Updated: Aug 6th, 2024

Overcrowding in Dubai Government Emergency Department Proposal

Exclusively available on Available only on IvyPanda® • No AI

Background

Over the decades, different institutions fostered the development of distinct models of care focusing on the alleviation of major problems. One of the significant challenges within the Dubai government emergency department encompasses overcrowding. The initiative causes profound adverse effects among the patients and medical practitioners cause of the drawback in the processing timeline amid patients that risks poor service delivery system.

Research by Kader (2019) indicates that insufficient supply of equipment and facilities poses a dynamic hindrance towards the performance outlier among the nurses and the effective patient treatment. Salim and Rahman (2020) stipulate that the problem of congestion of patients in Dubai healthcare facilities violates the UAE Vision 2020 pillar on boosting the quality of medical care.

In a different spectrum, lack of adequate studies involving the assessment of the setback of congestion within the healthcare institutions contributes to the prevailing factor within the Dubai territories. A quantitative and qualitative survey regarding the inherent perplexity renders proficient outcomes and insights upon the effective solution outline.

The emergency departments in Dubai face various issues due to the overcrowding of patients within the facilities. Al-Alawy et al. (2021a) articulate that it is essential for the government to implement strategies that enhance the performance between the nurses in the service delivery system. The efficiency in the processing of the clients fosters a trickle-down effect towards the actionable handling of various illnesses without the risk of death among the personnel (Nichols, 2012).

Delays within the entity bring about distractions among the parties due to the prominent consideration of compromising quality over quantity to reduce the workload. In different research by Al-Alawy et al. (2021b), installing technology and an effective policy plan for the managerial team and the employees steers the intensification to the coordination and assortment of the activities elevating the profitability margin.

Aburayya et al. (2020) depict that the attested dissatisfaction among sick individuals in Dubai is a consequence of the long waiting queues before accessing assistance from a doctor. Different illnesses demand dynamic attention among people (Strselecka et al., 2021). Primarily, the analysis demonstrates that Dubai is the only city highly affected by the issue of overcrowding of casualties. Below is the tree diagram for the problem statement:

Tree diagram for the problem statement

The rationale for Government intervention

The rationality for the government intervention is an important factor cause of the emergent issues on healthcare operations. The overcrowding of patients in the emergency departments compromises the standards of engagement between clients and workers. Improving quality of services within the medical care sector involves enhancing the accessibility of functional tools and expertise among nurses (Kader, 2019). The approaches foster the alleviation of the overload and the emergent inherent issues regarding burnout amid the healthcare practitioners and customers’ dissatisfaction.

Intensifying stress among the laborer risks the occurrence of a higher marginal error among the personnel. Therefore, rendering administrative support surges the system performance with the UAE. The persistence of the issue endangers the reputation of the city’s ability to provide competent care plans among consumers (Muslim, 2019). The significance of addressing the hindrance engulfs triggering savings on incurred costs while coordinating the distinct activities.

Policy Objectives

To intensify the public awareness level regarding overcrowding in healthcare facilities as a social issue.
To provide the necessary materials and equipment for fighting the core issue.
To enhance the reduction of the work burden among the medical practitioners to improve the quality of operations.
To facilitate the appropriate developmental plan for the system in Dubai.
To render the improvement of medical care’s public image across UAE.

Policy Context

The policy focuses on the integral value of boosting the standard of operations within the healthcare sector in Dubai. UAE Healthcare Department (n.d) considers the research an essential platform to address the issue of the overcrowding of patients within the facilities that compromises the quality and profitability scale. Adequate insights on the interdependent relationship and the alternative solution render the influential outlier on workers’ performance and customer satisfaction.

Policy Scope

The distinct measures used in addressing patient overload in Dubai include:

Community-based awareness
The development of a list of illnesses referred to paramedics, and when the patients are in the red zone, they contact the doctors.
The encouragement of the community on visiting PHC for easier access.
Ensuring the increase in the PHC clinics within the Dubai community.
Triaging training among the doctors for effective performance.
Enhancing provision of protected emergency care services.
Fostering timely response to emergency incidences.

