DeWulf Annelies, Otchi Elom H, Soghoian Sari
Department of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, USA.
Public Health Unit, Korle Bu Teaching Hospital, Accra, Ghana.
BMC Emerg Med. 2017 Aug 30;17(1):28. doi: 10.1186/s12873-017-0139-0.
Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program.
Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities.
Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality.
ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.
医疗质量改进是全球优先事项，了解一线医护人员的观点有助于指导可持续且有意义的变革。我们报告了对加纳一家三级医院急诊科工作人员质量改进优先事项的定性调查。该研究的目的是让工作人员了解世界卫生组织（WHO）对医疗质量的定义，并确定建立部门质量改进计划的初步重点。
对急诊科工作人员进行半结构化访谈，使用开放式问题探究他们对世界卫生组织定义的六个质量维度的理解和重视程度。然后要求参与者对这些维度按质量改进的重要性进行排序。对定性回答进行主题分析，对关于质量改进优先事项的定量数据确定有序排名。
二十（20）名不同岗位的工作人员参与其中，包括急诊科医生、护士、勤杂工、一名保安人员和一名会计。大多数参与者（61%）将获得紧急医疗服务列为质量改进的高度优先事项。两个反复出现的主题——经济可及性和医院床位可用性——占了大部分讨论内容，且每个主题都与医疗质量的所有维度相关。
急诊科工作人员将世界卫生组织的所有质量维度与他们的工作联系起来，并将获得紧急护理作为最重要的改进领域列为优先事项。参与者表达了提高医疗质量的高度积极性，该研究有助于制定一个专注于急诊服务可及性这一广泛主题的部门质量改进计划。
