So when things are falling apart in the emergency department and the charge nurse comes to you and says,

do something and you've spoken to your consultant services and you've done what you can.

And it seems that there's nothing else you can do.

There is always something you can do.

Find the thing that you can do.

Find the bottleneck that you can address and address it.

The real issue in access block are the patients who need to lie down, who need more complex

care.

Many of them eventually need a bed and they can't get upstairs and we can't get the next patient

who needs a stretch or a place to lie down.

If you asked an inpatient nurse or physician who's accountable for the admitted medical patient in the

emergency department, they'd say, well, the emergency department is.

It's a bit like fighting fire by switching off the fire alarm or treating exangonating hemorrhage

by catching the blood in a cup so it doesn't spill on the floor.

We have a very provider-centric system, and there are solutions out there, but we have to

not only provide incentives and accountability. We also have to challenge people on their

entrenched self-interest in way they approach their work.

It's a maldistribution that fails any sort of ethical sniff test that I could come up with.

I think we're understanding this better.

We're communicating it better.

And I think we should have a sense of hope rather than a sense of despair.

EMK has sent out a survey to a few thousand listeners like you last year.

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