Title: Investigating the impact of process complexity on quality of care in hospital emergency departments

Authors: Lesley Strawderman; Laura R. Thomas; Kari Babski-Reeves; Allen Greenwood

Addresses: Department of Industrial and Systems Engineering, Mississippi State University, P.O. Box 9542, Mississippi State, MS, USA ' Rapides Regional Medical Center, 211 4th St., Alexandria, LA 71301-8454, USA ' Department of Industrial and Systems Engineering, Mississippi State University, P.O. Box 9542, Mississippi State, MS, USA ' Department of Industrial and Systems Engineering, Mississippi State University, P.O. Box 9542, Mississippi State, MS, USA

Abstract: Prior research has acknowledged the effect of complexity on provider and system performance in hospital emergency departments (EDs). This research examined the impact of ED process complexity on hospital quality outcomes. Nine emergency department nurse managers from hospitals in Mississippi, Alabama, and Louisiana were interviewed regarding processes of registration, laboratory testing, medication administration, radiology and discharge. Interview data was coded according to variables in proposed equations for patient-focused, provider-focused, and overall process complexity. Hospital quality was measured using existing process of care, outcome of care and patient satisfaction standards. Results showed a strong negative correlation between process complexity and overall quality, suggesting that hospitals with lower process complexity experience higher quality outcomes. Regression analysis showed that the average number of patient steps in a process and the overall complexity of the registration process were significant predictors of overall quality. Methods of reducing patient steps and registration process complexity are discussed.

Keywords: healthcare quality; process complexity; quality of care; hospital emergency departments; accident and emergency; A&E; patient registration; laboratory testing; medication administration; radiology; patient discharge; care process; patient satisfaction; care outcomes.

DOI: 10.1504/IJHTM.2013.055082

International Journal of Healthcare Technology and Management, 2013 Vol.14 No.1/2, pp.22 - 38

Received: 18 Jan 2012
Accepted: 02 Oct 2012
Published online: 19 Jul 2014 *

Full-text access for editors Full-text access for subscribers Purchase this article Comment on this article