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Accident emergency hospital (AEH) services require cohesive, collective, uninterrupted streamlined medical diagnostic and satisfactory patient care. Medical service efficiency in AEHs is difficult to quantify due to the clinical complexity involved in treatment involving various units, patient conditions, changes in contemporary medical practices and technological developments. This paper aims to show how to measure efficiency by eliminating waste in AEH system, identify service failure points, identify benchmark medical services, identify patient throughput time and measure treatment time when AEH services are nonstandard. The applications shown in this paper are distinct in particular; we the authors use nontraditional and systems engineering approach to collect data as the traditional data collection is difficult in real-time AEHs.

The authors show in this study how to measure overall patient treatment time from admission to discharge. Project evaluation and review technique (PERT) captures the inconsistencies involved in measuring treatment time, including measures of variability. The irregular treatment time and complexity involved in the emergency health-care services are usual. The research methodology illustrates how the time function map and service blueprint can improve value-added time in AEHs and benchmark services between similar AEHs.

The inconsistency in treatment time between AEH in public and private hospital is found to be in ratio of 1:20. The private hospital suggests variety of treatments and long stays for recovery. The PERT computations show that the average time a patient remains in a government AEH is about 10 days. The standard deviation of the AEH treatment time is about 0.043 per cent of the expected patient care time. The inconsistency is not significant as compared to the expected value. In 89.64 per cent of the cases, a patient may be discharged in less than 10 days’ time. The patient on average is discharged in 13 days in a private hospital.

The patient treatment time of an AEH is evaluated with PERT project management approach to account for inconsistencies in treatment time. This research makes new contributions in benchmarking AEH throughput time, identify medical service failure points with service blueprint, measure the efficiency with time function map and collect patient data with nontraditional methods. The inherent inconsistencies in a clinical process are identified by PERT analysis with the variance as a characteristic of the treatment time. Improvement of variability implies cost reduction in AEH system.

Although self‐harm is most common in younger people in Britain, the risk of suicide subsequent to an initial act of self‐harm is considerably greater in older age groups. Four characteristics have been shown to be associated with increased vulnerability in older people who self‐harm: increased suicidal intent, physical illness, mental illness and social isolation. This paper is part of a broader analysis of all self‐harm presentations to a British hospital accident and emergency department over a five‐year period. It examines the prevalence of these vulnerability indicators in patients aged 65 or over, and considers whether greater vulnerability in older patients is reflected in their clinical management within the hospital and in community support planning on discharge.At the first presentation older patients (n=91) exhibited greater vulnerability than did younger patients (n=2,326). Despite this, we found no evidence that older self‐harm patients were any more likely than younger patients to routinely receive either a psychosocial assessment from a member of staff with specialist mental health training, or community aftercare planning on discharge from the hospital. This study lends weight to recently published national guidelines recommending that all acts of self‐harm in older people be regarded as evidence of serious suicidal intent at the outset.

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.

Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

This article has important information on US emergency service availability in the hospital industry.

The purpose of this paper is to address a gap in the recent literature on employment of temporary workers by exploring the impact of temporary workers on the perceptions, attitudes and behaviour of permanent staff with particular reference to their implications for patient safety and service quality in hospital accident and emergency departments. The analysis is set in the context of the job demands-resources theory.

The research was undertaken using a case study approach with semi-structured interviews in two London hospitals. Participants included staff from the HR director level, clinical managers and permanent staff who all had an influence in the hiring and management of temporary staff in some way. Transcripts were analysed thematically using an adopted framework approach.

The results indicate that the effect of temporary staff on permanent staff depended on the quality of the “resource”. There was a “hierarchy of preference” for temporary staff based on their familiarity with the context. Those unfamiliar with the department served as a distraction to permanent staff due to the need to “manage” them in various ways. While this was rarely perceived to affect patient safety, it could have an impact on service quality by causing delays and interruptions. In line with previous research, the use of temporary staff also affected perceptions of fairness and the commitment of some permanent staff.

A model developing an approach for improved practice when managing temporary staff was developed to minimise the risks to patient safety and service quality, and improve permanent staff morale.

The review highlights the difficulties that a limited amount of temporary staff integration can have on permanent staff and patient care, indicating that consideration must be placed on how temporary staff are inducted and clarifying expectations of roles for both temporary and permanent staff.

This paper studies the under-researched impact of temporary staff, and, distinctively, staff employed on a single shift, on the behaviour and attitudes of permanent staff. It highlights the need to consider carefully the qualitative nature of “resources” in the job demands-resources theory.

