Understanding the causes of the policy problem
The overcrowding of patients occurs in the emergency department in the Dubai government sector.
This problem has increased over the last ten years as the population has grown.
The main cause of the overcrowding issue is the visit of non-urgent patients who insist on being seen in the emergency department instead of being treated in Primary Health Care (PHC).
Another factor that contributes to overcrowding is the lack of medical insurance, which results in patients rushing to the governmental ED hospital.
Finally, another cause of the problem is the understaffing in hospitals which prevents the effective management of an increased number of patients.
The overcrowding problem can lead to additional issues, such as poor quality of healthcare services, medical staff burnout, medical errors, and dissatisfaction among patients and healthcare personnel, as shown in the issue tree diagram.
The outcomes that will follow the policy implemented are:
- To provide all required equipment and materials necessary to eliminate the problem.
- To reduce the overburden on medical staff and increase the quality of the service.
The outputs that will result in the follow-up strategic actions are:
- Encourage the population’s trust in the healthcare system
- To increase the awareness of the public about the overcrowding and overload issues.
- Suggest adequate strategies after analyzing the current situation.
|Policy impacts |
|Indicators||Present value||Target value||Estimated number of years needed to reach the target|
|Enhanced health care system in Dubai |
While the UAE has a universal healthcare system, there are capacity gaps that must be met to ensure that the population’s healthcare needs are met.
|M&M rates; patient and staff satisfaction; patient outcomes; population’s trust.||Patient and staff dissatisfaction increased medical errors and M&M rates due to limited accessibility to emergency care.||Improved patient outcomes and access to emergency care||4|
|Addressing the population growth issue |
Population growth is 3.9% greater than global growth (DHA, 2018, p. 64). As a result, patients’ needs increase and need to be met.
|Bed availability and turnover; medical equipment utilization; patient waiting time.||Long patient waiting time; insufficient capacity of high acuity bays; lack of hospital beds.||Minimize patient waiting time; ensure 35 emergency bays by 2025; increase the number of hospital beds (Aburayya et al., 2020).||4|
|Enhanced quality of healthcare service in Dubai||Monitor KPIs and conduct surveys through the happiness system; improve patient flow and bed management; regular clinical review and audits (Aburayya et al., 2020)||Availability of emergency care and hospital beds need to be improved to ensure the provision of critical care in a timely manner and decrease M&M||minimize the emergency waiting time||increase the number of medical staff, physicians, and nurses. Ensure that Emergency medicine specialists are trained and available in emergency departments||higher retention rates of qualified medical specialists||ensure the financial sustainability of the ED|
|Improved satisfaction of patients and staff||Increase the number of medical staff and equipment available; provide staff scheduling that ensures safe handover. Employee retention rates and the number of healthcare facilities available in the community (Salehi et al., 2018)||Patient and staff dissatisfaction; poorer patient outcomes; occupational illnesses, poor work-life balance, the possibility of developing unhealthy coping strategies, and medical errors;||Implement the Canadian Triage and Acuity Scale (CTAS) – 5 Level Triage (Aburayya et al., 2020)||train more family physicians, which will allow the population to refrain from visiting the emergency department in case of non-life-threatening issues||increase the number of primary care clinics||build more hospitals and medical care facilities|
|Improved population’s trust in the healthcare system||Survey through happiness system to measure patient satisfaction; KPI monitoring; communication channel to address patients’ concerns||Overcrowding in emergency departments; increased medical errors, and limited access to acute care compromise the population’s trust in the healthcare system||improve public knowledge about the availability of PHC for the general public||increase the use of advanced technologies (Salehi et al., 2018)||decrease health risks, infection rate, and medical errors||enhance the quality-of-service delivery|
|Decreased mortality and morbidity||Fast tracks and the implementation of the Canadian Triage and Acuity Scale to treat patients in need of acute care immediately (Aburayya et al., 2020)||Overcrowding elevates morbidity and mortality rates resulting in public health load. In turn, public trust is compromised due to the inability of healthcare facilities to meet patients’ needs.||Implement the Canadian Triage and Acuity Scale||Implement fast tracks in emergency departments (Aburayya et al., 2020)||Improve bed management policies in hospitals||increase the number of primary care clinics in Dubai|
