Here, the introduction of the 4 hour wait target brought a new reckoning and re-embedding of time in the ED. Under this new “temporal rhythm”, patients arrived with a well-defined “temporal trajectory” of their condition while staff had a very “close and inflexible time horizon” to complete activities . Any delay could cause the ED to (unjustifiably) exceed Inhibitors,research,lifescience,medical the 2% exceptions margin on target breaches. As ownership of the target moved across the hospital  more measures were taken to improve flows and minimise bottlenecks. Since the target was introduced, there has been, for instance, substantial growth in the number of emergency medicine consultants,
development of new clinical
specialities for treating minor injuries (ENP) [24,43] as well as increased leadership, particularly for nurses, who now have an enhanced role in care coordination. In effect, the target brought about a change in the ED’s relationship with Inhibitors,research,lifescience,medical the rest of the hospital. There was a major shift in the balance of power  between the ED and other hospital departments. We offer striking evidence of ED staff Inhibitors,research,lifescience,medical arguing up the hospital hierarchy and pushing for specific actions to take place so as to speed up care  and prevent a target breach. Pressure on nurses to meet targets was passed onto those they consider (partly) responsible for the breaches (doctors in inpatient specialities) Inhibitors,research,lifescience,medical . Moreover, our findings demonstrate how the new technology of EDIS came to support an increasing need for the ED to accumulate and remotely display more information so as to track patients and coordinate activities . Through a more efficient “horizontal” and “vertical” surveillance Inhibitors,research,lifescience,medical , it has become an essential aspect of the new model of target-oriented clinical teamwork. Importantly, it has also contributed to the reconfiguration of inter-professional power relationships. By taking up the sequencing activities, EDIS acted as a reliable and independent
‘observer’ who provided the shared temporal order necessary for work synchronisation. In effect, it equalised power relationships with fewer work-related much conflicts between these two groups . This is because the meanings and purposes of organisational activities, and boundaries are redrawn as everyone gets synchronised to the technology’s temporal rhythm . While the new resources and shift in the balance of power in ED’s favour were viewed positively by the ED staff, other unintended consequences of the target were more unwelcome. We did not find evidence pointing to any change of the type or quality of care , but clinicians were concerned about how the target had affected their ways of working. They felt like they had less time with their patients, and were under more pressure to keep Rigosertib moving them through the department [27,31,76].