Barriers and facilitators in implementing quality indicators for pediatric respiratory diseases in Jordanian emergency departments: A qualitative study

Background: The implementation of quality indicators (QIs) in emergency departments (EDs) is relatively limited, and the factors underlying their poor implementation remain poorly understood. This study aimed to identify and explore the barriers and facilitators to successfully implementing pediatric respiratory disease QIs in the ED from the perspective of expert panels. Materials and Methods: A qualitative study design was conducted in March 2024, using semi-structured face-to-face interviews with a purposive sample of 13 physicians. Thematic analysis was used to identify key themes related to the barriers and facilitators of QI implementation in Jordanian ED settings. Results: Thematic analysis identified several key themes and subthemes regarding the barriers and facilitators of implementing pediatric respiratory disease QI initiatives in the ED. The main themes included human resources, infrastructure constraints, policy and organization, influence on quality culture, electronic health systems, documentation, and administrators. The subthemes included lack of staff, lack of QI experts, workstation issues, resource availability, data availability, time constraints, standardized guidelines, triage procedures, management, lack of QI knowledge, workforce support, education and training, automated processes, user-friendly systems, standardization, printed guidelines, awareness, legal requirements, stakeholder involvement, monitoring and feedback, and administrative support. Conclusions: Successfully implementing pediatric respiratory disease QIs in ED requires addressing both key barriers and facilitators. This includes resolving infrastructure constraints, enhancing data availability through rigorous documentation, and ensuring robust administrative support. Additionally, adopting standardized forms and clear written protocols can streamline processes, while accountability measures and motivational strategies encourage the consistent implementation of QIs.