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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  31 In the increasingly complex, interdependent world in which health care services are delivered, meaningful change can only be achieved through strategic partnerships and interdisciplinary alliances focused upon a shared vision. Convening alliances of this kind require both significant efforts at learning to work well with others and a cessation of blame. Emergency departments can and should lead the charge of transforming emergency medicine; taking the lead, however, doesn’t mean coming up with changes in a vacuum, but instead mobilizing interdisciplinary partnerships to generate systems-level solutions. The emergency department can help coordinate these efforts and provide ongoing feedback to the hospital about the effectiveness of the changes. Once these solutions are identified, all departments and divisions should be expected to modify their practices in support of the overall change. Here, executive leadership is crucial. Fortunately, there is significant precedent for this type of change elsewhere in U.S. manufacturing. But little of what was learned in the 1970s in that sector has been passed on to health care. When Ford declared that “Quality is job one” over two decades ago, it was mostly wishful thinking on their part. Joint, sustained effort between engineers and mechanics to plan a new vehicle (the Ford Taurus), produced a breakthrough in quality and efficiency. In manufacturing the process where people from different specialties come together to assess and improve the design of their total system is called “concurrent engineering.” General Electric’s “Work Out” program and General Motors

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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31
In the increasingly complex, interdependent world in which health care
services are delivered, meaningful change can only be achieved through strategic
partnerships and interdisciplinary alliances focused upon a shared vision.
Convening alliances of this kind require both significant efforts at learning to
work well with others and a cessation of blame. Emergency departments can
and should lead the charge of transforming emergency medicine; taking the lead,
however, doesn’t mean coming up with changes in a vacuum, but instead
mobilizing interdisciplinary partnerships to generate systems-level solutions.
The emergency department can help coordinate these efforts and provide
ongoing feedback to the hospital about the effectiveness of the changes. Once
these solutions are identified, all departments and divisions should be expected
to modify their practices in support of the overall change. Here, executive
leadership is crucial.
Fortunately, there is significant precedent for this type of change elsewhere
in U.S. manufacturing. But little of what was learned in the 1970s in that sector
has been passed on to health care. When Ford declared that “Quality is job one”
over two decades ago, it was mostly wishful thinking on their part. Joint,
sustained effort between engineers and mechanics to plan a new vehicle (the
Ford Taurus), produced a breakthrough in quality and efficiency. In
manufacturing the process where people from different specialties come together
to assess and improve the design of their total system is called “concurrent
engineering.” General Electric’s “Work Out” program and General Motors


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