title: Barriers to change hindering quality improvement: the reality of emergency care.
abstract: OBJECTIVE
  The aim of this study was to investigate physicians' and nurses' perspectives and prerequisites for quality improvement in the emergency department based on results from a previous patient survey.
  
  
  METHODS
  The study used an explorative design with a qualitative approach and was conducted at the main emergency department of a Swedish university hospital. Interviews were conducted with 5 focus groups. In total, the groups comprised 22 respondents.
  
  
  RESULTS
  The respondents suggested goals and quality improvements, such as more patient-centered care, reduced waiting times, and better pain management. However, barriers to quality improvement also were identified and represented 3 themes: the patient is looked upon as an object or a problem; the physicians and nurses belong to different organizational cultures; and the hospital's organization hinders the optimal flow of patients and improvements to quality.
  
  
  CONCLUSIONS
  When assigning priority to the topic areas, most of the focus groups ranked "information, respect, and empathy" as most important to improve. Adequate information, proper care, and treatment within a reasonable time in the emergency department were cited as the goals for patient care, but the health care professionals perceived barriers to change in the hospital culture and organization. To ensure quality care and patient safety, these barriers should be addressed by leaders on all levels in the organization, including the hospital board. Health care professionals' perspectives of quality of care are valuable and should be included in quality improvement work.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden. asa.muntlin@pubcare.uu.se
authors.forename: Asa
authors.initials: A
authors.lastname: Muntlin
authors.forename: Marianne
authors.initials: M
authors.lastname: Carlsson
authors.forename: Lena
authors.initials: L
authors.lastname: Gunningberg
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D009726:Nurses; D015279:Organizational Culture; D009936:Organizational Innovation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians; D011785:Quality Assurance, Health Care; D013548:Sweden