The Entropy of Suffering: an inquiry into the consequences of the 4-Hour Rule for the patient-doctor relationship in Australian Public Hospitals

In 2011, the Australian Government instituted a range of reforms to the public health-care system, including some directed at improving access for patients to Emergency Departments, which had, over many years, become increasingly overwhelmed by the number and complexity of presentations. This included a target of four hours within which patients in Emergency Departments were to be discharged, admitted or transferred to alternative institutions. These reforms generated widespread strong emotional responses from medical and other health staff with whom I worked, and I was prompted to consider the origins of these powerful human reactions to the administrative intervention. Emergency Departments are often described, derisively, as chaotic working environments. However, this epithet may instead be describing something quite profound about the ontological nature of hospitals and Emergency Departments — that they are, indeed, non-linear dynamical physical systems in which phenomena of complexity exist. Other human-centred interactional and transactional systems have been successfully examined from a complexity perspective, including economics and human physiology. Framing inquiry into Emergency Departments, and the humans who encounter each other within them, from a complexity perspective might also then prove useful in defining and characterising the complex and manifold relationships and interactions between people, technology and systemic organising principles.