Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Abstract

Acknowledgement:The authors acknowledge the Department of Health Services Management, Faculty of Health Sciences, University of Malta for providing funding for this research and the Mater Dei Hospital managers, Msida, Malta for facilitating this research. Structured Abstract:Purpose: This article aims to develop an integrated patient focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/Methodology/Approach: The study adopts a case study approach. First, a thorough literature review was undertaken to study various healthcare quality management methods. Second, a healthcare quality management framework was developed using combined Quality Function Deployment (QFD) and Logical Framework Approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness, which has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps were undertaken with the stakeholders' involvement. Findings: The major and related problems faced by the hospital staff under study were overcrowding at A&E and beds shortage respectively. The combined framework ensures better A&E services and patient flow. Quality Function Deployment identifies and analyses the A&E issues and challenges and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address A&E service quality. Practical implications: The proposed framework can be easily integrated within any healthcare unit and within entire healthcare systems due to its flexible and user-friendly approach. It could be part of six sigma and other quality initiatives. Originality/value: Although QFD has been extensively deployed in healthcare setups to improve quality, little has been researched on combining QFD and LFA to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This article bridges these gaps. Moreover, little has been written on the Maltese health care system. Therefore, this study demonstrates Malta's emergency care quality. IntroductionIn many tertiary care hospitals, accident and emergency (A&E) unit is the entry point for critical healthcare. The A&E unit is characterised by complexities in health care delivery that warrant a coordinated approach to quality assurance (Shah, 2006;El Sayed, 2012). These complexities include life threatening presenting conditions (e.g., trauma and cardiac arrest); high patient attendances and turnover; fluctuations in work demands and workload particularly when faced with not so co...

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