(Con)Figuring out influence: a modified Delphi approach to configural diagramming to identify influential work system factors on emergency department disposition decision-making

The emergency department (ED) is characterised by varied demands. Yet, processes like ED disposition decision-making have been previously conceptualised as occurring similarly regardless of demand. The goal of this study was to develop a reproducible methodological approach to operationalising configuration by identifying the factors that most strongly shape the ED disposition decision-making process under conditions of low and high demand. Using a modified Delphi approach consisting of surveys sent to ED clinicians, we identified the influence of 32 work system elements on the disposition decision-making process under varied demands. Fifty-nine percent of elements were given similar ratings under low and high demand. Variations in ratings represent meaningful differences in the ED work system structure. Understanding how the influence of ED work system elements varies across the demand continuum can support the translation of descriptive findings into prescriptive insights that can inform and prioritise future research or system design.