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. 2012 Oct;17(4):233-40.
doi: 10.1258/jhsrp.2012.011141. Epub 2012 Sep 28.

Reconfiguring the Emergency and Urgent Care Workforce: Mixed Methods Study of Skills and the Everyday Work of Non-Clinical Call-Handlers in the NHS

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Reconfiguring the Emergency and Urgent Care Workforce: Mixed Methods Study of Skills and the Everyday Work of Non-Clinical Call-Handlers in the NHS

Joanne Turnbull et al. J Health Serv Res Policy. .

Abstract

Objectives: To examine the skills and expertise required and used by non-clinical call-handlers doing telephone triage and assessment, supported by a computer decision support system (CDSS) in urgent and emergency care services.

Methods: Comparative case study of three different English emergency and urgent care services. Data consisted of nearly 500 hours of non-participant observation, 61 semi-structured interviews with health service staff, documentary analysis, and a survey of 106 call-handlers.

Results: Communication skills and 'allowing the CDSS to drive the assessment' are viewed by the CDSS developers and staff as key competencies for call-handling. Call-handlers demonstrated high levels of experience, skills and expertise in using the CDSS. These workers are often portrayed simply as 'trained users' of technology, but they used a broader set of skills including team work, flexibility and 'translation'. Call-handlers develop a 'pseudo-clinical' expertise and draw upon their experiential knowledge to bring the CDSS into everyday use.

Conclusions: Clinical assessment and triage by non-clinical staff supported by a CDSS represents a major change in urgent and emergency care delivery, warranting a detailed examination of call-handlers' skills and expertise. We found that this work appears to have more in common with clinical work and expertise than with other call-centre work that it superficially resembles. Recognizing the range of skills call-handlers demonstrate and developing a better understanding of this should be incorporated into the training for, and management of, emergency and urgent care call-handling.

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