Quality management and the Emergency Services Enhancement Program

Abstract

Since the introduction of the Emergency Services Enhancement Program (ESEP) in Victoria in 1995, improvements have been demonstrated in the indicators relating to Emergency waiting times, ambulance bypass rates and inpatient bed access block. This study focuses on staff perceptions of changes in these indicators, factors perceived to influence performance improvements and the extent to which ESEP is perceived to have contributed to overall patient care. A questionnaire was directed at four focus groups within each of the hospitals participating in ESEP. These were Chief Executive Officers, Emergency Department Directors and Nurse Unit Managers, bed coordinators and personnel from the Emergency Department floor. A total of 101 staff responded. Emergency Department staff were generally accurate in their perceptions of performance changes. The most important factors effecting the changes were perceived to be changes in staff profile, management of patient flow through the department, changes in administrative policies and changes in work practices. Staff perceived that patient care has improved by 10% since 1995 and that ESEP has contributed 8% of this improvement. Staff have perceived improvements in ESEP performance indicators consistent with actual changes. The possible mechanisms by which these changes have occurred are presented and discussed. Factor analysis indicated that changes perceived to be most likely to result in improvements were: changes in staff profile (seniority), managing the flow of patients through emergency departments, changing administrative policies, changes in work practices and changes in staff numbers. Improvements in patient care were considered partly due to ESEP. In addition, ESEP has raised awareness of quality management issues.

Access block and ED overcrowding

“…Multifaceted, multidisciplinary and hospital interventions are believed more likely to improve health outcomes than single‐faceted and single hospital interventions 13,14 . However, 89% of the evidence reported in Table 2 derives from single hospital interventions 19–23,25–26,29–44,46,49–63,65,67–71 and only 11% from multicentre interventions 27,45,47–48,64 …”

Access block in NSW hospitals, 1999–2001: does the definition matter?

“…Cameron et al have suggested that the traditional model of hospital beds is not sustainable into the future 4 . These authors and others 15 have also indicated an association between access block and ambulance diversion. Our study is consistent with those findings.…”

“…Patients who were brought to EDs by any kind of ambulance had higher rates of access block 4 , 15 . This may be associated with complexity of illness, as patients in triage categories 2 and 3 had a higher rate of access block than others.…”

The Relationship Between the Customer Relationship Management and Patients’ Loyalty to Hospitals

“…Cobelas et al concluded that when a hospital meets a patient's needs at a higher level than he/she expects, then this patient will not change the hospital ( Cobelas et al, 2001 ). Adeleke ( Adeleke & Aminu, 2012 ) introduced three factors of ‘the quality of services’, ‘customer satisfaction’ and ‘the perception of participation’ as three main factors of customer loyalty.…”