Directors of emergency medicine's beliefs about, barriers to, and enablers of solutions to emergency department crowding and access block.

Abstract

To identify opportunities for directors of emergency medicine (DEMs) to lead change efforts to address ED crowding and access block. DEMs were surveyed about their beliefs about, barriers to, and enablers of solutions to ED crowding and access block. Key barriers were insufficient resources, entrenched hospital culture, and lack of political will to address ED crowding and access block. Key enablers were developing hospital-wide understanding of the problems, developing a supportive hospital culture, and improved engagement by hospital executive. Addressing the political and cultural forces that sustain ED crowding and access block are key adaptive challenges requiring DEM leadership.