Competing Values of Emergency Department Performance: Balancing Multiple Stakeholder Perspectives


  • Deborah Tregunno,

    Search for more papers by this author
    • Address correspondence to Deborah Tregunno, R.N., Ph.D., Canadian Health Services Research Foundation Post Doctoral Fellow, Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, Ontario, Canada M5S 3H4. G. Ross Baker, Ph.D., Jan Barnsley, Ph.D., and Michael Murray, Ph.D. are with the Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto.

  • G. Ross Baker,

  • Jan Barnsley,

  • Michael Murray

  • This research was supported by a Canadian Institutes of Health Research/Health Canada Doctoral Fellowship to Deborah Tregunno; and by the Hospital Report Project, Department of Health Policy, Management and Evaluation, University of Toronto. Hospital Report Project is a joint initiative of the Ontario Hospital Association and the Government of Ontario.


Objective. To describe the performance interests of multiple stakeholders associated with the management and delivery of emergency department (ED) care, and to develop a performance framework and set of indicators that reflect these interests.

Study Setting. Stakeholders (1,100 physicians, nurses, managers, home care providers, and prehospital care personnel) with responsibility for ED patients in hospitals in the Canadian province of Ontario.

Study Design. Sixty-two percent of stakeholders responded to a mail survey regarding the importance of 104 potential ED performance indicators. Descriptive and inferential statistics are used to explore the interests of each stakeholder group and to compare interests across the five groups.

Principal Findings. Emergency department stakeholders are primarily interested in indicators that focus on their role and capacity to provide care. Key differences exist between hospital and nonhospital stakeholders. Physicians mean ratings of the importance on ED performance measures were lower than mean ratings in the other stakeholder groups.

Conclusions. Emergency department performance interests are not homogeneous across stakeholder groups, and evaluating performance from the perspective of any one stakeholder group will result in unbalanced assessments. Community-based stakeholders, a group frequently excluded from commenting on ED performance, provide important insights into ED performance related to the external environment and the broader continuum of care.