Assessing the feasibility and acceptability of implementing emergency department quality standards in Palestine: a qualitative study

BACKGROUND: Emergency departments are critical for timely, life-saving care, particularly in conflict-affected, resource-constrained settings such as Palestine. Despite national prioritization of healthcare quality, sustained workload pressures from routine emergencies and occupation-related injuries, combined with the absence of ED-specific quality standards, limit systematic improvement of emergency services. METHODS: This qualitative study assessed the perceived feasibility and acceptability of context-specific EDQS in Palestine. Ten semi-structured interviews were conducted with ED physicians, nurses, and quality leaders from nine hospitals, and data were analyzed using thematic analysis to identify key themes and subthemes related to staff experiences and expectations regarding EDQS implementation. RESULTS: Four main themes and 16 subthemes were identified, highlighting both the enabling factors and challenges related to the implementation of EDQS. Enablers included professional commitment, leadership support, and cultural alignment. In contrast, key challenges included resource constraints, training gaps, and political and financial instability. Participants perceived the EDQS as acceptable and potentially feasible under supportive implementation conditions. CONCLUSION: This study found that frontline ED staff perceive the EDQS as both feasible and acceptable within the Palestinian context, despite persistent challenges related to knowledge gaps, resource constraints, and resistance to change. Importantly, these perceptions reflect professional commitment rather than ideal implementation conditions. The successful roll-out of EDQS will therefore depend on targeted capacity building, optimization of available resources, and a phased implementation approach supported by leadership and continuous monitoring, rather than solely on the standards themselves.