Factors Affecting Quality of Emergency Service in Iran’s Military Hospitals
A Qualitative Study
Keywords:
Quality, Military Hospital, Emergency DepartmentAbstract
Introduction: Quality is a key factor for the success of any organization. Moreover, accessing quality in the emergency department is highly significant due to the sensitive and complex role of this department in hospitals as well as the healthcare and medical treatment system. This study aimed to identify, from the perspective of medical experts and nurses serving in the military health and medical treatment system, the factors that affect the quality of emergency service provided in selected military hospitals in Iran.
Methods: This qualitative research was performed in Valiaser Hospital of Tehran (Iran) in 2015, using the framework analysis method. The purposive sampling technique was used for data collection. A total of 14 participants included two emergency medicine specialists, four general physicians, two senior nurses (holding M.Sc. degrees), and six nurses (holding B.Sc. degree). Data were collected through semistructured interviews. Sampling continued until data saturation occurred. The Atlas/Ti software was employed for data analysis.
Results: Four basic themes emerged as the effective factors on the quality of emergency services, namely, structural themes, process/performance themes, outcome themes, and environmental/contextual themes. Moreover, through a framework analysis, 47 subthemes were specified and summarized as indicators of the different aspects of the main themes.
Conclusion: The factors affecting the quality of emergency services in Iran’s selected military hospitals are especially complicated due to the diversity of the missions involved; thus, different factors can influence this quality. Therefore, an effort should be made to tackle the existing obstacles, facilitate the identification of these effective factors, and promotion of the quality of healthcare services.
References
Albassam T, Alshawi S. Service Quality Measurement in the Specific Context of Internet-Based Self- Service Technologies: A Review. UK Academy for Information Systems Conference Proceedings. 2009; 1.
De Vos M, Graafmans W, Keesman E, Westert G, van der Voort PH. Quality measurement at intensive
care units: which indicators should we use? J Crit Care. 2007; 22(4): 267-74. doi:
1016/j.jcrc.2007.01.002. PMID: 18086396.
Rahman NH, Tanaka H, Shin SD, Ng YY, Piyasuwankul T, Lin CH, et al. Emergency medical services key
performance measurement in Asian cities. Int J Emerg Med. 2015; 8(1): 12. doi: 10.1186/s12245-015- 0062-7. PMID: 25932052, PMCID: PMC4412872.
El Sayed MJ. Measuring quality in emergency medical services: a review of clinical performance
indicators. Emerg med int. 2012; 2012: 161630. doi: 10.1155/2012/161630. PMID: 22046554, PMCID:
PMC3196253.
O'Reilly P. Involving service users in defining and evaluating the service quality of a disability service. Int
J Health Care Qual Assur. 2007; 20(2-3): 116-29. doi: 10.1108/09526860710731816. PMID: 17585611.
Botje D, Klazinga NS, Wagner C. To what degree is the governance of Dutch hospitals orientated towards
quality in care? Does this really affect performance? Health Policy. 2013; 113(1-2): 134-41. doi:
1016/j.healthpol.2013.07.015. PMID: 23953878.
Meisel ZF, Shea JA, Peacock NJ, Dickinson ET, Paciotti B, Bhatia R, et al. Optimizing the Patient Handoff
Between Emergency Medical Services and the Emergency Department. Ann Emerg Med. 2015; 65(3): 310- 7. doi: 10.1016/j.annemergmed.2014.07.003. PMID: 25109535.
Makai P, Klazinga N, Wagner C, Boncz I, Gulacsi L. Quality management and patient safety: Survey
results from 102 Hungarian hospitals. Health Policy. 2009; 90(2-3): 175-80. doi:
1016/j.healthpol.2008.09.009. PMID: 19004518.
Arab M, Movahed KE, Mahmoodi M. Surveing Contributory Factors of Clients'satisfaction in Emergency
Unit of Selected Hospitals Affiliated with Tehran and Shahid Beheshti University of Medical Sciences.
Hospital. 2015; 14(1): 37-49.
Shen X, Wang X. Improving the health-care delivery process at hospital emergency services by a better use
of inpatient bed information. Electronic Commerce Research and Applications. 2015; 14(1): 14-22. doi:
1016/j.elerap.2014.10.008.
