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Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Sandra Catherine Buttigieg (Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta)
Prasanta Kumar Dey (Aston Business School, Aston University, Birmingham, UK)
Mary Rose Cassar (Mater Dei Hospital, Msida, Malta)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 14 March 2016




The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital.


The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital.


The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit.


The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives.


Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.



The authors thankfully acknowledge the contribution of the Department of Health Services Management, Faculty of Health Sciences, University of Malta for providing funding for this research and the management of Mater Dei Hospital, Msida, Malta for facilitating this research. The authors also acknowledge the contributions of two anonymous reviewers. Their comments help improving the quality of the paper substantially.


Buttigieg, S.C., Dey, P.K. and Cassar, M.R. (2016), "Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta", International Journal of Health Care Quality Assurance, Vol. 29 No. 2, pp. 123-140.



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Copyright © 2016, Emerald Group Publishing Limited

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