The working experience of medical staff in the hospital‐wide bed‐sharing mode: A qualitative study

Abstract Aim The purpose of this study was to provide a comprehensive understanding of the attitudes and experiences of the medical staff regarding the hospital bed‐sharing model. Design The present research was a qualitative study. Methods This qualitative study used in‐depth individual interviews with 7 doctors, 10 clinical nurses and 3 head nurses, which were then transcribed and analysed thematically. Results The study identified six overall themes. Issues were raised about the efficient utilization of hospital bed resources, greater challenges for nursing work, adjustment of doctors' work modes, barriers to communication between doctors, nurses, and patients, potential medical risks, and differentiation of patients' medical experience. Implications for Nursing Management Hospital administrators and nurse managers should work together to solve the challenges that medical staff face, including strengthening nursing training, improving medical–nursing collaboration models, standardizing and effective communication strategies, and improving patient experiences.

hospital shares the nursing staff, beds, equipment, and other resources (Novati et al., 2017).
The value of hospital-wide bed-sharing has been demonstrated in research from other countries. American hospitals have established specialized Capacity Command Centers (CCCs) (Davenport et al., 2018;Franklin et al., 2022;Kane et al., 2019;Morris & Carter, 2015) to improve their overall perception and ability to coordinate actions and to carry out joint coordination among units in the hospital and even among hospitals. In German hospitals, patient admission planning and allocation are typically handled by the case management department (Case Management, CM) and the standard care department (Standard Care, SC) (Schmidt et al., 2013). The goals of the case management department are to improve all aspects of patient treatment, nursing and aftercare. Dutch hospitals have introduced bed classification based on length of stay, level of care and urgency (Bekker et al., 2017).
Although some research (Ajmi et al., 2022;Howell et al., 2008;Tortorella et al., 2013) has been conducted on this model, most studies have focused on benefit indicators such as the bed utilization rate and the average length of stay. There have been few studies on the cognitive attitudes of the medical staff, patients' experiences with medical treatment and unresolved issues in the implementation process.
The purpose of this study was to understand the cognitive attitudes and experiences of medical staff in a tertiary hospital in Southwest China towards the hospital-wide bed-sharing model, to explore further solutions to the issues in implementing this model, to promote the full utilization of medical resources and to address the 'difficulty in seeing a doctor' for patients. This question served as the starting point.

| Design
Since this study aimed to deeply understand the cognitive attitude and feelings of healthcare professionals participating in the hospitalwide bed-sharing mode, qualitative research using the phenomenological method was adopted.

| Sample and setting
The front-line clinical medical staff of a tertiary hospital in Chongqing was selected for interviews using the purposive sampling method.
The study was conducted between September 2021 and March 2022 and included the analysis of various socio-demographic factors such as departments, job divisions, working years, education and professional titles. Inclusion criteria: (1) the doctor/nurse had worked for more than 1 year; (2) the department/ward has participated in the hospital bed-sharing model for over 1 year; (3) the study participant could express themselves well; (4) the study participant had submitted informed consent and participation was voluntary.
Exclusion criteria: (1) participants on maternity leave, sick leave or going out for training; (2) if, over the previous 3 months, the total number of patients admitted across departments in the department/ward was less than 30 person-times.
The interviewees provided informed consent to participate in the interview and agreed to have the entire process recorded.
The sample size was determined by assuming that no new topics emerged during the interviews and that the data had reached saturation. Finally, 20 medical staff members were interviewed. Among them, there are seven doctors (D1-D7), two females and five males, aged 28-42 (35.71 ± 6.24) years, with working experience of 3-19 (11.71 ± 6.53) years, and 10 clinical nurses (N1-N10), all women, aged 26-40 (32.40 ± 4.43)

