How do emergency care providers and law enforcement officers navigate the competing imperatives of saving lives and serving justice? A qualitative case study in a Ghanaian secondary hospital.

Abstract

Emergency care departments often navigate the dual imperatives of providing timely medical care and cooperating with police as law enforcement officers (LEOs) involved in injury-related cases. Using Strauss' negotiated order theory, we examined the engagements between clinicians and the police at the Upper West Regional Hospital in Ghana, analysing the structural and negotiation contexts shaping their interactions. We used a qualitative case study design. The study was conducted at the Upper West Regional Hospital in Ghana. Participants included clinicians (n=11; 7 nurses and 4 doctors) and police officers (n=10; 6 Criminal Investigation Department and 4 Motor Traffic and Transport Department) with experience engaging with each other during patients' visits at the emergency department of the Upper West Regional Hospital. Participants were recruited through snowball sampling. We first conducted semi-structured interviews (April 2024 and February 2025) with the 21 participants. We then conducted a validation workshop with clinicians, healthcare managers and police in April 2025, incorporating key insights from the workshop into the thematic analysis to strengthen the study's credibility and contextual relevance. We found that interactions between clinicians and police were shaped by three key structural factors: (1) organisational structures like role boundaries and decision-making authority; (2) the policy environment, particularly legal and ethical obligations; and (3) wider cultural contexts, such as societal norms. Within these contexts, negotiations centred on how clinicians and police balanced autonomy with collaboration, shared information, resolved disputes and built interprofessional trust. Informal networks and feedback were particularly important mechanisms for building smoother engagements. Clinician-LEO interactions are dynamic and require continuous negotiation to align healthcare priorities with law enforcement mandates. Clear policies on engagements, interprofessional training programmes and culturally responsive frameworks are needed to enhance emergency care.