Professional Contributions and Social Value in High-Acuity Medical Care Settings

Traditional healthcare policy and management often rely on return on investment (ROI), financial indicators, or other easily quantifiable performance measures to evaluate system outcomes. However, in high-acuity medical care settings such as emergency, trauma, intensive care, and complex critical care, the workload, professional responsibility, decision-making pressure, and team coordination required of healthcare professionals may not be fully reflected through conventional output or financial indicators.

Healthcare professionals in these settings often work under high pressure and high uncertainty, while also facing challenges related to professional development, knowledge transfer, and workforce retention. Some professional contributions, such as teaching, mentoring, cross-disciplinary collaboration, quality improvement, and informal coordination, may represent important but less visible forms of value. If these contributions are not adequately recognized or measured, they may influence professional identity, perceived value, role burden, and long-term workforce stability.

This observational, non-interventional study focuses on high-acuity medical care settings and their relevant stakeholders. The study aims to explore experiences and perceptions related to institutional processes, professional contributions, team interactions, care experiences, and perceived value. Social Return on Investment (SROI) will be used as a conceptual framework to explore value domains that may have public meaning or intrinsic importance but are not easily assigned a market price. Systemic CPR (Communication, Professional Engagement, Relationship) will be used as an observational concept to organize experience domains related to communication, professional engagement, and relationships within the care system.

The study will be conducted in two phases.

In the first phase, healthcare professionals working in high-acuity medical care settings will be invited to complete questionnaires related to work experience, burnout, and moral injury. The Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and the Moral Injury Symptom Scale - Health Professionals Version (MISS-HP) will be used. Qualitative interviews will also be conducted to explore work experiences, care processes, professional contributions, team collaboration, institutional support, and perceived value. Patients, important family caregivers, and other relevant stakeholders may also be invited to participate in interviews to provide perspectives on care experiences and service processes.

Qualitative interviews will mainly be conducted as one-on-one in-depth interviews. If participants prefer a group format and the study team considers the topic and participant composition appropriate, focus group interviews with approximately 3 to 5 participants may be arranged. Participation is voluntary, and participants may decline or withdraw without affecting their employment rights, medical care, or other related rights.

In the second phase, the study team will develop an online anonymous survey based on the findings from the first phase. The survey will be used to collect broader perspectives from multiple stakeholder groups, including healthcare professionals, patients, important family caregivers, and relevant public-sector personnel involved in emergency and critical care systems.

All collected data will be analyzed in aggregate or de-identified form. The study does not aim to provide a final monetary valuation of a single closed intervention. Instead, it aims to identify relevant stakeholders, value domains, support needs, and potential indicators that may serve as a basis for future evaluation, institutional improvement, workforce development, and policy discussion in high-acuity medical care settings.

Inclusion criteria

• Adults aged 18 years or older who are able to understand the study information and provide informed consent or agreement to participate.
• Healthcare professionals working in hospital-based high-acuity clinical areas, such as emergency departments, trauma and critical care, intensive care units, respiratory care units, and related settings. Eligible participants may include physicians, nurses, allied health professionals, case managers, registry or data management personnel, and administrative staff involved in these areas.
• Patients who have received care in high-acuity medical care settings.
• Important family members or main caregivers who have accompanied, cared for, or supported decision-making for patients in high-acuity medical care settings.
• Public-sector or emergency response personnel involved in emergency care, rescue, health, or social service systems related to high-acuity medical care.

For the first phase, healthcare professionals may be invited to complete questionnaires and/or participate in qualitative interviews. Patients, important family caregivers, and other relevant stakeholders may be invited to participate in qualitative interviews. For the second phase, eligible stakeholder groups may be invited to complete an anonymous online survey.

Exclusion criteria

• Individuals who decline to participate after receiving the study explanation.
• Individuals who do not meet the inclusion criteria.
• Individuals who are unable to understand the study information or complete the study procedures.