Cite as:

Mark Smith and Craig Feied, DRAFT: The emergency department as a complex system, George Washington University School of Medicine and Health Sciences (1999).


The following is a useful framework for applying complexity theory to understanding and improving the functioning of a healthcare organization. That organization could be a clinical department like an Emergency Department (ED) or Intensive Care Unit (ICU), a comprehensive full service hospital, a managed care organization, or a vertically integrated system of primary care providers, hospitals, and outpatient services. The framework is tripartite:

  1. Description of the healthcare organization as a complex system, using the vocabulary and concepts of complexity theory

  2. Application of complexity theory to facilitate change in the organization

  3. Use of the concepts and principles of complex systems to construct new organizational processes

In this paper, we will apply this framework, with some embellishments, to the organization known as the Emergency Room (ER) or Emergency Department.