An exploration of the cardiac catheter laboratory healthcare system in the United Kingdom

Background: The cardiac catheter laboratory (cath lab) delivers interventional care for conditions including coronary heart disease, structural heart disorders, and cardiac electrophysiological syndromes. Increasing procedural complexity and workforce demands highlight the need for innovative service delivery. The cath lab multidisciplinary team experiences workforce challenges that can negatively affect care. While some attempts have been made to address these issues, there is little evidence of their effectiveness or national impact. Patient engagement in service design is also lacking, despite its association with improved satisfaction. Method: This thesis is made of three parts framed by complexity theory – 1. A literature review comprised of a systematic scoping review to establish research questions: “Workforce development and patient experience in the cardiac catheter laboratory 2. A qualitative study: “Patient experiences of cath lab services” used individual semi-structured telephone interviews conducted to understand patient experiences of undergoing a procedure at one UK cath lab. 3. A Delphi study: “Establishing Consensus of Requirements for the Multidisciplinary Workforce in UK Cardiac Catheter Laboratories”. Cath lab experts were recruited to complete an online Delphi study. Results: Findings suggest the cath lab operates as a complex adaptive system, where changes to one professional role can create feedback loops affecting the whole team, sometimes causing instability. Patients are generally unaware of these dynamics but value clear information, competence, safety, and friendliness from staff. To improve patient experience, staff should communicate clearly, provide opportunities for questions, and reinforce verbal information with written materials. Staff value education and training and advanced practice that stays within professional boundaries may be beneficial. The study’s insights can inform policy and workforce strategies, using complexity theory to understand past challenges and guide future workforce development in UK cath labs.