’re in the Emergency Department, for example, you’re the fish bowl that everybody can look at but we can’t see what anybody else is doing, which is a chip on the Emergency guys' shoulders sometimes, which we also need to drop. But I think it’s nice to see the other person’s pressures as well’. (Doctor 7)
Improved external relationshipsBasically what I can say to you is it’s communication between the nursing director and the wards that we transfer to. It’s just that network we’ve built up. We’ve realised the importance of it. It’s the traffic light system that’s actually helped us see that. When they see that we’re at this and we don’t have a lot of room to move, they will support us in taking the patients out, rather than bed blocking’. (Manager 3)
  • ICU, intensive care unit.