Abstract for: Resilient Capacity on the Front Lines: Coping with Challenges to Patient Flow
This paper is about resilience – how people on the front lines cope with the challenges of operating a sub-optimal system. The work of an Emergency Department (ED) takes place mostly under constraints on resources and time, facing physical stress, uncertainty, and shifting goals, so it is somewhat striking that overcrowding has not resulted in more instances of failure or catastrophe. We look at how the ED system has been coping with chronic conditions of overload to achieve resilience. We studied the day-to-day operating practices in one focal emergency department, including a level 1 trauma center, at 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.