Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the\nworkforce. However, â??flexibilityâ? is never defined or empirically examined. This study explores the nature of flexibility\nin a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the\nconcept of workforce flexibility. Taking a holistic perspective on the teamâ??s division of labor, it measures task\ndistribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational\nconditions that drive flexibly.\nMethods: The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency\ndepartment (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role\n(151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time\nstudy was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain\nthe phase 1 observations and were analyzed thematically.\nResults: The roles were occupationally specialized: â??Assessment and Diagnosisâ? tasks consumed the largest proportion\nof doctorsâ?? (51.1%) and NPsâ?? (38.1%) time, and â??Organization of Careâ? tasks for RNs (27.6%). However, all three roles were\nalso multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly\nin response to patientsâ?? needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable\nworkload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses.\nConclusion: Not every healthcare team requires the type of flexibility found in this study since that was shaped by\npatient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires\nto â??be flexibleâ? (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be\ndefined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and\nadapt to patientsâ?? needs within its organizational context. The studyâ??s findings suggest that solutions for a more flexible\nworkforce may lay in the organization of healthcare work.
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