ABSTRACT
Public sector operations managers often are presented as using fixed capacity to cope with the challenge of arrival emergency demand.Research in healthcare emergency services predominantly focuses on the emergency department (ED), often referred to as accident and emergency (A&E), which is usually located within a hospital setting. Solely focusing on the ED organisational boundary limits the understanding and visibility of the emergency arrival process. Incoming patient/citizen flows are also part of the emergency arrival process as are the actions of paramedics, ambulance services and a plethora of alternative provision in assessing, diagnosing and stabilising patients prior to arrival at ED. In this chapter we explore this holistic process to understand whether the potential for variations in the process of arrival (prior to ED) can provide insights for managers who are endeavouring to reconcile capacity and emergency demand as a whole.The lens of the theory of ‘swift and even flow’ is used to analyse literature and challenge operational conventions in emergency healthcare services. From a comprehensive review of the literature, a conceptual model is proposed which includes three discrete stages of arrival demand, which is counter to the well-versed single continuous dimension of demand. An emergency episode can be triggered at any point from which an accident or
emergency occurs to the point at which a diagnosis (and in some cases treatment) is made regardless of organisational boundary. Emergency services imply an ‘unexpected combination of circumstances that demands immediate action’ (Fitzgerald and Dadich, 2009: 22), are therefore time sensitive (Ahmad et al., 2012), and reside in the context of increasing need.Yet, globally reduced available public funds at a macro level result in a political drive for improved productivity driven by the narrative of new public management (NPM) (Pollitt and Bouckaert, 2004). Combined with these factors emergency public services are commonly believed to contend with an inability to control incoming demand (Sampson, 2000). It is the potential to understand variation along the emergency arrival process
that in turn can inform and possibly shape how responses are managed i.e. communication, co-ordination, control and cognition (Comfort, 2007) and how policy
interventions are designed to achieve productive operational flow.Therefore we seek to understand:
• What is the process of arrival for emergency ED services provision? • What theoretical models can public service managers use to help improve their
understanding of the arrival emergency process? • How will these models help public services managers and policy makers improve
the design and performance of emergency services and increase citizen satisfaction?
