The influence of continuous improvement and clinical practice on emergency department (ED) operational performance

The study tests the relationships between continuous improvement (CI) and clinical practices (CP) with perceived operational performance in Australian and New Zealand (NZ) emergency departments.

A survey instrument was designed to collect data from Australian and NZ Emergency Department physicians to test a model developed from the literature, the continuous improvement and clinical practice (CICP) model. Hypotheses were developed and tested using bivariate correlation analysis and multiple regression analysis.

ED operational performance is positively impacted by CI culture, reinforced by an established CI governance structure built on employee education of CI tools and methods. The lack of nonclinical time allocation for CI activities has remained a major impediment for the implementation of a sustainable CI culture. The study found physicians experience tension between continuous improvement and clinical practice.

Developing a CI mindset across all levels of emergency departments would encourage staff to embrace change to support the implementation of CI and to improve clinical practices. The study highlights potential implications for national bodies, academics, policymakers and ED physicians. Study insights suggest that continuous improvement and effective clinical practices are crucial for enhancing ED performance results in their day-to-day responsibilities.

The paper is original by applying methodological rigour to identify the best predictors of performance in EDs and how a theoretical causal model can be tested to identify the best predictors of operational performance in EDs.