Obstacles to continuous improvements in care production in hospital emergency departments

Paper in proceeding, 2016

Patients at emergency departments often face waiting times and queues. Due to budgetary constraints, these problems are not easily resolved. Previous research has shown that the implementation of process flow solutions derived from the operations management field could offer a way to overcome these challenges. Several theories have been proposed regarding the benefits of process flow solutions, but their impact is often limited. This paper is based on empirical data from a longitudinal case study of emergency departments at a university hospital. The paper addresses the research question of why it is so hard to work with continuous improvement in emergency departments in order to achieve increased flow efficiency. A qualitative method similar to a clinical methodology was used to study the factors that influence continuous improvement work. This identified several factors which play a significant role in continuous improvement work, related to professions and their traditional ways of working, physicians´ traditional autonomy, and difficulties related to changing established hierarchies and ideas. Traditions and professional hierarchies have an impact on leadership and how knowledge in operations management is developed and established in the organization.