Strategies for adapting under pressure: an interview study in intensive care units

Area of Science:

• Healthcare Management
• Critical Care Medicine
• Organizational Psychology

Background:

• Healthcare systems experience substantial pressure, leading to improvised and uncoordinated adaptations by clinicians and managers.
• Intensive care units (ICUs) face unique daily pressures impacting staff and patient care.
• Understanding these pressures and staff adaptations is crucial for developing coordinated management strategies.

Purpose of the Study:

• To identify and describe the everyday pressures encountered in intensive care settings.
• To document the adaptive strategies employed by intensive care staff in response to these pressures.
• To lay the groundwork for developing practical, coordinated strategies for managing under pressure.

Main Methods:

• Qualitative semi-structured interviews were conducted with 20 senior multidisciplinary healthcare professionals in UK ICUs.
• Interviews focused on exploring daily pressures and adaptive strategies used by intensive care staff.
• Thematic template analysis was applied, utilizing a pre-existing taxonomy of pressures and strategies.

Main Results:

• The primary pressure identified was staff shortages, exacerbating workload and hindering patient flow.
• Adaptive strategies were categorized as anticipatory or 'on the day'.
• Due to dynamic ICU demands, 'on the day' strategies, such as staff flexing, task prioritization, and enhanced communication, were most common.

Conclusions:

• Intensive care unit staff utilize diverse adaptive strategies to mitigate risks and maintain patient care standards during high-pressure situations.
• These findings support the development of a flexible portfolio of adaptive strategies for use in critical care.
• Training clinical leaders and teams in effective adaptive strategy utilization holds significant potential.