|Decreased health risk||Infection rates, M&M rates, readmissions and length of stay; waiting times||Multiple health risks can result from the overcrowding problem, such as infection rates due to the higher number of potential transmitters (Salehi et al., 2018).||Care coordination improvement||Manage patients who refuse medical screening||increase the use of advanced technologies and automated digital systems to ensure precise diagnosis and effective patient management (Salehi et al., 2018)||Focus on the aged population to identify and prevent additional health risks|
|Enhanced quality-of-service delivery||Monitor KPIs and conduct surveys through the happiness system; improve patient flow and bed management; regular clinical review and audits (Aburayya et al., 2020)||Overcrowding affects the delivery of quality service due to numerous factors that put patients at risk||minimize the emergency waiting time||Develop an extensive general practitioner network||increase the use of technology to automize processes and increase the efficiency and precision of operations (DHA, 2018)||ensure the financial sustainability of the ED|
|Reduced medical staff overburden||Staff satisfaction survey, improved protocols for specific populations||Understaffing aggravates medical personnel’s health and decreases occupational safety since fatigue and burnout can lead to medical errors and occupational illnesses in nurses and practitioners (Salehi et al., 2018)||adding triaging doctor in ED||increase the number of medical staff, physicians, and nurse’s technicians, and build more hospitals||raise public knowledge about the availability of PHC for the general public||increase the number of primary care clinics and train more qualified physicians|
|Minimized emergency waiting time||Monitor KPIs||Long waiting times affect patient outcomes and lead to some patients walking out of the hospital before receiving medical care, which aggravates the problem||Implement the Canadian Triage and Acuity Scale; ensure staffing to demand||provide additional training workshops and triage system training for nurses||create temporary emergency care units during peak demand||PHC in each city in Dubai|
|Higher retention rates of qualified medical specialists||Turnover rates, retention rates, staff satisfaction surveys; sufficient training||Burnout and associated problems contribute to healthcare specialists’ turnover rates.||Efficient personnel management that allows for sufficient rest, rewarding employees respectively to their contributions to the organization||increase the number of medical staff, physicians, and nurse’s technicians, and build more hospitals||increase the use of technology to automize processes and increase the efficiency and precision of operations (DHA, 2018)||increase the number of primary care clinics and train more qualified physicians|
Policy Theory of Change Summary
There is a problem related to emergency departments in Dubai healthcare. Despite numerous models of care that have been developed to reduce overcrowding and processing time in the emergency room, the current situation is not as favorable as it can be. Therefore, this problem has had a negative impact on both patients and medical staff. An extensive number of patients and the absence of the facilities necessary to provide qualified emergency procedures produce adverse outcomes (Kader, 2019). One possible reason is a lack of studies using quantitative and qualitative methods to investigate the extent of issues, such as the lack of resources that directly impact the level of healthcare. In turn, such research findings could result in an informative overview of the problem and an implementation of a remedy for the issue of inefficient management that results in overcrowding.
The current situation in the healthcare sector of Dubai revealed numerous problems associated with emergency departments. The issue is related to patient overcrowding in government emergency departments in Dubai city, which directly impacts the quality of service provided by healthcare workers and causes significant disruption to both patients and medical staff.
The issue of overload and overcrowding takes place in emergency departments in government hospitals of Dubai and, therefore, results in an increase in infection rates. Researchers have examined these issues and found a maximization in violations during the last years, which correlates with the idea that Dubai requires additional safety measures and improvements (Al-Alawy et al., 2021a). Moreover, researchers mention that Dubai healthcare facilities will benefit from developing performance measures and specific regulations that address problems within organizational outcomes and patient satisfaction (Al-Alawy et al., 2021b). A study examining the same domain concluded that patients seeking healthcare services in Dubai are unsatisfied with the waiting time caused by significant influxes of people aiming to receive medical advice or treatment (Aburayya et al., 2020). The evidence proves that the city in question is the location that is most affected by overcrowded emergency rooms.
Initially, the problem started in the early 1990s during the rapid development of the UAE. As the population has increased in a relatively short period of time, emergency departments were not fully equipped to assist many such patients. This led to a shortage of beds in the emergency department.
