Introduction of the Policy Problem
Despite numerous models of care that have been developed to reduce overcrowding and processing time in the emergency room, the current situation in the healthcare sector of Dubai revealed numerous problems associated with the emergency departments, having a negative impact on both patients and medical staff. The problem directly impacts the quality of service provided by healthcare workers and causes significant disruption to both patients and medical staff, as well as increases infection rates. An extensive number of patients and the absence of the facilities necessary to provide qualified emergency procedures produce adverse outcomes (Kader, 2019). Researchers have examined these issues and found a maximization in violations during the last years, which correlates with the idea that Dubai requires additional safety measures and improvements (Al-Alawy et al., 2021a). Moreover, researchers mention that Dubai healthcare facilities will benefit from developing performance measures and specific regulations that address problems within organizational outcomes and patient satisfaction (Al-Alawy et al., 2021b). The government should consider the following problem due to its contribution to social issues, lack of regulations, and market failures.
UAE Vision 2020 specifically emphasizes the importance of having a world-class healthcare system, which directly correlates with improving patient satisfaction and risk mitigation (Salim & Rahman, 2017). Since the government illustrates the significance of addressing this domain, contributing to a more organized emergency department is one of the initial concerns that require improvement. Team resource management is an approach used in commercial aviation to analyze in order to reduce the frequency and severity of overcrowding errors and to minimize the number of accidents. This approach was developed based on new ideas about the causes of such incidents. It is based on an understanding of the characteristics of professional activities carried out in conditions of high emotional stress and increased risk, which are also characteristic of the conditions for the provision of emergency departments. There is a need for more efficient exchange and ownership of information, which is effective communication between team members, the use of all available information, and the achievement of educational goals.
Moreover, economists use the term market failure to categorize situations or conditions that cause the observed equilibrium to deviate. The health department in Dubai experiences many problems in the emergency department, one of which is the hospital failure in the market. It has led to a significant market failure in the healthcare department manifested through delayed treatment, stretched resources, and leads to poor patient outcomes. Also, it may lead to ambulance diversion because patients may leave before being checked by the physician. Again, an overcrowded emergency creates a high risk of medical errors that threaten the patient’s safety. Critically ill patients have to wait for long hours in the overcrowded emergency departments where they are boarded therefore deteriorating their conditions (Arnould & DeBrock, 1986, p. 288). For this reason, the hospital markets fail due to the stiff competition implied by the other hospitals. Besides, the hospital should use the funds provided by the government to expand its capacity. Avoiding boarding patients admitted in the emergency department, providing alternatives for primary care, and providing care to emergency patients will reduce overcrowding in the emergency department, hence improving the hospital’s market.
Importance of Government Intervention
The reasons why the government should intervene to solve the problem include the disruptions caused by overcrowding in Dubai hospitals. Firstly, it could lead to high morbidity and mortality levels associated with emergencies, including traumas and operations. Secondly, patient management procedures could be delayed due to the increased load on the medical staff. Thirdly, the earlier issue could increase the waiting time, which is highly undesirable in emergency and acute situations. Fourthly, the professional burnout and dissatisfaction of healthcare workers are associated with the medical staff’s stress and anxiety at a period of high workload (Kader, 2019). Finally, overcrowding and overload lead to common medical errors; high workload and stressful environment result in mistaken procedures starting from documentation to diagnosis identification.
Governmental support and intervention are required because of the effect on the healthcare system of the UAE. If this tendency continues, it will harm the image of healthcare workers (Muslim, 2019). Moreover, the issues mentioned above, such as poor quality of healthcare services, professional burnout, dissatisfaction, an increased number of medical errors, will ruin the country’s healthcare system (Muslim, 2019). Government should take action as the quality of the healthcare services will affect the quality of life of the general population (Muslim, 2019). Moreover, this issue could create a private emergency healthcare sector leading to financial loss in medicine.
- To increase the awareness of the public about PHC facilities for non-emergency cases.
- To reduce the burden on the medical staff.
- To improve the quality of healthcare service.
- To decrease mortality and morbidity rate with infection rate.
- To develop strategies between ambulance and ED.
Policy Context and Scope
The offered policy is a unique approach to the existing problem. According to the UAE Healthcare Department (n. d.), a similar strategy has never been implemented prior. A similar model based on identical desired outcomes was proposed in Iran in 2015, aiming at effective overcrowding management (Babatabar-Darzi et al., 2020). Successful experience of the neighboring countries and Western models could help cope with the issue in question by acting as real-life examples and helpful information that can give an overview of the potential future.
The scope of measures that will be considered to address overcrowding are:
- Community awareness
- Creating a list of critical diseases directed towards paramedics in case patients in the red zone contact physicians.
- Giving doctors in the emergency department triaging training.
- Encouraging the community to visit PHC by making access easy. o Increasing the number of PHC clinics in the community.
- Connecting emergency doctors and PHC with the paramedics to develop policies.
- Planning strategies to manage physicians’ professional burnout.
- Ensuring instantaneous and appropriate responses to emergency cases.
- Providing protected emergency care services
The policy will be implemented in Dubai city and be available for all patients delivered to a government emergency department.
