Abstract

Introduction
English health policy is written with an aim to recreate
in health care services the quality and efficiency
improvements successfully used by enterprise
organisations.
The aim of this paper is to examine whether policy has
resulted in a framework that will achieve such
improvements in the Emergency Department of a rural
English hospital.
Methods
A mixed method approach is applied through a single
site case study.
Results
The research uncovered a lack of defined processes and
competent actors, rigid departmental barriers and
reactionary decisions leading to poor performance
against a policy target designed for Emergency
Departments. Also, in an improvement intervention to
meet local needs, pressure from the policy target and
the competence of people enacting the process failed to
support its continued efficacy.
Discussion and conclusion
Policy has not provided a framework for improvement
that replicates enterprise success. Capacity and demand
planning should be considered within the emergency
care system and lead to robust processes run by
competent people.