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The dynamic interaction of quality and efficiency in the emergency department: Squaring the circle?

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  • Nugus, Peter
  • Braithwaite, Jeffrey

Abstract

This paper examines the relationship between clinical quality and organizational efficiency in emergency departments (EDs). Previous studies have often emphasized the incompatibility of quality and efficiency, or have neglected to account for their inter-relationships. Policy perspectives reflect normative prescriptions for throughput and reduced waiting times which do not always align with clinicians' foci or day-to-day practices. According to Merton's (1957) theory of "value-assimilation", medical students, for instance, are socialized to reconcile seemingly contradictory values. We aimed to explore ethnographically the possibility of the dynamic interactions of quality and efficiency in clinical practice. This study drew on empirical data from ethnographic field work, conducted over one year, including 234Â hours of semi-structured observations and 56 semi-structured field interviews in the EDs of two tertiary-referral hospitals in Sydney, Australia. We found that seniority and experience of emergency clinicians intersect with the functions of role-modeling, performance management, and formal and informal learning, to facilitate the care of multiple patients as they progress through the ED. These practices fundamentally embed quality in the ED's enactment of efficiency. The relationship between clinical quality and organizational efficiency can be understood through a sociological lens that highlights the roles of interdependent clinicians in a clinical pecking order, working to provide care, and balancing the two. The paper is novel in expanding "value-assimilation" into the clinical domain, and strives to reconcile policy with everyday practice in emergency settings. It moves the debate about quality versus efficiency to one that emphasizes interdependence.

Suggested Citation

  • Nugus, Peter & Braithwaite, Jeffrey, 2010. "The dynamic interaction of quality and efficiency in the emergency department: Squaring the circle?," Social Science & Medicine, Elsevier, vol. 70(4), pages 511-517, February.
    • Handle: RePEc:eee:socmed:v:70:y:2010:i:4:p:511-517
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    References listed on IDEAS

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    1. Callen, Joanne L. & Braithwaite, Jeffrey & Westbrook, Johanna I., 2007. "Cultures in hospitals and their influence on attitudes to, and satisfaction with, the use of clinical information systems," Social Science & Medicine, Elsevier, vol. 65(3), pages 635-639, August.
    2. Braithwaite, Jeffrey & Westbrook, Mary T. & Iedema, Rick & Mallock, Nadine A. & Forsyth, Rowena & Zhang, Kai, 2005. "A tale of two hospitals: assessing cultural landscapes and compositions," Social Science & Medicine, Elsevier, vol. 60(5), pages 1149-1162, March.
    3. Macinati, Manuela S., 2008. "The relationship between quality management systems and organizational performance in the Italian National Health Service," Health Policy, Elsevier, vol. 85(2), pages 228-241, February.
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    1. Rachel Cross & Julie Considine & Judy Currey, 2019. "Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(5-6), pages 1010-1021, March.
    2. Nugus, Peter & Greenfield, David & Travaglia, Joanne & Westbrook, Johanna & Braithwaite, Jeffrey, 2010. "How and where clinicians exercise power: Interprofessional relations in health care," Social Science & Medicine, Elsevier, vol. 71(5), pages 898-909, September.
    3. Nugus, Peter & Carroll, Katherine & Hewett, David G. & Short, Alison & Forero, Roberto & Braithwaite, Jeffrey, 2010. "Integrated care in the emergency department: A complex adaptive systems perspective," Social Science & Medicine, Elsevier, vol. 71(11), pages 1997-2004, December.
    4. Agovino, Massimiliano & Musella, Gaetano & Scaletti, Alessandro, 2022. "Equilibrium and efficiency in the first aid services market: The case of the emergency department of Sorrento," Socio-Economic Planning Sciences, Elsevier, vol. 82(PB).
    5. Stefanini, Alessandro & Aloini, Davide & Gloor, Peter & Pochiero, Federica, 2021. "Patient satisfaction in emergency department: Unveiling complex interactions by wearable sensors," Journal of Business Research, Elsevier, vol. 129(C), pages 600-611.
    6. Hilligoss, Brian, 2014. "Selling patients and other metaphors: A discourse analysis of the interpretive frames that shape emergency department admission handoffs," Social Science & Medicine, Elsevier, vol. 102(C), pages 119-128.
    7. Lanham, Holly Jordan & Leykum, Luci K. & Taylor, Barbara S. & McCannon, C. Joseph & Lindberg, Curt & Lester, Richard T., 2013. "How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts," Social Science & Medicine, Elsevier, vol. 93(C), pages 194-202.
    8. Sandra G. Leggat & Pauline Stanton & Greg J. Bamber & Timothy Bartram & Richard Gough & Ruth Ballardie & Kathy GermAnn & Amrik Sohal, 2018. ": 4P recommendations for implementing change, from research in hospitals," Public Money & Management, Taylor & Francis Journals, vol. 38(1), pages 45-50, January.
    9. Nugus, Peter & Greenfield, David & Travaglia, Joanne & Braithwaite, Jeffrey, 2012. "The politics of action research: “If you don't like the way things are going, get off the bus”," Social Science & Medicine, Elsevier, vol. 75(11), pages 1946-1953.

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