Advertisement

Challenging the dominant logic of emergency departments: guidelines from chaos theory

      Abstract

      Chaos is order without predictability (
      • Cartwright T.J.
      Planning and chaos theory.
      ). Any unfortunate patient who has recently made a trek to an Emergency Department (ED) or even better, has watched the immensely popular TV show, ER, knows that the visit can be a frustrating and a time consuming experience. The waits are so protracted that one can observe all cycles of birth, death, love, and romance in the waiting room. The process is tedious for the patient who must tell one’s tale to a triage nurse, a registration clerk, the primary nurse, the nursing care partner, and finally the emergency physician. Then, the patient must face more delays while being pushed, ineffectively, in a horizontal fashion, through vertical functional silos of care, such as laboratory and radiology. mThe mind-set or dominant logic of this system of ED patient flow assumes that waits are acceptable and unavoidable, and that the function of the ED is to care for only the truly emergent patient. This dominant logic, coupled with the market constraints of population-based versus case-based payment mechanisms, has led to a declining trend in ED visits for the first time in 20 years (

      American College of Emergency Physicians News. 1997;16.

      ). In order to improve the quality of ED care as well as to increase acceptability for patient and payer, the dominant logic must be challenged. An understanding of chaos theory and perception of the Emergency Department as a complex adaptive system foster methods for challenging the dominant logic.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cartwright T.J.
        Planning and chaos theory.
        APA J. 1991; 44
      1. American College of Emergency Physicians News. 1997;16.

        • Gleick J.
        Chaos theory. Penguin Books, New York1987
        • Stacey R.D.
        Managing the unknowable. Jossey-Bass, San Francisco1992
        • Wheatley M.J.
        Leadership and the new science. Berrett-Koehler, San Francisco1994
        • Begun J.W.
        Chaos and complexity.
        J Management Inquiry. 1994; 3: 329-335
        • Sharp L.F.
        • Priesmeyer H.R.
        Tutorial. Chaos theory—A primer for health care.
        Quality Management Health Care. 1995; 3: 71-86
        • Begun J.W.
        • White K.R.
        Altering nursing’s dominant logic.
        Complexity Chaos Nursing. 1995; 2: 5-15
        • Briggs J.
        Fractals. The pattern of chaos. Touchstone Publishing, New York1992
      2. Stacey RD. Strategy as order emerging from chaos. Long Range Planning 1993:26, 67.

        • McDaniel R.R.
        Strategic leadership.
        Health Care Management Rev. 1997; 22: 21-37
        • Bettis R.A.
        • Prahalad C.K.
        The dominant logic.
        Strategic Management J. 1995; 16: 5-14
        • Williams R.
        Distribution of emergency department costs.
        Ann Emerg Med. 1996; 28: 671-676
        • Martin R.R.
        Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal trauma.
        J Trauma. 1992; 33: 354