The influence of workplace culture on the continuing professional development of emergency medical services providers in Saudi Arabia: an ethnographic study

Abstract

Emergency medical services (EMS) providers deliver critical pre-hospital clinical emergency and lifesaving practices. These providers need to engage in continuing professional development (CPD) activities to meet their registration requirements, and maintain and develop their knowledge, skills and professional competencies in order to provide competent and safe EMS practices. The literature has highlighted a number of significant impacts of workplace culture on CPD from the perspectives of a wide range of healthcare professionals. However, the influence of workplace culture on the CPD of EMS providers in Saudi Arabia, and the extent to which these providers value and engage in CPD are not well understood. The research question for this study on EMS in Saudi Arabia was: How does the workplace culture of emergency medical services providers influence their continuing professional development? This study adopted a focused ethnography approach. Focused ethnography is concerned with studying narrowly determined cultures, such as a specific category of providers or a department in a healthcare facility. The theoretical framework developed by Spradley guided the research process. The study was conducted in one of the main institutions that provides public EMS to the community in the Aseer region within Saudi Arabia. Three participant groups were included: (1) administrative leaders; (2) trainers; and (3) EMS providers. Ethics approval was obtained from the Human Research Ethics Committee at the University of Adelaide and from the participating institution. Data was collected from: 133 participants in an online survey; 5 focus groups with a total of 23 participants; 13 semi-structured individual interviews; 300 hours of field observations; and a review of a number of non-confidential workplace documents. The quantitative data from the online survey were analysed using descriptive statistics. The qualitative data were thematically analysed using the steps of analysing and interpreting ethnographic data developed by Holloway and Galvin. The study found a number of aspects of workplace culture that discouraged formal CPD for EMS providers. These issues related to administrative systems; leadership profiles; EMS workloads; language barriers; and significant shortages of appropriate human, material and financial resources. However, some cultural factors supported informal CPD for EMS providers. All levels of participants were aware of and valued CPD. There was a culture of positive collegial relationships and personal friendships among EMS providers, which assisted them to support each other in engaging in some form of CPD. The original contribution of this study to the body of knowledge is that, even though the value placed on CPD was high across the participating groups, support for CPD within the workplace culture was weak. This is due to the lack of integrated structures and systems that govern and promote such behaviours across the workplace. This resulted in an absence of sustainable, timely and high-quality formal CPD for EMS providers. To maintain the growth and evolution of the EMS profession and to deliver safe, contemporary EMS practices to patients then this approach to CPD needs to be modified and improved. Patient safety and the quality of EMS care in the participating region could be compromised.