How do staff work in NHS hospital operations management meetings to support resilience in everyday service delivery? A qualitative study.

Background: Operations Management meetings in NHS hospitals provide an opportunity for operational and clinical staff to monitor demand and capacity and manage patient flow. These meetings play an important role in the achievement of resilient performance over time. However, little is known about the work that takes place within these meetings in the United Kingdom's National Health Service.

Methods: We conducted a qualitative study observing 29 Operations Management meetings across three English hospitals between June and October 2023. The observations focused on: who was present; how meetings were organised and conducted; what data were used; how decision-making took place; and the types of work that were undertaken. We also conducted 17 semi-structured interviews with divisional leads and meeting chairs. A grounded theory analytic approach involved exploring the data in two sites to identify key themes, and then testing these themes through a third comparator site.

Results: We identified the type and extent of work that took place in these meetings to maintain flow and enable resilient service delivery. Operations Management meetings provided an opportunity for staff to come together to engage in collective sense-making, to develop a shared mental model of the state of the hospital and to build a collective understanding of where action was needed. Review of centralised data, formally encoded and recorded in numerical form, played an important role, but staff also drew on local intelligence to make sense of and adapt to often pressurised situations. We identified three types of work: Sense-making and Interpretation, and Risk work (which together contributed to maintaining organisational function) and Maintaining morale (which supported individual staff resilience).

Conclusions: The work that went on in Operations Management meetings functioned to support organisational and individual resilience, through staff repeatedly sharing and assessing information on capacity and demand, taking action to address these continually changing pressures, and having their efforts recognised.