Volume 23 Supplement 1

Proceedings of the 6th Danish Emergency Medicine Conference

Open Access

The organization of Danish emergency departments may not have allowed for a full realization of their performance potential

  • Anders Møllekær1, 2Email author,
  • Iben Duvald2,
  • Børge Obel2,
  • Jacob Eskildsen2 and
  • Hans Kirkegaard1
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201523(Suppl 1):A52

https://doi.org/10.1186/1757-7241-23-S1-A52

Published: 16 July 2015

Background

According to The Danish Medical Association the 21 Danish emergency departments (EDs) have different organizational designs. Research shows that a 30% performance loss (i.e. quality of care and efficiency loss) can be attributed to organizational design. The aim of this study is to investigate the organizational design of Danish EDs and point to where the full potential of the EDs may not have been reached.

Method

The study uses a qualitative design. Eight hospitals participated in the study. At each hospital five-six recorded semi-structured interviews were conducted with hospital management, ED leaders, physicians, nurses, and secretaries. Data on the ED's organizational design were collected and analyzed using the multidimensional contingency model. The model describes the relationship between the building blocks that constitutes any organization: Organizational scope, strategy, environment, configuration and complexity, knowledge exchange, process and people and coordination, and control. Alignment between the building blocks is the ideal state (fit). Misalignment (misfit) is a state that is likely to cause decreased performance. The interviews took place from October to November 2013 and from May to August 2014.

Results

Two main designs were identified: A functional design and a process-orientated design. Both shared the same goal, strategy, and environment. The functional design was organized around the medical and surgical specialties. It had misfits caused by a predominantly functional configuration, ad hoc based communication, limited incentives to do work in the ED, and difficult coordination and control of work processes. The process-orientated design was organized around the patient care process. It had misfits related to staff competencies (people) and coordination and control. In addition, four EDs had a process-orientated design during daytime and a functional design during evening/night time, thus greatly increasing the number of misfits.

Conclusion

ED organization is very complex. Four out of eight EDs had two organizational designs. There seem to be unrealized potential to improve performance further. Research is needed to expand the study to include the remaining EDs and the relationship between the organizational design and performance.

Authors’ Affiliations

(1)
Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University & Aarhus University Hospital
(2)
Interdisciplinary Center for Organizational Architecture (ICOA), Department of Social and Business Science, Aarhus University

Copyright

© Møllekær et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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