Qualitative analysis of perceptions and experiences of emergency department staff in relation to implementation and outcomes of the Four-Hour Rule/National Emergency Access Target in Australia.

ED staff perceived important effects on quality and safety of care; access block and overcrowding; and medical education and training. In relation to an optimised ED role, quality of care and access block were overall felt to be improved, while education and training deteriorated. Our study increases understanding of the complexity of policy implementation processes and its impact on staff. Staff perceptions are a valuable measure of system performance and should be incorporated into system change evaluations.