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Inadequate design of emergency departments (EDs) is a major cause of crowding, increased length of stay, and higher mortality. The main reason behind this inadequacy is the lack of stakeholders' involvement in the design process. This work reports and analyzes the results of a large survey of the requirements of ED stakeholders. It then compares these requirements with existing designs on the one hand and international standards on the other. Further, we propose a new hybrid design which combines the requirements of both the stakeholders and international standards using quality function deployment (QFD), also known as the House of Quality, method. The proposed method was used to assess two existing EDs located in two countries. The analysis of the survey responses showed certain discrepancies between stakeholder requirements and the existing designs such as the absence of an initial admission unit and insufficient space of the treatment unit. The results showed a strong correlation between the QFD-based design and stakeholder requirements (r = 0.92 for ED1 and r = 0.93 for ED2) which is attributed to the incorporation of stakeholders' opinions into the QFD method. The new design was also positively correlated to the international standards (r = 0.94 for ED1 and r = 0.91 for ED2). Our findings suggest that international design standards should be based on more structured methods for incorporating stakeholders' views and that a certain degree of difference should be allowed depending on the region in which the hospital is located to reflect both cultural and environmental differences.

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