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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  8 when possible, shadowing different individuals and roles, identifying informants and conducting informal interviews) team members conducted over 100 hours of structured observation and produced more than fifty pages of field notes. Once observations were complete, the research team met to review field notes and identify cultural themes and tensions. The result of these meetings was a six-page, single-spaced narrative reflective of the CHC ED culture (see Appendix). Next, the ED Director assembled an ad hoc group representative of the various positions in the ED to review the narrative. In the course of a two- hour meeting, the narrative was read aloud and feedback was solicited. A revised narrative was presented to the executive team of the hospital in a similar fashion, emphasizing trends and ensuring employee confidentiality. ED management found the narrative to be both insightful and useful. Concurrent with this study, the Director of the ED hosted a number of off-site meetings for staff, focusing on current ER challenges as well as ideas for improvement. The summary narrative and results of the off-site meetings were provided to a new task force charged with creating a performance improvement plan for the ED. The remainder of this paper is divided into three parts. First, using a flow map of the process that had been developed for patients and families by the ED staff, we describe how emergency care is ideally supposed to happen (See Figure One). Second, this chart is re-examined and revised to reflect the findings of this

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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8
when possible, shadowing different individuals and roles, identifying informants
and conducting informal interviews) team members conducted over 100 hours of
structured observation and produced more than fifty pages of field notes.
Once observations were complete, the research team met to review field
notes and identify cultural themes and tensions. The result of these meetings
was a six-page, single-spaced narrative reflective of the CHC ED culture (see
Appendix). Next, the ED Director assembled an ad hoc group representative of
the various positions in the ED to review the narrative. In the course of a two-
hour meeting, the narrative was read aloud and feedback was solicited. A
revised narrative was presented to the executive team of the hospital in a
similar fashion, emphasizing trends and ensuring employee confidentiality.
ED management found the narrative to be both insightful and useful.
Concurrent with this study, the Director of the ED hosted a number of off-site
meetings for staff, focusing on current ER challenges as well as ideas for
improvement. The summary narrative and results of the off-site meetings were
provided to a new task force charged with creating a performance improvement
plan for the ED.
The remainder of this paper is divided into three parts. First, using a flow
map of the process that had been developed for patients and families by the ED
staff, we describe how emergency care is ideally supposed to happen (See Figure
One). Second, this chart is re-examined and revised to reflect the findings of this


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