The key stakeholders involved in implementing the policy plan enshrine the medical staff, DHA, community patients, emergency department personnel, and the primary healthcare centers. However, other entities that encounter the significant impact of the situational platform include government, the World Federation of Public Health Associations (WFPHA), Joint Commission International Accreditation (JICA), and healthcare departments of government hospitals in Dubai.

Analyzing the Policy Evidence Base

PESTLE Analysis

Political

The amount of financial resource from the government budget.
The government regulatory framework.
The stability of the political situation.

Economic

The waste of the medical recourse practice.
The employment rate of nurses in Dubai.

Socio-cultural

The demographic emergent trend.
The birthing rates.

Technological

Effective social media marketing initiative.

Legal

The employees’ protection legal clause.
The patients’ protection law.

Environmental

The recycling and the management of waste.
The eco-friendly products’ attitude.

SWOT Analysis

Internal variations

Strengths

The decreased time during the interaction between patient and physician.
The administration of earlier treatment.
The increase in the satisfaction index among patients.
The higher probability of necessary and accurate tests.
The elimination of the process on sick peoples’ treatment.

Weaknesses

The increase in the lower acuity patients.
The mental and physical demand for the physicians.
The increase in the workload with reduced nurses’ population.
Extra costs for the hiring of other medical practitioners.

External variations

Opportunities

The positive public relations.

Threats

The increasing population density.
The stressing condition of the public domain risks a decrease in the budget and efficiency.

Stakeholder Engagement Plan

Patient

Dubai is one of the cities in the UAE that harbor a significant population of individuals from different regions. Therefore, emergency department overcrowding contributes to problems for patients by increasing their waiting time, length of stay, morbidity and mortality (Salway et al., 2017). The policy proposal will address patient needs and aim to improve the quality of health care services in Emergency Departments and Health Centers. Hence, it is expected that this group of stakeholders will support the change.

Medical Staff

The patient overload poses an imminent effect on the medical practitioner’s due to the persistence in maintaining high standards under stressful conditions. The current policy problem implies medical staff burnout and dissatisfaction, which, in turn, contribute to occupational illnesses, poor work-life balance, the possibility of developing unhealthy coping strategies, and medical errors (Bahadori et al., 2017). The policy proposal will reduce overburden on the medical staff, which justifies the assumption that this group will support it.

Emergency Department

The central role of the healthcare management team enshrines advocating for timely care for customers to avoid the risk of complications. Emergency Departments in Dubai are affected by the overcrowding problem. The proposed policy recommends adequate strategies after analyzing the current situation. It addresses issues associated with overcrowding in emergency departments, such as difficulties in bed management and poor patient flow. Therefore, it is expected that emergency care providers will support the suggestion.

Government Hospital

Patient protection is a prominent factor across the Dubai environment, hence involving the administrative organs in the outlying conditions. The primary purpose of the Dubai Health Authority (DHA) is to protect public health and ensure an accessible and efficient health care system. DHA will be involved in the policy implementation process as the health care regulator. Furthermore, it is crucial to raise public awareness and encourage the population’s trust in the healthcare system.

Primary healthcare centers

There is an interdependent relationship between sustainability and the medical care index across the public domain. Overcrowding in primary health care centers results in increased waiting times, prolonged patients’ length of stay, poor access to services, financial losses, and dissatisfaction in patients and staff (Salway et al., 2017). The support of this group is expected since the policy proposal aims to provide all necessary equipment and materials necessary to eliminate the problem.

Government institutions

A nation’s administrative mandate enshrines incorporating measures that enhance equity in the distribution of services. The UAE has a government-funded health care system that includes public facilities, clinics, hospitals, and medical services. The overcrowding problem decreases the quality of care, thus interfering with the government’s objective to maintain a high standard of medical services (Bahadori et al., 2017). The policy proposed addresses the health care system issue, which allows for expecting support from the governmental institutions’ side.

