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Identifying and prioritizing the determinants of improving the ability to provide emergency medical services using a multi-criteria decision-making approach and network analysis
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Leyla Najafi *   , Ali Jahan2 , Mansour Bakhtiar2 |
Department of Health Service Management, Islamic Azad University, Semnan Branch,Semnan,, Department of Health Service Management, Islamic Azad University, Semnan Branch,Semnan, , lnajafikia@gmail.com
2- Department of Health Service Management, Islamic Azad University, Semnan Branch,Semnan, |
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Abstract: (17 Views) |
Background: Emergency departments (EDs) play a pivotal role in healthcare systems, yet they face persistent challenges such as overcrowding, prolonged waiting times, and limited resources. Identifying and prioritizing the determinants that enhance service delivery capacity is essential for improving quality of care and patient outcomes.
Methods: This mixed-methods (qualitative-quantitative) study was conducted in 2018. In the qualitative phase, 30 physicians and nurses with at least five years of ED experience were purposively selected, and data were collected through semi-structured interviews analyzed by conventional content analysis. In the quantitative phase, 400 ED patients were selected via stratified random sampling. A researcher-made 26-item questionnaire was used, with confirmed content validity (Delphi technique) and reliability (Cronbach's alpha = 0.78). The integrated DEMATEL and ANP approach was employed for causal-relationship identification and final weighting. Data were analyzed using one-sample t-test (p < 0.05).
Findings: Six main factors and 26 sub-factors were identified. All six factors were reported to be in a significantly unfavorable condition (p < 0.001). The ANP weighting revealed that staff shortage (0.294) had the highest priority, followed by delay in patient transfer (0.238), weakness in decision-making speed (0.231), shortage of drugs and equipment (0.114), physical space (0.082), and delay in paraclinical measures (0.045), respectively.
Conclusion: Improving service delivery capacity in EDs necessitates a comprehensive approach prioritizing nursing human resource management, enhancing inter-departmental coordination for patient transfer, implementing clinical guidelines to expedite decision-making, and upgrading physical and equipment infrastructures. Managers should focus on staff empowerment, continuous monitoring of performance indicators, and process redesign to achieve sustainable improvements |
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| Keywords: Emergency Service, Hospital, Delivery of Health Care, Decision Support Techniques, Quality Improvement |
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Type of Study: Research |
Subject:
Special
Received: 2025/Nov/Sun | Accepted: 2025/Oct/Thu | Published: 2025/Oct/Thu
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