Resilient performance of emergency department: Patterns, models and strategies

Emergency Departments (EDs) in the U.S. have long experienced difficulties in meeting the often-unexpected healthcare demands resulting in widespread overcrowding. Understanding performance adjustment in such complex systems would inform initiatives to improve ED resilience to expected and unexpected demands. Resilience Engineering (RE) literature offers abundant case-based findings that highlight performance adjustment in ED practices. However, there is a lack of effort to generalize such findings into a harmonized knowledge base. By reviewing and summarizing findings from literature, this study first presents four patterns of performance adjustment: Adjustment by Matching, Extending, Sustaining, and Transforming. Second, five conceptual models of resilience are presented from the literature exhibiting different characteristics of resilience in EDs. Third, in order to support ED practitioners in coping with the chronic safety issues, this paper provides a repertoire of resilience strategies to manipulate four ED resources: staff, supplies, space, and sequence (four S's) that can facilitate performance adjustment. As the synthesis of such findings, the patterns and strategies are incorporated into each model. Strengths, weaknesses, and recommended usage for the ED resilience models are also discussed. By inspiring a transition from a case-based approach to a model-based approach for resilient healthcare, the findings of this paper provide an initial framework for developing better work strategies and new tools to deliver safer and more productive ED practices.