Examining the cultural impacts of an emergency department move using ethnography

Objective: The purpose of this ethnographic study was to evaluate the cultural impacts of an emergency department (ED) move from an old to new physical space. Method: Fieldwork was conducted over 14 months at an academic medical center ED in the United States. Primary data sources included participant observations and semistructured interviews. Results: Over 720 h of participant observation and semi-structured interviews (n = 39) with emergency nurse, non-nurse clinicians, and unit administrators were collected and analyzed. One cross-cutting theme, "decisional power," and three supporting themes "inadequate move preparation," "change fatigue," and "lack of change standardization" were identified. "Decisional power" was the perceived influence certain ED groups had making move-related decisions over others. "Change fatigue" described the impact of frequent change implementation on participants' work processes, well-being, and job satisfaction. "Lack of change standardization" described power differentials between nurses striving to standardize new move-related processes and physicians implementing work styles discordant with such processes. Conclusion: Findings can inform recommendations for health care policy and organizational operations such as: 1) including frontline stakeholder perspectives in move-related decisions; 2) allocating adequate time for clinician/employee training/education in the pre-move period; 3) assessing clinician/employee well-being throughout move implementation; 4) increasing unit administrator sensitivity to clinician change fatigue.