IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v70y2010i4p511-517.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00750-3
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    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. 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.
    3. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    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. 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.
    4. 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.
    5. 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.
    6. 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).
    7. 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.
    8. 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.
    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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jacobs, Rowena & Mannion, Russell & Davies, Huw T.O. & Harrison, Stephen & Konteh, Fred & Walshe, Kieran, 2013. "The relationship between organizational culture and performance in acute hospitals," Social Science & Medicine, Elsevier, vol. 76(C), pages 115-125.
    2. 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.
    3. Ancarani, Alessandro & Di Mauro, Carmela & Giammanco, Maria Daniela, 2009. "How are organisational climate models and patient satisfaction related? A competing value framework approach," Social Science & Medicine, Elsevier, vol. 69(12), pages 1813-1818, December.
    4. Ronald Ebenezer Essel, 2020. "Assessing Total Quality Management (TQM) Effect on Hospital Performance in Ghana Using a Non-Probabilistic Approach: The Case of Greater Accra Regional Hospital (GARH)," Metamorphosis: A Journal of Management Research, , vol. 19(1), pages 29-41, June.
    5. M. R. Ibrahim & D. U. Muhammad & B. Muhammad & J. O. Alaezi & J. Agidani, 2023. "The Key to Organizational and construction Excellence: A Study of Total Quality Management," Papers 2305.13104, arXiv.org.
    6. Macinati, Manuela S. & Anessi-Pessina, E., 2014. "Management accounting use and financial performance in public health-care organisations: Evidence from the Italian National Health Service," Health Policy, Elsevier, vol. 117(1), pages 98-111.
    7. Nida Nazar & Sara Ravan Ramzani & Temoor Anjum & Imran Ahmed Shahzad, 2018. "Impact of Entrepreneurial Orientation of Bank Performance in Pakistan," Business Management and Strategy, Macrothink Institute, vol. 9(1), pages 290-309, December.
    8. Botje, Daan & Klazinga, Niek S. & Wagner, Cordula, 2013. "To what degree is the governance of Dutch hospitals orientated towards quality in care? Does this really affect performance?," Health Policy, Elsevier, vol. 113(1), pages 134-141.
    9. Olgun Çiçek & Hakar Mohammed, 2014. "Testing The Relationship Between Total Quality Management Practices and Performance - An Applied Study at Girne American University," Proceedings of International Academic Conferences 0100615, International Institute of Social and Economic Sciences.
    10. Singh, Vedant & Kumar, Akshay & Singh, Tej, 2018. "Impact of TQM on organisational performance: The case of Indian manufacturing and service industry," Operations Research Perspectives, Elsevier, vol. 5(C), pages 199-217.
    11. Macinati, Manuela S. & Rizzo, Marco G., 2014. "Budget goal commitment, clinical managers’ use of budget information and performance," Health Policy, Elsevier, vol. 117(2), pages 228-238.
    12. Lucile Veran, 2016. "La relation entre les coûts et la qualité des soins : une alliance profitable pour les établissements de santé ? The relationship between costs and quality of care : a profitable alliance for hospital," Working Papers CREGO 1160401, Université de Bourgogne - CREGO EA7317 Centre de recherches en gestion des organisations.
    13. Minh Hue Nguyen & Anh Chi Phan & Yoshiki Matsui, 2018. "Contribution of Quality Management Practices to Sustainability Performance of Vietnamese Firms," Sustainability, MDPI, vol. 10(2), pages 1-31, January.
    14. Giorgio, Luca & Mascia, Daniele & Cicchetti, Americo, 2021. "Hospital reorganization and its effects on physicians’ network churn: The role of past ties," Social Science & Medicine, Elsevier, vol. 286(C).
    15. Parast, Mahour Mellat & Golmohammadi, Davood, 2019. "Quality management in healthcare organizations: Empirical evidence from the baldrige data," International Journal of Production Economics, Elsevier, vol. 216(C), pages 133-144.
    16. Hosang Jung & Chi-Guhn Lee & Chelsea White, 2015. "Socially responsible service operations management: an overview," Annals of Operations Research, Springer, vol. 230(1), pages 1-16, July.
    17. Degeling, Chris & Carroll, Jane & Denholm, Justin & Marais, Ben & Dawson, Angus, 2020. "Ending TB in Australia: Organizational challenges for regional tuberculosis programs," Health Policy, Elsevier, vol. 124(1), pages 106-112.
    18. Gordana Pejović & Jovan Filipović & Ljiljana Tasić & Valentina Marinković, 2016. "Towards medicines regulatory authorities' quality performance improvement: value for public health," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(1), pages 22-40, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:70:y:2010:i:4:p:511-517. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.