Conflicting demands for clinical practice (CP) and continuous quality improvement (CQI) in emergency departments (EDs)

Purpose Emergency department (ED) physicians are expected to effectively implement continuous quality improvement (CQI) practices in EDs while providing clinical service at the same time. This causes tension that often results in unsuccessful CQI implementation in EDs, leading to increased costs and disgruntled patients and staff. The purpose of our study is to explore the underlying factors that contribute to the paradox faced by ED physicians in balancing their clinical duties and CQI expectancies to improve process efficiencies in Australian EDs. Design/methodology/approach The methodology is based on convergent interviews of 16 physicians of Australian EDs. To share their perceived challenges in dealing with clinical and CQI practice of the paradox and how ED physicians dealt with the challenge. Findings The qualitative data reveal ED physicians’ appetite to implement CQI in their EDs. The results also unveiled significant gaps in physicians’ CQI knowledge and the need for the allocation of more non-clinical time to ED physicians to undertake CQI activities to build a culture of continuous improvement. This would minimise “tension” and improve perceived ED performance outcomes. Practical implications Results would equip ED physicians with a greater understanding of the complexities and tensions surrounding EDs when adopting CQI strategies, while providing clinical care to meet community expectations and to reduce costs. Originality/value The paper is original in its methodology and research findings. The study provides a theoretical framework as part of the methods of the interview to assist ED physicians to address the tension between clinical and CQI practice.