Provides an analysis of the innovation process in order to understand its development and to provide those responsible for its management with knowledge about this subject, as well as the behaviours that make it easy to introduce innovation successfully. The exploratory research work was carried out within the framework of a hospital’s accident and emergency department and the development of several cases of innovation was monitored in situ. Observes that not all innovations develop following the same pattern, but rather each one is determined by the radical nature of the innovation.

Accidents are the most common cause of death to children over the age of one year. Pre‐school children are at particular risk and account for 30 percent of child attendances following an accident at Hull Royal Infirmary Accident and Emergency Department. With children spending more time outside the home at pre‐schools, playgroups and nurseries there is a need to ensure that accident prevention and safety remains high on their agenda. This paper details the development of the Focus on Safety award scheme developed by a multi‐agency group in Hull. Participating groups are asked to consider their own health and safety policies and how they promote accident prevention to both children and their parents / carers. The pilot of the Award Scheme showed that it was very popular with nurseries, pre‐schools and playgroups and that it was meeting a definite need.

The purpose of this paper is to report on the development of a qualitative systems model developed to understand why average emergency department (ED) length of stay (LOS) was rapidly increasing while the number of ED visits was relatively constant. The paper's focus was to identify systemic causes for poor patient flow so that the model could then be used to evaluate improvement options using a more complete view of the causal structure for the ED delays.

In this case study, a disciplined system dynamics approach was used that included development of a dynamic hypothesis, causal loop and stock and flow diagramming, interviews with system experts, and data collection and analysis.

Results support the dynamic hypothesis that an aging population and shortages of resources to treat chronically ill patients (among other dynamics) were causing longer average LOS. Older and sicker patients were consuming more ED resources and causing less acute patients to leave without being seen or to avoid visiting the ED in the first place. In essence, the ED was acting as a safety valve for the wider health care system as many parts of this wider system became overloaded.

Owing to the systemic causes for the patient treatment delay problem in the ED, simple local solutions are unlikely to be effective. The system model can be used as a basis to understand the underlying dynamics of the systemic causes for poor patient flow and identify robust and long‐term solutions.

The paper presents a process for developing a dynamic model to engage the various participants in a health care system in understanding the causes for delays and poor patient flow. The modeling approach can be used as a means for health care managers/administrators to identify improvement options that address the systemic problems.

The use of accessible, portable, mental health crisis information in people with intellectual disabilities has not been previously reported. The purpose of this paper is to explore whether crisis information could be modified to be made accessible and meaningful for people with intellectual disabilities.

Personalized information to help in a mental health crisis was recorded on folded A4 sized sheets that could be carried in a conveniently sized wallet.

Three quarters of the participants carried their crisis information wallets on a daily basis for six months before evaluation. They and their carers expressed positive feedback about them carrying the crisis information. No one carrying the information actually experienced a mental health crisis in the six months follow up period so their usefulness in such crises could not be evaluated. However, they were unexpectedly used in other non‐mental health settings and reported to have been helpful.

The sample size in this was small but the findings suggested that the carrying of crisis information might be a helpful measure for some people with intellectual disabilities. A further, larger scale trial is warranted.

Using a modified version of the service profit chain, the purpose of this paper is to examine the mediating role of service climate (SC) by exploring predictors of SC (i.e. service training (ST), managerial practices (MP), physical design (PD), and job design ( JD), job satisfaction ( JS), and employee empowerment) on service quality (SQ), client satisfaction (CS) with service, and client empowerment (CE). The larger proposition being that certain structural variables, through their impact on SC have the potential to positively influence outcomes in health care.

Registered nurses (N=180) from emergency departments across one province in Canada provided information about internal SQ (i.e. ST, MP, PD, and JD), JS, feelings of empowerment, and SC. Furthermore, these nurses provided information on external SQ, CS with service, and CE by responding to questions from the vantage point of the client. The data were analyzed using statistical package for the social sciences; structural equation modelling (SEM) was implemented using LISREL.

SEM analyses showed that JS and empowerment only partially mediated the relationship between MP, PD, and JD and SC. In addition, SQ, CS with service, and CE were fully mediated by SC.

A limitation of this study is that the researcher used only employee (nurses) data rather than employee and client data simultaneously in the research model. Future research should be done on the service profit chain theory to incorporate both viewpoints. In addition, research could be carried out in other service occupations and organizations to test the invariance of the research model.

The results should lead health care managers to consider the importance of emphasizing internal SQ features that facilitate SC in health care.

This contribution of this research is apply the service profit chain framework in exploring the role of SC in health care. In addition, emphasize the importance of the PD of emergency department to creating a climate for service in health care.