Informing quality in emergency care: understanding patient experiences.

PURPOSE: Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED). DESIGN/METHODOLOGY/APPROACH: The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10). FINDINGS: Capturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating. RESEARCH LIMITATIONS/IMPLICATIONS: Owing to the ED patient's emergency nature, participants were recruited if triaged at levels 3-5 (Manchester Triage System). The study explored patients' immediate rather than post hoc experiences where recollections may change over time. ORIGINALITY/VALUE: To the authors' knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

Performance management of the public healthcare services in Ireland: a review.

PURPOSE: Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. DESIGN/METHODOLOGY/APPROACH: An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. FINDINGS: PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. RESEARCH LIMITATIONS/IMPLICATIONS: The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. ORIGINALITY/VALUE: This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.