A qualitative exploration of value and waste in a Trinidadian emergency department patient flow process: perspectives of patients and clinicians

• Published in: Journal of health organization and management 2021-06, Vol.35 (4), p.523-539
• Main Authors: De Freitas, Loren, Goodacre, Steve, O'Hara, Rachel, Thokala, Praveen, Hariharan, Seetharaman
• Format: Article
• Language: English
• Subjects: Age; Case studies; Collaborative approach; Decision makers; Decision making; Demography; Emergency medical care; Emergency services; Gender differences; Generalizability; Health administration; Health care management; Health services; Inappropriate use; Inappropriateness; Patient participation; Patients; Physicians; Qualitative research; Single case studies; Usefulness; Value; Workforce planning
• ISSN: 1477-7266; 1758-7247
• DOI: 10.1108/JHOM-03-2020-0073

PurposeA process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective.Design/methodology/approachA qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process.FindingsValuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process.Research limitations/implicationsThe single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender.Practical implicationsThe study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings.Originality/valueQualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.