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Table 1 Themes and categories based on the Diffusion of Innovations model [25] reported by participants

From: Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective

Themes Categories of 4HR/NEAT Consequences
Anticipated and desirable
(GOALS)
Unanticipated and desirable
(SERENDIPITIES)
Anticipated and Undesirable
(TRADE-OFFS)
Unanticipated and Undesirable
(UNINTENDED CONSEQUENCES)
Personal experiences of stress and morale • 4HR/NEAT improved the clinical role performance (8; 11) • 4HR/NEAT improved morale in ED staff (18; 52)
• 4HR/NEAT decreased stress (4; 4)
• 4HR/NEAT increased workload (81; 419) • 4HR/NEAT increased stress and decreased morale (109; 1147)
Intergroup dynamics • 4HR/NEAT improved relationships with rest of the hospital (33; 40)
• 4HR/NEAT signified the importance of hospital’s executive buy-in (21; 59)
• 4HR/NEAT necessitated the Whole of Hospital Approach (WoHA) (87; 334)
• 4HR/NEAT improved communications within ED staff (29; 50)
• 4HR/NEAT improved ED teams and teamwork (25; 39)
• 4HR/NEAT increased autonomy of ED staff (16; 25)
  • 4HR/NEAT undermined ED teams and teamwork (35; 82)
• 4HR/NEAT worsened communication within ED staff (26; 43)
• 4HR/NEAT shifted the power in decision making from ED to hospital executives (6; 7)
• 4HR/NEAT impaired relationships with rest of the hospital (77; 257)
• Hospital failed to employ the WoHA (54; 190)
• Suboptimal leadership and insufficient buy-in at hospital executive confounded 4HR/NEAT-related changes (47; 128)
Interaction with patients • 4HR/NEAT improved staff-patient communication (26; 56)   • 4HR/NEAT had no change on staff-patient relationships (17; 20) • 4HR/NEAT decreased staff-patient communication (43; 140)
• Non-4HR/NEAT factors influencing staff-patient communication (6; 6)
  1. NOTE: The numbers in brackets represent interviews and quotations per theme; (# interviews; # quotations)