| Data collection
The interview outline was developed through a literature review and group discussions. The interview outline mainly includes the following questions (Table 2).
Two researchers conducted semi-structured face-to-face, indepth interviews with the respondents. The researcher made an appointment with the interviewee in advance. The interview time was arranged after the interviewee's daily work and was held in a quiet and comfortable study room of the department with recording equipment. The interview lasted approximately 30-45 min. Before beginning the formal interview, the researcher introduced himself, explained the purpose, main content, and significance of the interview, collected general information about the interviewee, promised to protect the interviewee's privacy, replaced the name with a serial number, explained the principle of recording, and obtained information about the interviewee. The visitor then agreed. One researcher conducted the interviews during the research, while the other recorded the interviews. During the interview, the interviewer listened carefully, maintained a neutral attitude and used appropriate interview techniques. The recorder noted the interviewee's tone, demeanour, mood, and movement changes and recorded them in the memo.

| Ethical considerations
After selecting the participants at the beginning of the interview, the aims of the study were explained to them, and their verbal and written informed consent was obtained to participate in the study and for the audio recording. Participants were assured that the recordings would be used anonymously transcribed, their names would not be mentioned in any of the publications and the recorded TA B L E 1 Characteristics of the interviewees (n = 20).

| Data analysis
Within 24 h after the interview, the recording was transcribed into text data, and the interviewee's tone, expression, demeanour, movement and emotional changes were marked in the corresponding position. Colaizzi's seven-step analysis method (Lee, 2021) was used for data analysis using the following information: (1) detailed records and careful reading of all interview materials; (2) extraction of statements that were meaningful and consistent with the research; (3) summarizing and refining meanings from meaningful statements; (4) searching for common features or concepts of meaning to form themes and theme groups; (5) connecting the subject with the research and providing a complete description; (6) integration of the results by describing the research phenomenon in detail, and stating the essential structure of that research; and (7) feeding the results back to the research subject and asking them to confirm, thus improving the validity of the study. Two researchers independently analysed, coded and transferred the original data.
If there was a disagreement, the research group discussed it and decided on a solution. We used consolidated criteria for reporting qualitative studies (COREQ) checklists for methodological quality assessment.

| RE SULTS
Through our analysis, we identified six overall themes, efficient utilization of hospital bed resources, greater challenges for nursing work, adjustment of doctors' work modes, barriers to communication between doctors, nurses, and patients, potential medical risks, and differentiation of patients' medical experience (Table 3).

| Theme 1: Efficient utilization of hospital bed resources
The hospital-wide bed-sharing management model makes the hospital bed a shared resource for the whole hospital. The inpatients are arranged and allocated by the admission preparation centre to ensure the effective use of the beds in each ward and avoid the 'imbalance of supply and demand, and different busy and busy schedules' phenomenon, which improves the utilization rate of bed resources in each ward.

| Increased workload of nurses
The increased numbers of patients admitted and the diversity of disease specialties have led to an increase in the workloads of nurses, as evidenced by the need for communication with medical staff from multiple departments and the participation in training organized by hospitals and departments.

TA B L E 3
The working experience of medical staff in the hospital-wide bed-sharing mode.

| Theme 4: Barriers to doctor-patient communication
Doctors only possess patients, not permanent beds, under the hospital-wide bed-sharing concept. Patients will follow doctors, and doctors will follow the patient to whichever nursing ward the patient is in. The patients will be moved from a more densely populated region to a more dispersed one. The interaction between doctors and nurses has also shifted from a one-to-one 'linear' relationship to a 'network-like' relationship, which introduces new challenges to communication between doctors, nurses and patients.

| Theme 5: Potential medical risks
In the hospital-wide bed-sharing model, due to physical distance and the inexperience of nurses, there are certain risks in the processing of doctor's orders and drug use.

| Theme 6: Differentiation of patients' medical experience
Due to the different geographical locations of medical departments and nursing wards for interdisciplinary patients, some patients lack a sense of belonging and security while hospitalized. Simultaneously, some patients are more satisfied since the nurses are more skilled, the environment is better and the ward is affordable.

