Health service and systems design to improve safe patient flow through the Emergency Department 

Professor Robyn Clay-Williams was awarded a NSW Health Early-Mid Career Research Fellowship in 2017. This grant helped her establish her research career and played a major role in the application of cognitive work analysis in healthcare settings and in developing a novel tool that can be utilised globally in healthcare systems. 

Synopsis of project and impacts  

NSW emergency departments (EDs) have ongoing problems managing demand, which was exacerbated during the COVID-19 pandemic. There is significant scope to improve ED efficiency and capacity, but the complex and dynamic nature of the system and busy-ness of staff makes it challenging to assess interventions in real-world settings. Cognitive work analysis is a complex technique aimed at modelling intricate systems and assessing the effect of interventions, allowing detailed experiments to be completed without disrupting the system’s functioning in real life.  

Professor Clay-Williams led a team to develop cognitive work analysis models of the emergency departments at Blacktown and Mount Druitt Hospitals in the Western Sydney Local Health District of NSW Health.  

The models were validated and are available for use in the investigation of EDs across NSW. The research, funded by the NSW Health Early-Mid Career grant, contributed to 26 peer-reviewed publications (including 14 with Professor Clay-Williams as first author), more than 320 citations, seven book chapters, and 49 conference and other presentations. The models are currently being used to test interventions aimed at improving patient experience, outcomes and emergency department performance, and there are ongoing discussions with the Blacktown Hospital ED to use the current findings to improve outcomes for mental health patients.  

The Early-Mid Career grant played a major role in the application of cognitive work analysis in healthcare settings and in developing a novel tool that can be utilised globally in healthcare systems. These outcomes assisted Professor Clay-Williams in securing $20.3 million in additional funding. 

Reflections – career impact 

In 2017, Professor Clay-Williams began her fellowship as a Lecturer and Research Fellow. This was a pivotal moment in her academic career; funding for health services research has a low success rate and career progress is typically uncertain. Furthermore, having not yet been successful in being awarded a substantial grant, opportunity for further promotions was limited and teaching roles were not available for health services researchers to take on. Professor Clay-Willams’ own assessment of her situation was that, without the grant, she would likely have spent only a small period employed as a post-doctoral researcher before leaving academia. 

Instead of this, Professor Clay-Williams’ career in research has continued with rapid progression, including her recent appointment to Professor in January 2024. As her first major grant as a Chief Investigator, the Early-Mid Career grant facilitated her promotion to Senior Research Fellow and ensured that her research career was able to continue. The stability of funding for three years and the emphasis on skills development were essential to success, as learning the cognitive work analysis technique and applying it to health system design required significant investment due to the complexity of the models.  

“One key benefit of the fellowship was that it encouraged you to pick a research method that you were not familiar with and to learn a new research method which in early career research is really valuable because usually, when you finish your PhD, you don’t have that opportunity. You just have to start researching using your existing skills. This sort of gave me space to learn a brand-new research method.” 

The Early-Mid Career grant placed Professor Clay-Williams and her research team at the leading edge of her field. She has since received international recognition for her work and remains a key part of the research team with ongoing funding. 

Establishing collaborations in this fellowship has also been a major contributor to the success of Professor Clay-Williams. Through the Early-Mid Career grant, Professor Clay-Williams established connections with members of the Western Sydney Local Health District, Emergency Care Institute and local ED management. When a major Medical Research Future Fund grant opportunity was made available with only three weeks’ notice to final submission, the prior establishment of these connections made it feasible to develop an application which successfully secured $2.8 million in funding over 5 years, with $700,000 of in-kind support. Without the connections established through the Early-Mid Career grant, such funding and interactions would not have been likely. 

“It’s certainly put you in a position where you were in high-powered meetings where you could actually meet the right people.” 

 Overall, this fellowship was instrumental in turning the uncertain future of a promising academic into a professor with an expanding research team, international recognition, and unique expertise capable of driving systemic change to improve healthcare systems in NSW.