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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  30 for numerous factors that they cannot directly control. Moreover, it is impossible for any emergency department on its own to “fix” what is wrong with emergency medicine. Expecting them to do so is like wanting public schools to be solely responsible for children’s learning. This study revealed the ways that medical care in an ED is an iterative, non-linear process that routinely violates patient expectations for service. Process improvement in emergency medicine will require an interdisciplinary team effort and commitment to dealing with difficult, systemic challenges. No one expects emergency care to be perfect, but improvements in communication could reduce errors and increase efficiency. This study also has implications for the future use of qualitative methods, and in particular ethnography, for the study of health care processes. Many, if not most of the dynamics identified in this study could not be easily identified or understood through traditional social science methods like surveys and interviews, which mainly reflect people’s beliefs about what is happening. In this case, these beliefs were well understood as a result of a number of traditional analyses that had been conducted in the past by consultants. What was different was our ability to observe the work directly over time, from the perspective of an informed outsider not associated with a particular professional perspective. The resulting narrative yielded fresh insights that were richly detailed and a better reflection of the emotional lived experience of both patients and employees.

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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for numerous factors that they cannot directly control. Moreover, it is impossible
for any emergency department on its own to “fix” what is wrong with emergency
medicine. Expecting them to do so is like wanting public schools to be solely
responsible for children’s learning. This study revealed the ways that medical
care in an ED is an iterative, non-linear process that routinely violates patient
expectations for service. Process improvement in emergency medicine will
require an interdisciplinary team effort and commitment to dealing with
difficult, systemic challenges. No one expects emergency care to be perfect, but
improvements in communication could reduce errors and increase efficiency.
This study also has implications for the future use of qualitative methods,
and in particular ethnography, for the study of health care processes. Many, if
not most of the dynamics identified in this study could not be easily identified or
understood through traditional social science methods like surveys and
interviews, which mainly reflect people’s beliefs about what is happening. In
this case, these beliefs were well understood as a result of a number of
traditional analyses that had been conducted in the past by consultants. What
was different was our ability to observe the work directly over time, from the
perspective of an informed outsider not associated with a particular professional
perspective. The resulting narrative yielded fresh insights that were richly
detailed and a better reflection of the emotional lived experience of both patients
and employees.


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