Chicken
ED Diversion Standoff
ED Diversion Standoff is a Chicken scenario. The core lesson: When two EDs each want the other to absorb incoming volume, both waiting produces a forced distribution outcome worse than either accepting their share would have been. Two community hospitals share the same EMS zone. Both EDs are running above 90% capacity on the same Saturday evening. DecisionPlay maps the players, payoffs, and equilibrium dynamics that shape how this situation typically resolves.
The situation
Two community hospitals share the same EMS zone. Both EDs are running above 90% capacity on the same Saturday evening. EMS protocol allows only one hospital at a time to go on diversion status. If both request diversion simultaneously, the regional coordinator triggers a forced distribution override that routes patients based on raw census data, without regard for acuity mix or staffing. The charge nurse at each hospital knows the other is under pressure. Each is waiting to see whether the other will absorb the next wave.
Background
EMS diversion between competing EDs is a chicken game. Each hospital benefits if the other absorbs incoming volume, but if both wait, neither gets the diversion status they want and the forced protocol distributes patients in a way neither would have chosen. The first to request diversion gets relief; the second finds the window closed. Neither wants to be the one that absorbed volume while the other held out and requested diversion an hour later.
What this reveals
Why diversion standoffs repeat themselves
Chicken games in EMS diversion do not resolve through patience. Both EDs waiting for the other to move produces the forced distribution outcome neither wanted. The party that changes the information structure, by surfacing the joint situation to EMS or proposing a turn-taking arrangement, breaks the standoff without having to concede unilaterally.
How to counter it: When you suspect another ED is also near capacity, contact them before requesting diversion. A 30-second call converts a chicken game into a coordination problem with a cooperative solution.
A question to sit with
Where else in your organization do two departments wait for the other to absorb a shared burden, with the result that a worse outcome gets imposed on both?
Frequently asked questions
- What game theory concept does ED Diversion Standoff illustrate?
- ED Diversion Standoff illustrates Chicken. When two EDs each want the other to absorb incoming volume, both waiting produces a forced distribution outcome worse than either accepting their share would have been.
- What is the situation in ED Diversion Standoff?
- Two community hospitals share the same EMS zone. Both EDs are running above 90% capacity on the same Saturday evening. EMS protocol allows only one hospital at a time to go on diversion status.
- What does ED Diversion Standoff reveal about how people decide?
- Why diversion standoffs repeat themselves. Chicken games in EMS diversion do not resolve through patience. Both EDs waiting for the other to move produces the forced distribution outcome neither wanted. The party that changes the information structure, by surfacing the joint situation to EMS or proposing a turn-taking arrangement, breaks the standoff without having to concede unilaterally.
- How do you avoid the trap in ED Diversion Standoff?
- When you suspect another ED is also near capacity, contact them before requesting diversion. A 30-second call converts a chicken game into a coordination problem with a cooperative solution.
- What is the research behind ED Diversion Standoff?
- EMS diversion between competing EDs is a chicken game. Each hospital benefits if the other absorbs incoming volume, but if both wait, neither gets the diversion status they want and the forced protocol distributes patients in a way neither would have chosen. The first to request diversion gets relief; the second finds the window closed.
- How long does ED Diversion Standoff take to play?
- About 8 min, at core difficulty, across 1 decision points. It runs in your browser with no account and no sign-in.
Keep exploring
More Healthcare Ops scenarios, or browse all scenarios. New to this? Start with how DecisionPlay works or the game theory glossary.
Topics: emergency-department, diversion, coordination, ems