Developing an integrated career and competence framework for whole systems approach to urgent and emergency care delivery

Background: The impact of crowding in emergency departments on patient safety, staff wellbeing, residents’ education and performance of the wider healthcare systems is a global concern. Attention to whole systems healthcare strategies to improve service efficiency is growing, but staff are not well prepared to deliver care across organizational boundaries. Our study aimed to develop an integrated career and competence framework for whole systems urgent and emergency care. Methods: We used mixed methods underpinned by a sequential exploratory design to collect data from a purposive sample. The sample included participants with clinical and mentoring or supervisory expertise in urgent and emergency care settings (n=27) and university lecturers in emergency care programs (n=7). Results: The integrated career and competence framework provides a broad pathway for urgent and emergency care across contributing contexts. The framework illustrates what to expect of staff in urgent and emergency care contexts, irrespective of discipline. Conclusion: The integrated career and competence framework highlights the capacity of care contexts to support informed navigation of the healthcare system in pursuit for urgent care. This initiative benchmarks a step toward whole systems urgent and emergency care to relieve the pressure on emergency departments and to grow staff across the system toward integrated working