THE MANAGEMENT OF TEMPORARY STAFF IN HEALTHCARE EMERGENCY DEPARTMENTS : IMPLICATIONS FOR PATIENT SAFETY AND SERVICE QUALITY
The use of temporary staff in healthcare presents a management challenge. There is a case for minimising their use to reduce the risks associated with their limited familiarity with the context and knowledge of protocols. However, staff shortages can negatively affect patient outcomes. Consequently, temporary staff are required but need to be carefully managed. This thesis uses the analytic framework of the psychological contract to explore the previously neglected management of the employment relationship with temporary staff. The empirical research consisted of two studies. The first explored the management of temporary staff in Emergency Departments (ED), analysing management perspectives at macro, meso and micro levels. The second studied the management of the launch of a Major Trauma Centre introducing a Consultant Resident On-Call for trauma, which required temporary contracts. The research was conducted through case studies utilising semi-structured interviews. The ED was specifically chosen because of its high use of temporary staff, and its particular challenges associated with patient care. Results indicated a conflict between the priorities of senior management to minimise staff costs, and department level management, concerned with staffing levels to maintain patient care and service delivery. Risks to patient safety, particularly when ad-hoc agency staff were recruited, were identified. Study 2 revealed a shift from relational to transactional psychological contracts when consultants were placed on temporary contracts due to the protracted management of the change process and perceived psychological contract breach. The results highlighted the distinctive characteristics of temporary staffing in healthcare, and the hierarchy of preferences 3 between the types of temporary staff identified. The research also revealed the consequences of the competing priorities between different management levels in the hospital. Finally, the studies revealed that the psychological contracts of temporary staff were predominantly transactional, whereas a more relational contract could improve temporary staff use and patient outcomes.
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