Bragard I, Fleet R, Etienne AM, Archambault P, Légaré F, Chauny JM, et al. Quality of work life of rural
emergency department nurses and physicians: a pilot study. BMC Research Notes. 2015; 8(1): 116. doi:
1186/s13104-015-1075-2.
Rahimi SH, Masoumpour M, Kharazmi E, Kavousi Z. Designing the Quality of Emergency Ward Services
in Shirazs Shahid Faghihi Hospital Based on Quality Function Deployment Method (QFD) in 2011-2012. J
Hospital. 2013; 12(3): 9-17.
Dormann H, Diesch K, Ganslandt T, Hahn EG. Numerical parameters and quality indicators in a medical
emergency department. Dtsch Arztebl Int. 2010; 107(15): 261-7. doi: 10.3238/arztebl.2010.0261. PMID:
, PMCID: PMC2864440.
Schull MJ, Guttmann A, Leaver CA, Vermeulen M, Hatcher CM, Rowe BH, et al. Prioritizing performance
measurement for emergency department care: consensus on evidencebased quality of care indicators.
CJEM. 2011; 13(5): 300-9. PMID: 21955411.
Van Harten WH, Casparie TF, Fisscher OA. The evaluation of the introduction of a quality management
system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002; 60(1): 17-37.
doi: 10.1016/S0168-8510(01)00187-7. PMID: 11879943.
Wardhani V, Utarini A, van Dijk JP, Post D, Groothoff JW. Determinants of quality management systems
implementation in hospitals. Health Policy. 2009; 89(3): 239-51. doi: 10.1016/j.healthpol.2008.06.008.
PMID: 18752866.
Liu SW, Singer SJ, Sun BC, Camargo CA JR. A conceptual model for assessing quality of care for patients
boarding in the emergency department: structure–process–outcome. Acad Emerg Med. 2011; 18(4): 430-5.
doi: 10.1111/j.1553-2712.2011.01033.x. PMID: 21496148, PMCID: PMC3682926.
Kalyan Y, Bansal R, Mathur S, Singh RK. Quality Assessment in Hospital: A Case Study, 2015.
Untachai S. Modeling Service Quality in Hospital as a Second Order Factor, Thailand. Procedia-Social and
Behavioral Sciences. 2013; 88: 118-33. doi: 10.1016/j.sbspro.2013.08.487.
Bennett P. Nursing quality indicators: The next step in enhancing quality in emergency care. Int Emerg
Nurs. 2012; 20(3): 179-86. doi: 10.1016/j.ienj.2012.04.001. PMID: 22912990.
World Health Organization. Quality of care: a process for making strategic choices in health systems. 2006.
Esmaeili VS, Cheraghi M, Masoudi R, Rabiee L. Decision Making in Prehospital Emergency Nurses: A
Qualitative Research. 2011; 3(1-2): 19-32.
Soleimanpour H, Gholipouri CH, Salarilak SH, Raoufi P, Rajaei Ghafouri R, Pouraghaei M, et al.
Assessment of patient satisfaction with emergency department services in Imam Khomeini Hospital,
Tabriz, Iran. Urmia Medical J. 2012; 23(1): 22-31.
Aronsky D, Jones I, Lanaghan K, Slovis CM. Supporting patient cares in the emergency department with a
computerized whiteboard system. J Am Med Inform Assoc. 2008; 15(2): 184-94. doi: 10.1197/jamia.M248.
PMID: 18096913, PMCID: PMC2274795.
Khajavi A. Contingency model of patient safety for Tehran University of Medical Sciences hospitals.
Tehran University of Medical Sciences. 2013.
Barratt H, Harrison DA, Fulop NJ, Raine R. Factors that influence the way communities respond to
proposals for major changes to local emergency services: a qualitative study. PloS one. 2015; 10(3):
doi: 10.1371/journal.pone.0120766. PMID: 25807143, PMCID: PMC4373871.
Welch SJ, Asplin BR, Stone-Griffith S, Davidson SJ, Augustine J, Schuur J, et al. Emergency department
operational metrics, measures and definitions: results of the second performance measures and
benchmarking summit. Ann Emerg Med. 2011; 58(1): 33-40. doi: 10.1016/j.annemergmed.2010.08.040.
PMID: 21067846.
