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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  4 uninsured individuals using the ER for primary care) would likely require sweeping policy changes and expanded health insurance coverage. Other difficulties, such as low patient satisfaction or a high level of management turnover, have mostly proved resistant to various industry-wide improvement programs and institution-specific organizational development efforts. One reason why past efforts may have failed to solve these problems is that they have not taken into account the real-life social dynamics of emergency departments. For example, there is a growing realization that conflating the VLWH of care- -the emergency room (ER)--with the emergency care process confounds attempts to address what appear to be intractable challenges  By focusing solely on what happens "in the ER," many observers define the problem in a way that may make it impossible to solve. An alternative approach would recognize the ER as a location where a good deal of emergency care gets done, but that the social practice of emergency medicine is distributed and diffuse, extending well beyond the boundaries of the ER or the emergency department, and involving numerous people and specialties. ER workers exist in a complex web of social relationships, and ER problems are perhaps better understood as symptoms of hospitals (and families, and societies) under stress (Brewster, Rudell, & Lesser, 2001). An ethnographic approach is one potentially effective way to illuminate how the practice of emergency medicine is situated in an orbit of practitioners and institutions, as it promises to “reveal a complexity that cannot be seen from

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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uninsured individuals using the ER for primary care) would likely require
sweeping policy changes and expanded health insurance coverage. Other
difficulties, such as low patient satisfaction or a high level of management
turnover, have mostly proved resistant to various industry-wide improvement
programs and institution-specific organizational development efforts. One
reason why past efforts may have failed to solve these problems is that they have
not taken into account the real-life social dynamics of emergency departments.
For example, there is a growing realization that conflating the
VLWH of care-
-the emergency room (ER)--with the emergency care process confounds attempts
to address what appear to be intractable challenges
 By focusing solely on what
happens "in the ER," many observers define the problem in a way that may
make it impossible to solve. An alternative approach would recognize the ER as
a location where a good deal of emergency care gets done, but that the social
practice of emergency medicine is distributed and diffuse, extending well beyond
the boundaries of the ER or the emergency department, and involving numerous
people and specialties. ER workers exist in a complex web of social
relationships, and ER problems are perhaps better understood as symptoms of
hospitals (and families, and societies) under stress (Brewster, Rudell, & Lesser,
2001).
An ethnographic approach is one potentially effective way to illuminate
how the practice of emergency medicine is situated in an orbit of practitioners
and institutions, as it promises to “reveal a complexity that cannot be seen from


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