World Federation of Public Health Associations (WFPHA)

The plan on alleviating the issue of overcrowding in the facilities in Dubai renders the importance of the entity’s participation in the practice to assert international standards. This non-governmental organization aims at encouraging partnerships among public health professionals that promote health care safety and quality through action and collaboration. Hence, WFPHA can contribute to the development of the proposed policy. It is crucial to include the institution cause of the prominent effect of the adversities to the global population.

Joint Commission International Accreditation (JICA)

Different stakeholders focus on the implementation of strategies that elevate the welfare of the personnel. Joint Commission International (JCI) provides the service of international health care accreditation to medical facilities worldwide. JCI can assist in developing and implementing high standards-driven policy to improve the quality and safety of care in the UAE. Healthcare Department of the government hospitals in Dubai. In this case, JICA’s involvement fosters significant attribution of dynamism in the perspective of the proposal.

Policy Theory of Change

The study’s primary purpose enshrines the assessment of the impact of overcrowding of patients within Dubai government emergency departments. The efficiency in processing of clients fosters a trickle-down effect towards the actionable handling of various illnesses without the risk of death among the personnel. Delays within the entity cause distractions amid the parties cause of the prominent consideration of compromising quality over quantity to reduce the workload (Chang et al., 2018).

Although the overload is a significant issue, a different factor attributing the necessity of addressing the matter is the concentration of ill people without emergency attendance baseline. Research by Idil et al. (2018) focuses on effects of non-urgent patients and demonstrates proficiency in the percentage distribution causing the hindrance. At least 36.4% of the patients required urgent care, while 30.9% had opportunities for alternative solutions. The factor that contributes to the leading cause is the lack of medical insurance, which results in patients rushing to the governmental ED hospital.

According to ASPE (2021), the proportion of emergency department visits generally reflected changes in health insurance coverage rates. It implies that unaffordable insurance costs lead to an increase in the number of non-urgent patients visiting the establishments. The understaffing in hospitals which prevents effective management of an increased number of patients is a significant outlier contributing to the poor service delivery and the trickle-down effect of the benefits and adversities. Below is a diagram of the policy theory of change:

Policy Theory of Change

Policy Impact and Outcomes

Policy impacts	Indicators	Present value	Target value	Estimated number of years needed to reach the target
Enhanced health care system in Dubai	Monitor KPIs Patient and staff satisfaction. Service Rate: patient served per hour. Regular clinical review and audits	% Quality service survey.	Increase % Quality service survey.	3 years
Reduce mortality rates and infection rates	The emergency department reduced the number of fatalities. This is one of the determinants of effectiveness in emergency departments (Boudi et al. 2020).	% Mortality & Morbidity rates. % Infection rate.	Reduction in % Mortality & Morbidity rates. Reduction in % infection rate.	4 years

Policy Outcomes	Indicators	Present value	Targets (year 1)	Targets (year 2)	Targets (year 3)	Targets (year 4)
Reduce patient waiting time	Monitor KPIs The ratio of service providers per the number of patients.	% Service Rate: patient served per hour	Increase service rate 75%	Increase service rate 80%	Increase service rate 85%	Increase service rate 90%
Improved satisfaction of patients and staff	Survey through happiness system to measure patient satisfaction.	Patient and staff dissatisfaction. Poorer patient outcomes; occupational illnesses. Poor work-life balance, the possibility of developing unhealthy coping strategies. Medical errors.	Increase happiness and satisfaction rate 88%	Increase happiness and satisfaction by 90%	Increase happiness and satisfaction by 93%	Increase happiness and satisfaction by 98%
Maintaining work stability and attracting external medical expertise	Employee retention rates and number of health care facilities available in the community (Salehi et al., 2018)	% Retention rates.	Reduction of retention rate 23%	Reduction of retention rate 20%	Reduction of retention rate 17%	Reduction of retention rate 15%

