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

Social Science & Medicine
Peter Nugus, Jeffrey Braithwaite

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 234 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...Continue Reading

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Citations

May 15, 2013·International Emergency Nursing·Peter NugusJeffrey Braithwaite
Jul 30, 2014·Journal of Health Organization and Management·Stephen TimmonsParaskevas Vezyridis
Jan 2, 2010·BMC Health Services Research·Nerida CreswickJeffrey Braithwaite
Sep 29, 2011·BMC Health Services Research·Nicola H ChapmanBeng H Chong
Jun 26, 2012·International Emergency Nursing·Margaret Fry
May 9, 2012·Annals of Emergency Medicine·Brian Hilligoss, Michael D Cohen
Apr 5, 2011·International Emergency Nursing·Peter Nugus, Roberto Forero
Oct 15, 2011·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Peter NugusJeffrey Braithwaite
Jul 9, 2010·Social Science & Medicine·Peter NugusJeffrey Braithwaite
Oct 16, 2010·Social Science & Medicine·Peter NugusJeffrey Braithwaite
Aug 23, 2012·Social Science & Medicine·Peter NugusJeffrey Braithwaite
Sep 30, 2016·Journal of Health Organization and Management·Sandra G LeggatAmrik Sohal
Nov 11, 2016·Internal and Emergency Medicine·Philippa NelsonPhilip D Anderson
Dec 22, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Morgan R BobbNicholas M Mohr
Nov 16, 2018·Journal of Nursing Management·Jo WaillingMaureen Coombs
Jul 8, 2018·BMC Health Services Research·Jeffrey BraithwaiteJanet C Long
Aug 31, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·William F BondRosemarie Fernandez
Jul 21, 2011·The Medical Journal of Australia·Mohamud SheikhC Raina Macintyre
Jul 13, 2021·Journal of Health Services Research & Policy·Sarah WiseMichael Roche
Aug 19, 2021·PloS One·Janet C LongJeffrey Braithwaite

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