| DISCUSS ION
The primary reasons for the uneven use of bed resources include the division of departments and beds based on the type of disease (Boaden et al., 1999), relatively independent management of the beds in each department, opaque bed reservation information (Gopakumar et al., 2016) and limited energy of medical staff in bed management (Dreher, 1988;Virtanen et al., 2008). The unavailability of beds in departments with short supply leads to wait longer times (Ma et al., 2022), delayed antibiotic dosing, a higher likelihood of adverse events and a reduction of nurses' satisfaction (Blay et al., 2012;Hiragi et al., 2022), resulting in patients staying in emergency departments. In order to solve the shortage of hospital beds, some departments add beds at will, and the use and management of beds are not standardized, increasing medical risks (Maldonado et al., 2021).
In American hospitals, the bed-sharing management approach is primarily concentrated in the emergency department  Schmidt et al., 2013).
The present analysis showed the limitations associated with bedsharing throughout the hospital, and the following solutions are offered based on the interview results.

| Enhance risk prevention awareness and ensure patient safety
The primary requirement is strengthening the training and analysis of the core system, supervising its implementation, and continuously improving the quality of medical care. This would enhance the system of reporting non-punitive adverse events and encourage active reporting. The head nurse organizes and encourages all employees to participate in a discussion and analysis of the reasons for adverse events and the taking of corrective measures. Each ward and nursing department should regularly organize relevant content assessments to inspect the training effects.

| Establish an effective communication model and strengthen the communication between doctors, nurses and patients
When the admission preparation centre admits patients, arrangements are made based on the type of disease and proximity con-

| Improve the patient medical experience and improve patient satisfaction
When handling hospitalization, there should be full communication with patients and their families for those who can be admitted across departments. Doing so will help prevent patients from misunderstanding the hospital's procedures, leading to dissatisfaction and unnecessarily heated medical disputes. As the leaders of medical activities, doctors should take the initiative to strengthen communication with interdisciplinary hospitalized patients and solve patients' problems timeously. The professional and comprehensive training of nurses should be improved, allowing them to deliver more expert and better service to patients. The hospital should develop standardized health education manuals for each nursing unit to ensure that the nursing staff delivers health education effectively and to make it convenient for patients to learn about various diseases.

| CON CLUS ION
The hospital-wide bed-sharing model avoids the disadvantages of the coexistence of bed shortages and surpluses caused by the fixed bed management model, alleviates a series of problems such as difficulty in hospitalization, waste of medical resources, and potential safety hazards caused by extra beds, and avoids blind expansion of the hospital scale. The healthy development of the hospital is realized, and the independence of the nursing discipline is also reflected by raising the management level, increasing work efficiency, and making full use of the available bed resources. While this model allows efficient use of hospital bed resources, it also faces greater challenges in nursing work, adjustments to doctors' work patterns, communication barriers between doctors, nurses, and patients, potential medical risks, and differentiation of patients' medical experience.

| Limitations of the study
The research subjects of this study were limited, as only medical professionals from a tertiary hospital in southwestern China were included, and studies with larger numbers of research subjects should be performed. Future research should also expand the survey parameters to allow in-depth investigation of patients' and medical staff's satisfaction, further focus on potential medical risks, and conduct longitudinal research on patients' incidence rate and length of stay.

AUTH O R CO NTR I B UTI O N S
The study design: LPL and YX; data collection: YX, CEW, LLZ and ZFH; data curation: YX; data analysis: YX and JQ; drafting of the manuscript: YX; supervision: LPL. All authors have read and agreed to the published version of the manuscript.

ACK N O WLE D G E M ENTS
Researchers express their gratitude and appreciation for the sincere cooperation of the participants.

FU N D I N G I N FO R M ATI O N
No funding.

CO N FLI C T O F I NTE R E S T S TATE M E NT
The authors declare that they have no conflicts of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.

E TH I C S S TATEM ENT
The study was approved by the Institutional Ethics Committee of Chongqing General Hospital (Project Identification Code: KY S2022-083-01).