“Me First, Others Later” A focused ethnography of ongoing cultural features of waiting in an Iranian emergency department

Abstract Background Waiting is an inevitable experience in all emergency departments (EDs). This waiting time may negatively influence the patients and their relatives’ satisfaction, healthcare professionals’ (HCPs) performance, and the quality of care provided. This study aims to explore, gain understanding of and describe what it is like to wait in an Iranian emergency department (ED) with particular focus on cultural features. Method A focused ethnographic approach based on Spradley’s (1980) developmental research sequence was conducted in the ED of a tertiary academic medical center in northwest Iran over a 9-month study period from July 2017 to March 2018. Participant observation, ethnographic interviews and examination of related documents and artefacts were used to collect data. All the data were recorded in either field notes or verbatim transcripts and were analysed using Spradley's ethnographic data analysis method concurrently. Results The overarching theme of “Me first, others later” emerged. Within this overarching theme there were seven sub-themes as follows: human-related factors, system-related factors, patients and their relatives’ beliefs and behaviors, HCPs’ beliefs and behaviors, consequences for patients and their relatives, consequences for HCPs, and consequences for ED environment and care process. Conclusion The mentality ‘me first, others later’ as the main cultural barrier to emergency care, strenuously undermined our positive practice environment. An accountable patient/relative support liaison, a clearly-delineated process of ED care delivery, guidelines for providing culturally competent ED care, and public awareness programs are needed to address the concerns and conflicts which establish a mutual trust and rapport.