To any observer, the Emergency Centre (EC) appears chaotic. There is an endless in-flow of patients, all with different presentations, complaints and needs. Often the sicker ones that require admission are stuck in the EC due to (amongst other reasons) limited available beds in the rest of the hospital. Thus, the EC remains responsible for non-routine, acute cases whilst simultaneously functioning as a multi-disciplinary inpatient-ward accommodating routines for surgical, medical, psychiatric and gynaecological patients. Adding time-critical pressure to prioritize and manage life-threatening conditions makes for some complicated challenges in this part of the hospital.
In January I found myself working on a reality television show called ‘I am a celebrity, get me out of here’. On this show a group of celebrities live for a few weeks in a constructed basic campsite in a jungle. They compete in challenges for food and other items for the camp. Each week one of the celebrities are evicted based on votes by the viewing public. The winner becomes the King or Queen of the jungle.
On set, it’s initially tricky to get your head around things e.g. all the radio channels and knowing when and how to communicate, the rapid changes and the variety of roles. Meanwhile, in the control room, there is an entire wall full of screens with the non-stop live stream of information and rows of people working with the raw information of what is happening in camp and during the challenges.
Yet, when watching the show, all the little bits somehow comes together in one coherent whole. Observing how things work behind the scenes, I more than once felt that there’s parallels between reality tv and the EC. I could see more similarities with reality tv than some of the other industries like manufacturing, aviation and formula 1 that healthcare has been learning from.
Too much information and it is constantly changing
Both have too many streams of information with various communication channels. This implies that everyone is not privy to or able to access the same information. With the oversupply of information people function by consistently blocking out ‘unnecessary’ information. Not receiving the same and the oversupply of information carries obvious risks for miscommunication or missing out on important information that was perceived as ‘white noise’.
In both industries there is limited control over the trajectory and the outcome. The participants (celebrities) and patients are unpredictable and have the power to change the storyline or treatment plan and can subsequently influence the desired outcome. Every situation is influenced by the interactions, dependencies and relationships between the people. Interactions and negotiations take time and can’t be rushed to fit the schedule.
Due to the unpredictability, situations unfold as it is happening. This is called emergence and it requires the ability to constantly adapt to new circumstances. The expected trajectory cannot be set in stone and linear step-wise rules cannot be applied. It’s better to respond to emergence in a flexible way, basically real-time editing to the situation. The most efficient way to deal with the constant flux is permitting the people on the ground to respond and act on situations as they deem fit.
In both each ‘scenario’ has a basic guideline. The reality tv hosts have a script, there is a plan and layout plans for camera’s, lighting, etc. In the EC we have typical presentations with algorhythms and triage policies. Despite the script and typical presentation, we can’t force all chest pain patients to describe their pain as an elephant sitting on their chest with pain radiating into the left arm. So, in both the tools (scripts, plans, algorithms) are guidelines and not rigid rules.
There is a time-critical element to both. And even though there is real-time editing, there is a time-critical limitation on the number of chances to get it right.
Different roles, tasks and goals but same end picture
In both, the different roles function independently with different reporting streams and hierarchies. At times the roles/functions are not aware of the reality that other roles/functions are facing. This can lead to conflict between disciplines on the best way forward. Even within the roles, there is a degree of independence e.g. two camera men on the same set have different views of what is happening.
Both industries are complex and the separate entities within them are also complex e.g. camera, sound, nursing, medical etc. These separate entities overlap and respond in various ways even within the same situation. They thus co-create the current state and what will happen next is unknown. Here, daily life is routine, yet non-routine, time-critical and constantly changing.
More about what we can learn from each other at another time. I’m in EM…get me out of here!