Bridging the gap: A qualitative analysis of divergent patient and provider experiences in the emergency department.

OBJECTIVES: Emergency departments (EDs) are critical access points within strained health systems. This study examined how patients and providers interpret shared ED encounters to identify strategies to improve patient experience and provider well-being. METHODS: We conducted a qualitative analysis of narratives from a mixed-methods study. Patients ≥ 16 years and ED physicians/nurses provided short narratives about their ED encounter and self-interpreted their experiences. In this article, qualitative data, analyzed using interpretive description, explored how perspectives differed. RESULTS: We reviewed 229 matched patient-provider pairs. Most pairs offered similar assessments; however, 21 were divergent and were the focus of this analysis. Three themes characterized these divergences: (1) the ethical and emotional toll of systemic dysfunction-clinicians described perceived personal inadequacy and perceived humiliation and dignity-eroding care for patients; (2) discrepant measures of 'success' and quality-providers prioritized clinical pathway completion and risk mitigation, whereas patients judged quality based on relationships and communication; and (3) less visible burdens and unmet needs-environmental stressors on providers were rarely noted by patients, while patients emphasized unattended basic needs (food, warmth, pain control) even when investigations and referrals were completed. CONCLUSION: Overall concordance between patients and providers was high, but divergent cases revealed distinct benchmarks of "good care." Future interventions could consider pairing organizational improvements intended to improve workflow and working conditions (including staffing to demand, protected assessment time, and streamlined consults) with a standardized fundamentals bundle that emphasizes clear communication and attention to patient comfort and dignity in ED care.