Policy Outputs	Indicators	Present value	Targets (year 1)	Targets (year 2)	Targets (year 3)	Targets (year 4)
Build PHC in each community & increase the hospital capacities.	Infection rates, M&M rates, length of stay; waiting times Rate of change of numbers of non-emergency cases directed to ED instead of PHC	Infection rates Rate of change of numbers of non-emergency cases directed to ED instead of PHC	Decrease medical (incident) error rate 90.5%	Decrease medical (incident) error rate 93%	Decrease medical (incident) error rate 94.5%	Decrease medical (incident) error rate 96%
Implement a triage system.	Medical (incident) error rate Monitor KPIs conduct happiness surveys Regular clinical review and audits (Aburayya et al., 2020)	% Of Medical (incident) error rate % Of waiting time for the patient in triage	Decrease medical (incident) error rate 95.5%	Decrease medical (incident) error rate 96%	Decrease medical (incident) error rate 97%	Decrease medical (incident) error rate 99%
Advance technology use in triaging patients.	Monitor KPIs Conduct happiness surveys Length of stay; waiting times Rate of change of numbers of patients seen	Length of stay; waiting times Rate of change of numbers of patients seen	Decrease waiting times 70%	Decrease waiting times 80%	Decrease waiting times 90%	Decrease waiting times 97%
Provides Insurance	The number of patients covered by health insurance.	% Covered patient with insurance.	Increase covered patients with insurance 88%	Increase covered patient with insurance 92%	Increase covered patient with insurance 95%	Increase covered patient with insurance 96%

Identifying and Appraising Policy Option

Policy instruments	Policy tool 1	Policy tool 2	Policy tool 3	Policy tool 4
Brief description of the policy tool	Telephone Triage: Telephone triage can assist in determining the patient’s need for immediate care or care that can follow in PHC. (Kader, 2019).	Fast Track: The fast track can expedite patients who require non-emergent care for conditions such as dog and cat bites, superficial wounds, sprains. (Kader, 2019).	Training program: Collaboration between ED and DCAS to define emergency and non-emergency cases.	Nurse-Requested X Rays: Nurse-requested x rays can help reduce wait times. (Kader, 2019).
What type of instrument is it?	Regulatory/Financial	Regulatory	Regulatory/Financial	Regulatory
How will it achieve the policy’s intended results?	The telephone triage policy Tool will achieve the objective by providing information and recommendations to health care facilities that seek to improve their overcrowding problem management. Al-Alawy et al. (2021a)	The fast Track tool will achieve the policy’s intended results by minimalizing patient waiting time and managing as fast as possible high-quality services.	The Training program policy will achieve the target by shifting the non-emergency cases to PHC. Therefore, it decreases overcrowding in ED.	The nurse-requested x rays policy tool aims to decrease patient overcrowding in ED by reducing patients’ time in ED.
How can it be implemented?	Provide medical information to patients through DHA regulation as DHA application (doctor to each citizen) or hotline services 800-DHA.	The Canadian Triage and Acuity Scale (CTAS) can be implemented in public health care facilities to provide timely and efficient acute care for patients in need.	Training programs for paramedics. The program will combine such methods as the Canadian Triage and Acuity Scale training.	Increase of the number of medical staff. Collaboration improved communication between nurses and physicians. The Joint Commission International Accreditation can ensure the high-standard quality of care (Salim & Rahman, 2017).
How can it be monitored?	Employee feedback, patients’ feedback; KPIs measurement in the long term (Howlett, 2019)	KPIs measurement patients are waiting times, several patients per physician per shift, Employee feedback, patients’ feedback.	KPIs measurement; measure effectiveness of training by a number of non-emergency cases brought to ED by ambulance.	JCI accreditation requirements must be met; internal guidelines and regulations within an organization (Department of Health, 2021). A number of wrong x-rays ordered done by nurses.
Initial high-level cost estimate	Database or website design and maintenance cost, research sponsoring for evidence-based practices, and a media campaign to raise the public’s awareness of using the service.	Training cost, training materials and equipment, teaching fees, and hiring cost for more nurses (nurse per doctor)	Training program design cost, teaching fees material, and equipment cost.	Accreditation fee; JCI accreditation maintenance cost; preparation cost.

