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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  7 how communication produces, maintains, repairs, and transforms (Carey 1988) this emergency department’s system and culture may provide important insights into both the nature of its current challenges and potential opportunities. 6HWWLQJ DQG $SSURDFK The urban community hospital selected for this study (identified as “CHC”, a pseudonym) opened in 1968 and has grown rapidly thereafter. The number of patients seen by the CHC emergency department has increased six-fold, from 11,000 in 1973 to over 65,000 in 2002. The patient population comprises of a diverse range of ages, income, and ethnic groups. Emergency physician services are contracted to a doctor's group that has been overseeing the ED for over 15 years. Recently, the CEO of the hospital has publicly recognized that since over half of hospital admissions come through the ED, it must be viewed as a "front door" to the hospital. For this reason, efforts are being made today to improve both its appearance and its effectiveness. After obtaining human subjects approval, members of the research team met with the Director and Nurse Managers of the ED to explain the aims and methodology of the study. Permission was granted to conduct ethnographic observations in the ED for a period of six months, after which time a summary cultural narrative would be provided. Research team members then attended two department staff meetings, described the proposed method of observation, and answered employee questions. Following commonly accepted ethnographic procedures (i.e., visiting different days and times of day, remaining unobtrusive

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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7
how communication produces, maintains, repairs, and transforms (Carey 1988)
this emergency department’s system and culture may provide important insights
into both the nature of its current challenges and potential opportunities.
6HWWLQJ DQG $SSURDFK
The urban community hospital selected for this study (identified as “CHC”,
a pseudonym) opened in 1968 and has grown rapidly thereafter. The number of
patients seen by the CHC emergency department has increased six-fold, from
11,000 in 1973 to over 65,000 in 2002. The patient population comprises of a
diverse range of ages, income, and ethnic groups. Emergency physician services
are contracted to a doctor's group that has been overseeing the ED for over 15
years. Recently, the CEO of the hospital has publicly recognized that since over
half of hospital admissions come through the ED, it must be viewed as a "front
door" to the hospital. For this reason, efforts are being made today to improve
both its appearance and its effectiveness.
After obtaining human subjects approval, members of the research team
met with the Director and Nurse Managers of the ED to explain the aims and
methodology of the study. Permission was granted to conduct ethnographic
observations in the ED for a period of six months, after which time a summary
cultural narrative would be provided. Research team members then attended
two department staff meetings, described the proposed method of observation,
and answered employee questions. Following commonly accepted ethnographic
procedures (i.e., visiting different days and times of day, remaining unobtrusive


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