HASTANELERDE ACİL SAĞLIK HİZMETLERİNİN YÖNETİMSEL SÜREÇLERİ VE ORGANİZASYONEL ÇERÇEVESİ
MANAGEMENT PROCESSES AND ORGANIZATIONAL FRAMEWORK OF EMERGENCY HEALTH SERVICES IN HOSPITALS

Summary/Abstract: Problem Definition and Scope: Healthcare services constitute one of the most visible service domains within the state system. These services generally comprise sub-service areas that are either undertaken by the public sector or shared with the private sector. However, the organization of emergency medical services (EMS) is predominantly carried out by the public sector and represents one of the most highly visible public services. Emergency medical service organizations are time-critical operational structures that focus on achieving operational effectiveness while simultaneously developing diverse protocols to address a wide range of cases. These organizations are both system-oriented and individually performance-driven in nature. In addition to these characteristics, the examination of this organizational structure—which delivers services of critical importance—from the perspective of management functions has been considered valuable. Methodology: Relevant legislation and literature concerning ambulance and emergency medical service organizations were reviewed and briefly discussed. Field studies were conducted within ambulance and emergency service units at Sakarya Training and Research Hospital Ambulance and Emergency Department, Gölcük Necati Çelik Hospital, and Kocaeli State Hospital Ambulance and Emergency Department. Within this framework, interviews were conducted with a group of ten healthcare professionals, including emergency medical technicians, nurses, and physicians working in ambulance and emergency services. Information was collected regarding the fundamental protocols implemented, the activities carried out during emergency interventions, and the organizational structure and operational processes. The challenges encountered during practice were examined in terms of core management functions, including planning, organizing, directing, coordinating, and controlling. Additionally, evaluations were conducted regarding the procedures applied when patients' relatives insisted on boarding ambulances and the intervention approaches used for intoxicated or drug-affected patients. Based on these evaluations, case-based examples were developed. Main Findings: Emergency department and ambulance service organizations constitute an important field of application for all major management functions, including planning, organizing, directing, coordinating, and controlling. Existing legislation should be designed in a mannerthat enhancesthe effectiveness of management functions. Among the commonly reported challenges faced by emergency service personnel are insufficient staffing, excessive workload, extended working hours, security-related concerns, and ambiguity in job descriptions. These issues significantly affect the operational efficiency of emergency healthcare services. Key Findings and Final Implications: The use of reward mechanisms by administrators has been identified as a potentially effective strategy for addressing performance-related challenges by improving employee performance and increasing motivation. In addition to ensuring adequate staffing levels in emergency units, the functionality of automation systems based on patient load monitoring can be enhanced to improve operational efficiency. Furthermore, job descriptions should be clearly defined, in-service training programs should be expanded, and the safety and security of healthcare personnel must be prioritized. Ensuring appropriate working conditions and addressing personnel shortages remain essential factors in maintaining the effectiveness and sustainability of emergency healthcare services.

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