title: Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta.
abstract: OBJECTIVE
  The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital.
  
  
  METHODS
  The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital.
  
  
  RESULTS
  The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. PRACTICAL/IMPLICATIONS: The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives.
  
  
  CONCLUSIONS
  Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.
authors.affiliation: Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta.
authors.forename: Sandra Catherine
authors.initials: SC
authors.lastname: Buttigieg
authors.forename: Prasanta Kumar
authors.initials: PK
authors.lastname: Dey
authors.forename: Mary Rose
authors.initials: MR
authors.lastname: Cassar
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008319:Malta; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D018570:Risk Assessment
keywords: Accident and emergency unit; Healthcare; Logical framework; Malta; Patient satisfaction; Process management; Quality frameworks; Quality function deployment; Service quality; Total quality management