The government should consider the following problem due to its contribution to social issues, lack of regulations, and market failures. UAE Vision 2020 specifically emphasizes the importance of having a world-class healthcare system, which directly correlates with improving patient satisfaction and risk mitigation (Salim & Rahman, 2017). Since the government illustrates the significance of addressing this domain, contributing to a more organized emergency department is one of the initial concerns that require improvement. In terms of social collapse, the issue elevates morbidity and mortality rates resulting in public health load. Moreover, the emerging obstacle of an increase in medical errors led to the burden associated with civil lawsuits and regulations issues (Strzelecka et al., 2021). In regard to market failure, the process detrimentally affects the resignation of emergency physicians resulting in a shortage of healthcare staff and emergency care facilities.
Theory of Change allows for a comprehensive illustration of planning for and measuring the success of the initiative. Two primary influences can be defined resulting from the implementation of the proposed policy. The global impacts anticipated include enhancing the health care system in Dubai and addressing the population growth issue, which contributes to the overall increased patient needs. In turn, the policy’s outcomes can be identified as enhanced quality of health care service in Dubai, improved satisfaction of patients and staff, and improved population’s trust in the health care system.
To achieve the desired outcomes, it is critical to determine the project’s outputs. In this regard, the proposed policy is expected to decrease mortality and morbidity, lower health risk and infection rates in patients, as well as reduce the number of medical errors, including documentation, medication, and patient identification errors, along with legal implications. Furthermore, the initiative aims to enhance the quality-of-service delivery and minimize emergency waiting time, which is associated with patient satisfaction and safety (Aburayya et al., 2020). In addition, the policy outcomes include reducing medical staff overburden, forging higher retention rates of qualified medical specialists, and maintaining the financial sustainability of the ED.
Activities and inputs are two integral elements of the planned work toward achieving the intended results. The project initiative suggests such activities as increasing the use of advanced technologies and the number of medical staff, physicians, and nurses (Aburayya et al., 2020). Furthermore, it is proposed to build more hospitals and medical care facilities, increase the number of primary care clinics, train more family physicians, add triaging doctors in ED, and provide additional training workshops and triage system training for nurses to address the public’s needs for emergency care. Another essential aspect of the proposed policy is improving the population’s knowledge about the availability of PHC for the general public, which can distribute the workload in a more efficient way among healthcare units. Finally, it is suggested to monitor KPIs and conduct surveys through the happiness system.
Numerous inputs are required for the implementation of the strategy and the achievement of the outlined outcomes. In particular, resources, such as new healthcare facilities and personnel, are vital in addressing the problem of overcrowding (DHA, 2018). In addition, medical equipment and materials are required to meet the patient’s needs, along with financial resources, including expenses associated with the training of family physicians and triage system training for ED nurses. Overall, the changes proposed can address the problem of overcrowding in emergency departments in Dubai in an effective manner.
The policy’s impact is to reduce overcrowding in emergency departments, which leads to lower mortality and morbidity, lower health risks, lower infection rates, and improved service delivery quality. The goal is to reduce medical errors, shorten emergency wait times, improve service quality, increase patient and medical staff satisfaction, reduce the loss of qualified medical staff, and ensure ED’s financial viability.
The output from increased usage of advanced technologies includes an increase in the number of medical staff, physicians, and nurse technicians, the construction of more hospitals, as well as an increase in the number of primary care clinics. More PHC physicians should be trained, improve public awareness of the availability of PHC for the general public addition of a triaging doctor in the ED will help in improving the triaging system, minimize the waiting time and improve the quality of work, providing additional training seminars regarding the triage system for nurses, physicians, and paramedics.
The hypothesis for dealing with overcrowding patients in emergency departments is to implement many changes in the system, beginning with providing health insurance to all UAE citizens so they can access medical services, increasing the use of advanced technologies, increasing the number of medical staff, physicians, nurses technicians, and building more hospitals, increasing the number of primary care clinics and training more family medicine physicians, and increasing public awareness about the ailment.
Implements these changes need time, and it will take at least 6-12 months to see some result. For example, by adding triaging doctor, we can measure the effect statistically of bun ember patients seen per shift, day, and month. KPI measurement also will help monitor the improvement and can measure the patient’s satisfaction.
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, 10, 1265-1276.
DHA. (2018). Dubai clinical services capacity plan 2018-2030. Web.
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.