Complex Spaces in Emergency Medicine

Complex Spaces is an interdisciplinary research collaboration between the Alpert Medical School Department of Emergency Medicine at Brown University and the Center for Complexity. It brings together practitioners of clinical medicine with practitioners of design, arts, and the humanities to improve how to assess and adapt to the many challenges on the frontlines of healthcare.

The current practice of emergency care reveals a divide between what practitioners are trained to do and the reality of challenges they face in the emergency room. In the ER, clinical expertise adapts to act in complex spaces under constrained conditions: high stress, high patient volumes, high stakes; care for anyone with any condition at any time; engaging multiple patients with little time, imperfect information, many motives and expectations. Experiences in the ER defy shorthand, quick fixes, or reductionism. The quality of emergency care is further impacted by constraints and pressures external to the ER: psychological and environmental factors, structures of government and the economy, institutions of medical education, and the medical institutions. How could clinical practice better adapt under these conditions to improve outcomes?

When it comes to analysis, a single lens of expertise encourages breaking things down into parts and isolating variables. These habits of mind are powerful and often productive. But it is easy to forget that we invent these divisions, and in so doing, limit the range of questions we consider and decisions we can make. The same applies to examining medical cases. When practitioners treat these divisions as fixed, they give rise to errors in how we know and decide. How do we know if the mental constructs we have created are adequate to respond to the situation at hand? In the context of emergency medicine, CfC works as creative practitioners with front-line professionals to explore the architecture of challenges, identify disconnects within systems and cultures, and develop pathways for strategically improving outcomes.

Emergency care requires new kinds of practices for decision-making, ones that can help examine situations as wholes. This means considering issues often viewed separately in integrated ways: managing uncertainty, processing emotions, communicating effectively, wrestling with moral conflict, collaborating with team members, making sense of clinical guidelines and norms against imperfect information, balancing provider and patient well-being, and navigating the hazards and constraints of the clinical environments

We need to invent the structural shifts to work towards 21st century structures of care