Factors Affecting Quality of Emergency Service in Iran’s Military Hospitals: A Qualitative Study

Abstract

IntroductionQuality 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.MethodsThis 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.ResultsFour 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.ConclusionThe 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.

Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff

“…Nurses in the ED confront excessive occupational stress, which can include factors such as the unpredictable number of patients at any time, rapid and unpredictable changes in patients, and injuries caused by accidents and conflicts [15] . Irregularity, unpredictable situations, high-atmospheric pressure, lack of control, and the limited amount of time available for evaluating the effectiveness of therapeutic interventions are stressors for nurses in the emergency department because patients referring to this section are usually in a critical state [16] . Emergency department nurses not only tolerate holistic psychological and physical pressures that dominate all parts of the hospital, but they also suffer some specific pressures, such as time urgency and exposure to the critical conditions of patients, which in turn create negative emotions in them [17] .…”

Explaining challenges of obstetric triage structure: A qualitative study

“…One of the leading structural factors in dropping the quality of care is the lack of supplies and equipment. Evidence has revealed that the structural factors such as the upgrading of medical equipment affect the quality of the emergency structure (Zaboli et al, 2018; Zaboli, Shokri, Javadi, Teymourzadeh, & Ameryoun, 2016). The results of the studies showed that the major shortage of equipment in the emergency structure is effective (Kotsiou, Srivastava, Kotsios, Exadaktylos, & Gourgoulianis, 2018) and the shortage of basic equipment leads to delays in triage and adverse outcomes, misconceptions and inappropriate decisions (Aloyce, Leshabari, & Brysiewicz, 2014; Fry & Burr, 2001).…”

“…Another study noted that human resources and poor knowledge can be the reason for this delay (Cavallaro & Marchant, 2013; Knight, Self, & Kennedy, 2013). In addition, the structural factors can affect the quality of the emergency structure (Zaboli et al, 2016, 2018), including the determined job descriptions, human resources, physical space, skills and experience of staff, the recruitment of professional staff, training and updating of medical equipment (Zaboli et al, 2016, 2018). A study reported that the skill, competence and number of triage performers are some of the internal factors affecting decision‐making in the triage.…”