Academic journal article Iranian Journal of Public Health

Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

Academic journal article Iranian Journal of Public Health

Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

Article excerpt


Background: European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM.

Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings.

Results: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs' scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs.

Conclusion: The INPHE's assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs' scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs' (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable.

Keywords: Quality Assessment, EFQM, INPHE, Emergency Department, Iran


Debate on quality and its management and improvement initially began in 1950s, which has served as an important criterion for evaluating the performance of most organizations' services, including health care organizations (HCOs) (1-3). Different models and systems, such as TQM (To-tal Quality Management), ISO (International Stan-dards Organization) and EFQM have been devel-oped or adapted over time to assess and improve the quality in health care. Bohigas and Heaton (4) place these programs in four main categories including certification by ISO, business excellence awards [e.g. MBNQA Malcolm Baldrige National Quality Award], EFQM, professional peer reviews [e.g. Visitation, Vasitatie in Dutch] and accre-ditation. Some of these programs have been applied in Iranian health sector. This study seeks to compare the evaluation results of two external assessment programs in Iran; trying to verify the performance assessment results of INPHE through the application of EFQM. Verification has also been previously used in the case of EFQM (5).

INPHE and EFQM: At a glance

The INPHE was established by Iranian Ministry of Health and Medical Education (MOHME) in 1997 at its new structure aiming to assess and improve the quality and safety of services delivered by all hospital nationwide (6). This program is of a national standard setting and local (decentralized) monitoring status (7). The highest evaluation grade granted to the hospitals by INPHE, as Braithwaite et al. (8) put it, is deemed as a valid indicator of high organizational performance and central to the safety and quality in HCOs.

The evaluation process of INPHE normally starts from the emergency department (ED) of hospitals. The ED evaluation is conducted entirely indepen-dent of the rest of the hospitals and has important implications for their assessment. That is, if a hos-pital does not obtain acceptable scores for its ED, its evaluation will be suspended until the ED gains a satisfactory score. In other words, the overall grade of the hospital can never exceed the grade of its ED (9). This emphasis on the EDs, given the nature (i.e. vitality) of the activities in this de-partment, is understandable (10). However, it might also force the hospitals to unwittingly neg-lect their main activities at the expense of obtain-ing higher grades for their EDs' evaluation. Successful evaluation of EDs is a departure point for the evaluation of entire hospitals. …

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