Dynamic Changes in Reliability and Resilience in the Emergency Department

Abstract

Emergency Departments (EDs) are open systems that routinely cope with highly variable and uncertain inputs. This paper will use two critical incidents to explore system adaptations to demand, complexity, unpredictability, and other threats to performance. We then relate the observations to three recently proposed graphical representations of organizational resilience: the resilience state space model; the stress-strain model of adaptation; and a dynamic model of resilience. We use these graphics to analyze the ED's response to chronic constraints and unexpected shocks. The models are found to be mutually reinforcing - each highlights some important aspects of resilience, while none capture all of the salient features.