Perceptions of Workplace Culture Among Emergency Physicians: Insights From In-Depth Interviews

BACKGROUND AND OBJECTIVES: Recently, the PEOPLE+ (Philosophy, Economics, Operational, Providers, and Leadership) model improved performance metrics in an emergency department (ED). However, ED provider perceptions of current workplace culture compared with previous ED work experience were not explored. METHODS: Using descriptive phenomenology, 18 physicians participated in semi-structured interviews that underwent reflexive thematic analysis. Interviews included open-ended questions related to physicians' perceptions of the PEOPLE+ model compared with prior ED experiences. RESULTS: Fifty-three codes about previous work culture and 61 codes about current culture were identified. Participants described previous work settings as profit-driven, understaffed, and individualistic, with limited leadership engagement and high turnover. These conditions were perceived to cause burnout, poor work-life balance, and decreased perceptions of support. The PEOPLE+ model was associated with positive perceptions across all domains, with participants reporting feeling valued, supported, and included in decision-making. Adequate staffing, fair scheduling, team-based care, and accessible leadership contributed to satisfaction and stability in the views of the participants. CONCLUSIONS: The PEOPLE+ model's primary characteristic is being provider-centered, employing simultaneous changes to philosophic, economic, operational, leadership, and staffing models, and workplace culture was perceived as improved following employment of the model. Participants characterized a positive workplace culture as team-based with a nontraditional compensation model and leadership that embraces listening.