Matthaeus-Kraemer CT, Thomas-Rueddel DO, Schwarzkopf D, Rueddel H, Poidinger B, Reinhart K, et al.
Barriers and supportive conditions to improve quality of care for critically ill patients: A team approach to
quality improvement. J Critical Care. 2015; 30(4): 685-91. doi: 10.1016/j.jcrc.2015.03.022.
Madsen M, Kiuru S, Castrèn M, Kurland L. The level of evidence for emergency department performance
indicators: systematic review. Eur J Emerg Med. 2015; 22(5): 298-305. doi:
1097/MEJ.0000000000000279. PMID: 25969341.
Lecky F, Benger J, Mason S, Cameron P, Walsh C; IFEM Quality Symposium Working Group. The
International Federation for Emergency Medicine framework for quality and safety in the emergency
department. Emerg Med J. 2014; 11(31): 926-9. doi: 10.1136/emermed-2013-203000. PMID: 23907367.
Alessandrini E, Varadarajan K, Alpern ER, Gorelick MH, Shaw K, Ruddy RM, Chamberlain JM; Pediatric
Emergency Care Applied Research Network. Emergency department quality: an analysis of existing
pediatric measures. Acad Emerg Med. 2011; 18(5): 519-26. doi: 10.1111/j.1553-2712.2011.01057.x.
PMID: 21569170.
Moore L, Lavoie A, Bourgeois G, Lapointe J. Donabedian's structure-process-outcome quality of care
model: Validation in an integrated trauma system. J Trauma Acute Care Surg. 2015; 78(6): 1168-75. doi:
1097/TA.0000000000000663. PMID: 26151519.
Gardner G, Gardner A, O'Connell J. Using the Donabedian framework to examine the quality and safety of
nursing service innovation. J Clin Nurs. 2014; 23(1-2): 145-55. doi: 10.1111/jocn.12146. PMID: 23834585.
Jayadevappa R, Chhatre S. Patient centered care-a conceptual model and review of the state of the art. The
Open Health Services and Policy J. 2011; 4(1): doi: 10.2174/1874924001104010015
Pedroto I, Amaro P, Romãozinho JM. Health systems organization for emergency care. J Best Practice &
Research Clinical Gastroenterology. 2013; 27(5): 819-27. doi: 10.1016/j.bpg.2013.08.014.
Carayon P, Wetterneck TB, Rivera-Rodriguez AJ, Hundt AS, Hoonakker P, Holden R, et al. Human factors
systems approach to healthcare quality and patient safety. Appl Ergon. 2014; 45(1): 14-25. doi:
1016/j.apergo.2013.04.023. PMID: 23845724, PMCID: PMC3795965.
Tsiknakis M, Kouroubali A. Organizational factors affecting successful adoption of innovative eHealth
services: A case study employing the FITT framework. Int J Med Inform. 2009; 78(1): 39-52. doi:
1016/j.ijmedinf.2008.07.001. PMID: 18723389.
Graff L, Stevens C, Spaite D, Foody J. Measuring and improving quality in emergency medicine. Acad
Emerg Med. 2002: 9(11); 1091-107. doi: 10.1111/j.1553-2712.2002.tb01563.x. PMID: 12414457.
Salminen-Tuomaala M, Leikkola P, Paavilainen E. Emergency health care professionals' experiences of
factors that influence care quality and safety. J Clinical Nursing Studies. 2015; 3(3): 60. doi:
5430/cns.v3n3p60.
Hoot NR, Aronsky D. Review of emergency department crowding: Causes, effects, and solutions. Ann
Emerg Med. 2008; 52(2): 127-36. doi: 10.1016/j.annemergmed.2008.03.014. PMID: 18433933.
Bahadori M, Ravangard R, Yaghoubi M, Alimohammadzadeh K. Assessing the service quality of Iran
military hospitals: Joint Commission International standards and Analytic Hierarchy Process (AHP)
technique. J Educ Health Promot. 2014; 3: 98. doi: 10.4103/2277-9531.139680. PMID: 25250364, PMCID:
PMC4165109.
Taghva A, Azizi M, Rajabian MH, Khademi M, Omid A, Donyavi V, et al. Average Military Service
Length and Soldiers' General Health. J Archives in Military Medicine. 2014; 2(4). doi:
5812/jamm.20604.
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