# Analysis of factors affecting organizational engagement between pre-hospital and hospital emergency departments: a qualitative study

## TL;DR

This study explores barriers to collaboration between pre-hospital and hospital emergency services, aiming to improve patient care through better organizational engagement.

## Contribution

The study identifies specific managerial, cognitive, and clinical barriers to organizational engagement in emergency services.

## Key findings

- Poor managerial coordination and weak leadership hinder effective communication and collaboration.
- Cognitive limitations and decision-making biases reduce mutual understanding between pre-hospital and hospital staff.
- Lack of standardized protocols disrupts patient care continuity and service quality.

## Abstract

The provision of efficient and integrated emergency services constitutes a vital cornerstone for reducing mortality rates and improving clinical outcomes for patients and casualties within complex healthcare systems. Effective engagement between hospital-based and pre-hospital emergency services is crucial for the delivery of higher quality and more appropriate patient care. This study was conducted with the aim of analyzing the factors affecting organizational engagement between pre-hospital and hospital emergency departments.

This was a qualitative study employing a conventional content analysis approach, conducted across pre-hospital emergency services and affiliated educational hospitals of Shahid Sadoughi University of Medical Sciences, Iran, in 2025. Participants included 38 experienced stakeholders in the field, encompassing managers, supervisors, physicians, nurses, and emergency medical technicians. These individuals were selected using purposive sampling until data saturation was achieved. Data were collected through semi-structured interviews and subsequently analyzed using MAXQDA software (Version 22). The credibility and trustworthiness of the findings were assessed according to Lincoln and Guba’s criteria.

Data analysis revealed that organizational interaction between pre-hospital and hospital emergency services faced significant barriers, primarily attributable to poor managerial coordination, cognitive and professional limitations, and gaps in clinical practice. Specifically, the lack of effective inter-organizational communication, weak leadership in conflict resolution, and insufficient structural and human resource support were identified as key managerial obstacles. In the domain of cognitive and professional limitations, negative attitudes, knowledge and skills gaps, and decision-making biases—often arising under conditions of high workload or limited information—were found to reduce mutual understanding and collaboration between personnel across the two sectors. Regarding clinical practice gaps, the absence of standardized patient handover protocols, inconsistencies in the implementation of care processes, and deficiencies in initial clinical assessments disrupted care continuity and diminished overall service quality.

The findings of this study provide scientific guidance for decision-makers seeking to establish a more integrated, efficient, and safer emergency system. Enhancing organizational engagement within the emergency system necessitates a multifaceted and policy-driven approach, wherein policymakers play a pivotal role in reforming organizational structures, empowering human resources, and standardizing operational processes.