Q methodology: a new way of assessing employee satisfaction.

As yet another nursing shortage faces the country, the issue of the satisfaction of nurses again becomes of critical concern to nursing managers in the interest of staff retention. The authors describe the use of the statistical technique Q methodology to assess the needs of nurses and other medical staff at a level one, tertiary care emergency department in the United States. Using the Q method, the authors were able to identify different, unique viewpoints concerning employee needs among the study population, as well as commonly shared views. This level of detail, not obtainable using more traditional statistical techniques, can aid in the design of more effective strategies aimed at fulfilling the needs of an organization's staff to increase their satisfaction.

Using Q methodology to assess the needs of emergency medicine support staff employees.

The support staff members of any Department of Emergency Medicine perform a plethora of tasks that are crucial to the productivity of both individual physicians and the department as a whole. It is important to ensure that the personal and professional needs of the support staff are being met. This report describes the use of a relatively new statistical technique, Q methodology, to elucidate the needs of the support staff. This method allowed the investigators to quantitatively reveal the presence of two distinct viewpoints on employee needs among the support staff. Additionally, opinions that were held by the employees concerning their needs were identified. These results allowed for strategies to be tailored to both the individual and the group. The results indicate that Q methodology can have widespread application in the relatively new area of health care quality research.

Health promotion practices of emergency physicians.

In this article we describe health promotion practices of emergency physicians (EPs). A survey was mailed to members of the West Virginia American College of Emergency Physicians. Main outcomes included the EP's beliefs regarding health promotion, perceived roles in health promotion, and perceived effectiveness in modifying the behavior of patients. Over 90% of respondents routinely asked about cigarette smoking and half about alcohol use. A minority routinely asked about illicit drug use, diet, exercise, domestic violence, or stress. The majority stated they were the main person responsible for patient health education in their emergency department (ED). Most felt prepared to counsel patients about smoking (68%) and alcohol (59%), although very few described themselves as successful in helping patients change their behavior. Although EPs feel responsible for promoting the health of their patients, only a minority reported routinely screening and counseling patients about prevention and most were not confident in their ability to help patients change their health-related behaviors.

Challenging the dominant logic of Emergency Departments: guidelines from chaos theory.

Chaos is order without predictability (1 ). Any unfortunate patient who has recently made a trek to an Emergency Department (ED) or even better, has watched the immensely popular TV show, ER, knows that the visit can be a frustrating and a time consuming experience. The waits are so protracted that one can observe all cycles of birth, death, love, and romance in the waiting room. The process is tedious for the patient who must tell one's tale to a triage nurse, a registration clerk, the primary nurse, the nursing care partner, and finally the emergency physician. Then, the patient must face more delays while being pushed, ineffectively, in a horizontal fashion, through vertical functional silos of care, such as laboratory and radiology. The mind-set or dominant logic of this system of ED patient flow assumes that waits are acceptable and unavoidable, and that the function of the ED is to care for only the truly emergent patient. This dominant logic, coupled with the market constraints of population-based versus case-based payment mechanisms, has led to a declining trend in ED visits for the first time in 20 years (2). In order to improve the quality of ED care as well as to increase acceptability for patient and payer, the dominant logic must be challenged. An understanding of chaos theory and perception of the Emergency Department as a complex adaptive system foster methods for challenging the dominant logic.