Abstract for: Why Patient Assignment and Teamwork in the Emergency Department is Challenging: A Simple Stock and Flow Insight
We conducted a close-in, ethnographic observation of the day-to-day operating practices in the emergency department and level 1 trauma center of a large, inner-city teaching hospital. This paper presents a case study focused on an initiative at the ED that was aimed at improving teamwork and patient flow. The ED implemented a new way of assigning patients to doctors and nurses. The change met with significant complaints from the doctors and nurses. In the paper, we present ethnographic and interview data describing the change initiative and develop a system dynamics model grounded in this data. We use simulation analysis to examine the shortcomings of the initiative. We find that the scheduling protocol fails to solve an inherent challenge rooted in basic differences between the task dynamics of doctors and the task dynamics of nurses that have important implications for the dynamics of patient flow.