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The rules for how the world is supposed to work are being re-written. Nowhere is this more apparent than in emergency rooms across the country and around the world. The challenges of how clinical staff approach decision-making under extreme conditions of uncertainty and complexity have never been more relevant.


CfC asked front-line practitioners to offer their reflections and analysis to the frame: 21st Century Structures of Care - How Should Emergency Medicine Transition from Covid? The six contributions here represent a breadth of experiences from professional care  providers working amidst the pandemic.


These unique insights, powerfully delivered, begin to expose the ecology of issues and dependencies; the vulnerabilities and strengths exposed by what Dr. Gina Siddiqui describes as the “complex global phenomena” that is Covid-19. Collectively, they function as a scaffold for this moment -- different perspectives brought together to reveal the relationships among the parts.

The Collaboration

The practitioners whose work is presented here were given the freedom to write consistent with their front-line experience and expertise. As creative practitioners interested in systems issues and operating at the edges, we asked the contributors to consider the following as they wrote:​

CfC Guiding Principles

  • the gap between expectations and reality

  • the mental models which limit the range of questions asked
    and decisions made

  • training for emergency medicine

  • culture of emergency medicine -- managing uncertainty, the role
    of emotions in decision-making, 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. 

  • complex spaces for effectively delivering emergency care 

  • pressures and factors external to ER which impact care such as economy, structures of government, psychological and environmental factors


CfC Guiding Questions to identify the nature of existing conditions
in Emergency Medicine:

  • What is signal and what is noise, and how to distinguish between them?

  • What should be kept and what should be discarded?

  • What should be repurposed and what should continue as is?

  • What should be prioritized and what should be ignored?

  • What things become important and what things become obsolete?

CfC aspires to develop new insights and knowledge in complex systems, and enable people to apply that knowledge in their practice. We look forward to building pathways of collaboration to work towards strategic improvement. Email Us Your Thoughts


and Practitioners

What is the Purpose
of Emergency Departments?

  • Gina Siddiqui — MD, Yale Department of Emergency Medicine; NYC Health + Hospitals


Doing Justice

  • Divya K. Chhabra — MD, Child Psychiatry Fellow in NYC; SAMHSA Minority
    Fellowship Chair


Orienteering in the Moral Landscape

  • Wendy Dean—MD, psychiatrist; co-founder and CEO of Non-Profit Moral Injury of Healthcare


Wilderness Medicine and Complexity: Gaining Perspective

  • N. Stuart Harris—MD, MFA, FRCP Edin.
    Chief, Division of Wilderness Medicine, MGH Department of Emergency Medicine. 
    Associate Professor of Emergency Medicine, Harvard Medical School


Can Emergency Medicine and Palliative Care Co-Exist in the American Healthcare System post Covid-19? 

  • Jaclyn O’Halloran—RN BSN


The Pandemic Pause:
Redesigning “Do No Harm.” 

  • Jay Baruch—MD, Associate Professor Alpert School of Medicine, Brown University; Director of the Medical Humanities and Bioethics Scholarly Concentration

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