Stakeholder Engagement Plan
The selection and analysis of the stakeholders relevant to the proposed policy have been conducting using PESTEL and SWOT analyses. Overall, nine stakeholders have been identified, including patients, medical staff (physician/nurse), emergency department, Government hospital (DHA), primary health care centers, governmental institutions, Healthcare Department of the government hospitals in Dubai, Joint Commission International Accreditation (JCIA), World Federation of Public Health Associations (WFPHA).
Emergency department overcrowding contributes to problems for patients by increasing their waiting time, length of stay, and morbidity and mortality (Salway et al., 2017). The policy proposal will address patient needs and aim to improve the quality of health care services in Emergency Departments and Health Centers. The policy proposal will reduce the overburden on the medical staff, which justifies the assumption that this group will support it. The proposed policy recommends adequate strategies after analyzing the current situation and addresses the issues associated with overcrowding in emergency departments, such as difficulties in bed management and poor patient flow in emergency departments.
DHA will be involved in the policy implementation process as the health care regulator. Overcrowding in primary health care centers results in increased waiting times, prolonged patients’ length of stay, poor access to services, financial losses, as well as dissatisfaction in patients and staff (Salway et al., 2017). The overcrowding problem decreases the quality of care, thus interfering with the government’s objective to maintain the high standards of medical services (Bahadori et al., 2017). The Healthcare Department of public hospitals in Dubai will benefit from developing performance measures and specific regulations. JCI can assist in developing and implementing high standards-driven policy to improve the quality and safety of care in the UAE. WFPHA can contribute to the development of the proposed policy since it aims at encouraging partnerships among public health professionals that promote health care safety and quality through action and collaboration.
The stakeholder analysis indicates that it is important to involve a group of stakeholders with high levels of both influence and interest. This group includes Government hospitals (DHA) and governmental institutions. The group of stakeholders that should be monitored includes WFPHA; it is essential to manage the Healthcare Department of the government hospitals in Dubai and JCIA. Finally, patients, medical staff (physician/nurse), emergency department, and primary health care centers should be acknowledged when implementing the policy.
Stakeholder Participation Plan
Printed and electronic communication channels will be utilized to inform patients about the policy options, and surveys will be conducted to obtain data to improve patient satisfaction and allow patients to express their concerns. Among the possible risks associated with the participation of this group of stakeholders are communication risks, lack of data, and insufficient feedback. Clear and open communication must be ensured to encourage patient involvement.
Medical Staff (Physician/Nurse)
Medical staff will be informed about the policy options and engaged in the process to promote proposals on improving the quality of care in emergency departments. Team meetings, clinical workshops, and surveys will be used to gain the staff’s opinion and support for the policy. Organizational and communication risks and the lack of support and commitment are considered threatening. Medical staff’s involvement must be promoted as a source of insight into addressing the problem.
Electronic communication channels and phone calls with emergency departments will be ensured to keep the stakeholders informed and involved in the collaborative process to improve the quality of health care. It is essential to reach out to emergency departments to involve them in the project initiative.
Government Hospital (DHA)
Dubai Health Authority will be involved as the entity regulating the health care industry. Its positive response with regard to the initiative is crucial, and clear communication will be ensured through electronic channels and phone calls to reach the desired outcomes. Careful planning is critical for required equipment and materials for the overcrowding problem elimination.
Primary Health Care Centers
Communication with primary health care centers will be ensured through electronic channels and phone calls to keep the stakeholders informed and allow for their involvement and contribution to the problem-solving process. It is essential to reach out to primary health care centers to involve them in the project initiative.
Governmental institutions will be contacted through electronic and phone communication channels for collaboration and direct involvement in policy implementation. It is critical to obtain this stakeholder’s support to ensure the success of the initiative. Clear communication and well-defined processes are required to ensure efficient change management.
Healthcare Department of the Government Hospitals in Dubai
The Healthcare Department of public hospitals in Dubai will be involved in the communication and encouraged to support the policy through electronic and phone channels. There are such risks associated with this stakeholder group as organizational and communication risks and lack of support or commitment. It is essential to reach out to health care departments to involve them in the project initiative.
Joint Commission International Accreditation (JCIA)
JCIA will be reached through electronic communication channels to seek collaborative effort in standards-driven policy implementation. Its purpose of improving the quality and safety of care in medical facilities worldwide aligns with the proposed policy’s objectives, which implies possible fruitful cooperation. Although no substantial risks are expected, it is necessary to ensure that a strong commitment to quality patient care in Dubai is demonstrated to ensure efficient collaboration with JCI.
World Federation of Public Health Associations (WFPHA)
WFPHA will be involved through electronic communication channels to encourage international collaboration and exchange for health care quality promotion. No substantial risks are expected from the involvement of this stakeholder in the policy implementation.
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Al-Alawy, K., Azaad Moonesar, I., Ali Mubarak Obaid, H., Gaafar, R., & Ismail Al-Abed Bawadi, E. (2021b). A mixed-methods study to explore the impact of hospital accreditation. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 004695802098146.
Babatabar-Darzi, H., Jafari-Iraqi, I., Mahmoudi, H., &Ebadi, A. (2020). Overcrowding management and PATIENT safety: An application of the Stabilization model. Iranian journal of nursing and midwifery research.
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