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Table 4 Validity outcomes of the PECA tool and methodological framework

From: A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

Face and Content Validity
 • Conforms to structure of other frameworks for defining and assessing facility-based EC (Tanzania [31] and Rwanda [32])
 • Adopts a contemporary patient-centred approach
 • Uses a common language shorthand applied to the essential components of facility based EC [23]
 • Incorporation of pre-hospital care and emphasis on triage acknowledges the recently developed WHO EC Systems Framework [2] and other WHO EC tools.
 • Adds new value by including less well measured but equally critical health care characteristics such as communication, leadership and staff morale
 • Allows insight about more conventional components of ED function, such as effective resuscitation teamwork and therefore leads to more reliable and broader inferences about ED function overall.
Construct Validity
 • Key national hospital, Ministry of Health and Australian Government Aid stakeholders all accepted the core findings of the 2014 Needs Assessment and concurred with the recommendations that prioritised leadership, staff improvements, triage, paediatric care and attention to overcrowding and patient flow
 • Components from the 2014 Needs Analysis that have been considered and acted upon since delivery to the stakeholders: (Table 3)
  o development and implementation of a new triage scale [33]
  o creation of a paediatric EC area within the ED
  o new protocols for managing ED overcrowding and patient flow
  o sustained support for local leadership and staff education.
Catalytic Validity
 • Solomon Islands: local ED stakeholders have taken a leadership role in transforming their ED (Table 3).
 • Each Needs Assessment process has performed as a trigger for locally-led developments
 • Each Needs Assessment report has provided a tool for subsequent reference and future local energy directed towards ED improvement [34, 35].
(Tables 3 and 5)
Reliability and Rigour
 • Limited ability to measure consistency over time due to single application in each site
 • Internal consistency and stability of the PECA tool confirmed through inter-observer agreement, triangulation of information, repeated observations at different times and days over the two-week period and iterative feedback from key stakeholders.
 • Two different nurses performed the Needs Assessment across the three sites thereby confirming inter-rater feasibility and consistency of application
 • Durability of the PECA tool and methodological approach illustrated through longevity of utility.
 • Rigour enhanced through reflexivity. Throughout each Needs Assessment project, the researchers / observers reflected on their collegiate and friendship relationships with the participants / observed.
 • Self-recognition of biases and assumptions aided interpretation of observations.