The future of emergency care: the interplay between territorial and organizational innovation and its effect on employee outcomes

A significant topic for both theory and practice is the analysis of working conditions in Emergency Departments (hereafter EDs) so as to ensure service quality and employee wellbeing. EDs are complex, semi-autonomous entities within hospitals, facing difficult tasks requiring timely cooperation, complex technology, and intricate relationships with internal and external actors (Georgopoulos, 1985). This research follows up on previous work by the research group, yielding valuable preliminary results. A 2022 pilot project collected data assessing work ability, job satisfaction, and other factors affecting employee wellbeing in University Hospital of Modena (hereafter AOU). A second project, funded by FAR FOMO 2023, is focusing on EDs (Policlinico hospital of Modena and Baggiovara’s hospital) using a mixed methods approach, including questionnaires and qualitative techniques (focus groups, interviews, participant observation). Preliminary quantitative results (Casolari et al., 2024a; 2024b) highlight critical issues in EDs: low work ability, unhealthy lifestyles and poor work-life balance. Key determinants include high workload, further need for managerial support, low autonomy, and a mismatch between job demands and skills. Preliminary qualitative findings report chronic staff shortages, inadequate role recognition, and high risks of aggression, as well as differences in work organization between different EDs, such as the adoption of job rotation and access to training programs. Despite these results, more research is needed for two reasons. First, there is a need to compare changes over time and evaluate the impact of wellbeing initiatives meanwhile adopted by EDs. Second, there is a need to take into account the Italian reform of territorial healthcare (regulated by Decree n. 77/2022), inspired by international healthcare reforms, which is likely to influence the effectiveness of the above changes. In Emilia Romagna, the national regulations have been followed by regional emergency-urgency reform, introducing urgent care centers (hereafter CAU) to handle low-complexity emergency cases, primarily white or green codes. The primary objective of the research is to assess the impact of organizational solutions identified in previous research projects (job rotation models, intervention for individual wellbeing and stress decompression strategies) on the performance and the well-being of EDs workers, assessing the possible moderating influence of the coordinator's leadership style and other contextual factors such as physical working spaces. Secondly, the project will evaluate whether the introduction of CAU-Modena reduced the objective and perceived workload for EDs staff as well as the incidence of physical or verbal violence. To do so, we employ a longitudinal, mixed methods and multidisciplinary approach, combining a questionnaire with focused ethnography, allowing for comprehensive analysis by integrating quantitative data with qualitative insights.