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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  5 of the responsibility; rather than take a pro-active stance in educating other departments, our attitude is fatalistic and resigned, i.e., “they don’t treat us well now and it’s not likely to improve.” A good example of our significant dependence on other departments is our endless pursuit of missing supplies. We spend too much time looking for supplies that have disappeared, like blood pressure cuffs, pillows, and IV poles. A range of supplies travels to the units, never to be heard from again. We don’t have an effective system for making sure that needed supplies either stay in the rooms or, at the very least, are returned in a timely manner. We’re doing better, although still not great, at stocking rooms—it’s a boring job. We need to come up with a new procedure for doing this—perhaps with volunteers or assigned techs, like we did in the past? Managing the emotions associated with our jobs is made even more difficult by the physical layout of the ED. Unlike some sites of emotional work (e.g., airplane cabins, hotels, doctor’s offices) there are no “backstage” areas in the ED. where we can collect ourselves and have more private conversations. Flight attendants cherish their meager galley space for a reason—it’s easier to maintain a positive focus on customers when there is a backstage area available to let down one’s guard from time to time. Because no such place exists in the ED, we may say and do things in the unit that could disturb others or violate their privacy; future remodels should consider adding such an area to facilitate our high-pressure emotional work. If staffing and coordination among departments are our most obvious concerns, a less apparent challenge is the straight-line nature of our processes. While it’s true that we are trying to get away from this, for the most part we still do one thing at a time, which means that much of the patient’s waiting time is spent in anticipation of labs, x-rays, or a doctor (whether an on-call doctor’s orders or the staff doctor’s diagnosis). There’s got to be a better way, some method for doing some things concurrently that would make us more efficient without compromising the quality of our decision-making. Linear processing makes us only as strong as our weakest link, such that any delay has the effect of holding up the whole works. Part of our current challenge has to do with a history of inconsistent and sometimes less than effective leadership. Things have been better of late, but management turnover has left the department short of its potential. The bright spot in this picture has been our physicians group. As managers have come and gone, our doctors have been a source of great stability. We really do work as one team. And while we are aware of challenges their group has had with the hospital, we never once saw these concerns affect their clinical practice. But it really isn’t fair to blame others for our present situation; the blame game is all too prevalent at CHC and gets us nowhere. True, we’re tired, and it gets old being the hospital scapegoat. But things do seem to be getting better, and many of us are hopeful. We take great pride in the work that we do, and everyone in the department wants to do a good job. We haven’t given up on wanting to improve, but it’s not simply a matter of treating patients better (although we could always do more of this). Instead, we know that improved processes and better relationships with one other—both inside and with other departments at CHC—are keys to our future success. Respectfully Submitted, May 20, 2002

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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5
of the responsibility; rather than take a pro-active stance in educating other departments, our attitude
is fatalistic and resigned, i.e., “they don’t treat us well now and it’s not likely to improve.”
A good example of our significant dependence on other departments is our endless pursuit of missing
supplies. We spend too much time looking for supplies that have disappeared, like blood pressure
cuffs, pillows, and IV poles. A range of supplies travels to the units, never to be heard from again.
We don’t have an effective system for making sure that needed supplies either stay in the rooms or, at
the very least, are returned in a timely manner. We’re doing better, although still not great, at
stocking rooms—it’s a boring job. We need to come up with a new procedure for doing this—
perhaps with volunteers or assigned techs, like we did in the past?

Managing the emotions associated with our jobs is made even more difficult by the physical layout of
the ED. Unlike some sites of emotional work (e.g., airplane cabins, hotels, doctor’s offices) there are
no “backstage” areas in the ED. where we can collect ourselves and have more private
conversations. Flight attendants cherish their meager galley space for a reason—it’s easier to
maintain a positive focus on customers when there is a backstage area available to let down one’s
guard from time to time. Because no such place exists in the ED, we may say and do things in the
unit that could disturb others or violate their privacy; future remodels should consider adding such
an area to facilitate our high-pressure emotional work.

If staffing and coordination among departments are our most obvious concerns, a less apparent
challenge is the straight-line nature of our processes. While it’s true that we are trying to get away
from this, for the most part we still do one thing at a time, which means that much of the patient’s
waiting time is spent in anticipation of labs, x-rays, or a doctor (whether an on-call doctor’s orders
or the staff doctor’s diagnosis). There’s got to be a better way, some method for doing some things
concurrently that would make us more efficient without compromising the quality of our decision-
making. Linear processing makes us only as strong as our weakest link, such that any delay has the
effect of holding up the whole works.

Part of our current challenge has to do with a history of inconsistent and sometimes less than
effective leadership. Things have been better of late, but management turnover has left the
department short of its potential. The bright spot in this picture has been our physicians group. As
managers have come and gone, our doctors have been a source of great stability. We really do work
as one team. And while we are aware of challenges their group has had with the hospital, we never
once saw these concerns affect their clinical practice.

But it really isn’t fair to blame others for our present situation; the blame game is all too prevalent at
CHC and gets us nowhere. True, we’re tired, and it gets old being the hospital scapegoat. But things
do seem to be getting better, and many of us are hopeful. We take great pride in the work that we do,
and everyone in the department wants to do a good job. We haven’t given up on wanting to improve,
but it’s not simply a matter of treating patients better (although we could always do more of this).
Instead, we know that improved processes and better relationships with one otherboth inside and
with other departments at CHC—are keys to our future success.
Respectfully Submitted,
May 20, 2002


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