Abstract for: Resilience in the Emergency Department: An Endogenous, Dynamic Phenomenon

Emergency Departments (EDs) offer an ideal laboratory to study how individuals cope with the challenges of their working environments. ED work takes place largely under conditions of time and resource constraints, physical stress, uncertainty, and ill-defined and shifting goals, so it is somewhat striking that the mounting stress from overcrowding has not resulted in more instances of failure or catastrophe. This paper looks at how the ED system has been coping with the chronic conditions of overload to achieve resilience. Motivated by ethnographic observation of the day-to-day operating practices in the emergency department, including a level 1 trauma center, of a large, inner-city teaching hospital the paper develops a system dynamics model and analysis with a particular focus on how the people and systems on the front lines adapt and adjust to cope with the challenges of excess demand. The result is a model of resilience as an endogenous, dynamic phenomenon. Simulation analyses generate important insights for theorizing about resilience.