Policy instruments	Selected or Rejected?	Please explain why you have selected or why you have rejected this policy option.
Policy Option 1	Accepted	It is a practical and cost-effective policy that incorporates the Lean Six Sigma process, improving efficiency and care quality.
Policy Option 2	Accepted	The Fast-Track policy is practical, evidence-based, and cost-effective, and equally important, more efficient.
Policy Option 3	Accepted	Paramedic training policy is practical and cost-effective it improves the health services and minimizes the unnecessary overcrowding in ED
Policy Option 4	Rejected	Although Policy 4 is a high integrative approach considering that international accreditation is an effective way to improve patient waiting time and prevent overcrowding in ED, it can’t be implemented at the time being as the nurse in DHA regulation does not have the authority to put x-ray for the patients.

References

Aburayya, A., Alshurideh, M., Albqaeen, A., Alawadhi, D., & A’yadeh, I. A. (2020). An investigation of factors affecting patients waiting time in primary health care centers: An assessment study in Dubai.Management Science Letters, 1265–1276.

Al-Alawy, K., Moonesar, I. A., Mubarak Obaid, H. A., Al-Abed Bawadi, E. I., & Gaafar, R. (2021a). Hospital accreditation: A review of evidence, regulatory compliance, and healthcare outcome measures. Dubai Medical Journal, 4(3), 248–255. Web.

Al-Alawy, K., Azaad Moonesar, I., Ali Mubarak Obaid, H., Gaafar, R., & Ismail Al-Abed Bawadi, E. (2021b). A mixed-methods study to explore the impact of hospital accreditation.INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 004695802098146.

Bahadori, M., Teymourzadeh, E., Ravangard, R., & Raadabadi, M. (2017). Factors affecting the overcrowding in outpatient healthcare.Journal of education and health promotion, 6, 21.

DHA. (2018). Dubai clinical services capacity plan 2018-2030. Web.

Howlett, M. (2019). The policy design primer: Choosing the right tools for the job.Routledge.

Kader, B. A. (2019). New steps to reduce crowding at Emergency units in Abu Dhabi. Health – Gulf News.

Mirhaghi, A., Kooshiar, H., Esmaeili, H., Ebrahimi, M., (2015). Outcomes for emergency severity index triage implementation in the emergency department. Journal of Clinical and Diagnostic Research, 9(4), OC04–OC07. doi:10.7860/jcdr/2015/11791.5737

Muslim, N. (2019). Public hospitals to charge only after patient stabilises. Health – Gulf News.

Nichols, L. M. (2012). Government intervention in health care markets is practical, necessary, and morally sound. The Journal of Law, Medicine & Ethics, 40(3), 547-557.

Salehi, L., Phalpher, P., Valani, R., Meaney, C., Amin, Q., Ferrari, K., & Mercuri, M. (2018). Emergency department boarding: A descriptive analysis and measurement of impact on outcomes.Canadian Journal of Emergency Medicine, 20(6), 929-937.

Salim, F. M., & Rahman, M. H. (2017). The impact of joint commission international healthcare accreditation on infection control performance: A study in Dubai hospital.GATR Global Journal of Business Social Sciences Review, 5(1), 37–45.

Salway, R. J., Valenzuela, R., Shoenberger, J. M., Mallon, W. K., & Viccellio, A. (2017). Emergency department (ED) overcrowding: Evidence-based answers to frequently asked questions.Revista Médica Clínica Las Condes, 28(2), 213-219.

Strzelecka, A., Stachura, M., Wójcik, T., Kordyzon, M., Chmielewski, J. P., Florek-Łuszczki, M., & Nowak-Starz, G. (2021). Determinants of primary healthcare patients’ dissatisfaction with the quality of provided medical services. Annals of agricultural and environmental medicine.

UAE Healthcare Department. (n.d.). Health strategies, policies and laws – the official portal of the UAE government.

More related papers Related Essay Examples